The document discusses antihypertensive agents and their use in treating hypertension. It defines hypertension and classifies blood pressure levels. The main types of antihypertensive agents discussed are diuretics, agents affecting adrenergic function, vasodilators, and agents affecting the renin-angiotensin system. Lifestyle modifications such as diet, exercise, and weight loss are recommended initially before use of medications to control blood pressure.
The document provides information on antihypertensive agents including their classifications, mechanisms of action, effects, and uses. It discusses classes such as diuretics, agents affecting adrenergic function, vasodilators, and agents affecting the renin-angiotensin system. Within each class, specific drugs are outlined with details about their mechanisms, effects, adverse effects, pharmacokinetics, and clinical applications for treating hypertension.
Nearly 1/3 of Indians have high blood pressure, with urban rates higher than rural. Only 25% of rural and 42% of urban hypertensive Indians are aware of their condition, and even fewer (25% rural, 38% urban) are receiving treatment. Lifestyle modifications like weight loss, following a DASH diet, reducing sodium, increasing physical activity, and limiting alcohol can all help to lower blood pressure. Medical management involves drug classes that target the renin-angiotensin system, calcium channels, adrenergic receptors, and vasodilation to control blood pressure. The goal of treatment is to prevent complications through achieving and maintaining a blood pressure under 140/90 mmHg.
This document summarizes guidelines for treating hypertension. It defines hypertension and classifications of blood pressure. The goals of treatment are to reduce risks of stroke, heart disease, heart failure, and kidney disease. Lifestyle changes and medication are used to achieve a target blood pressure of less than 140/90 mmHg or 130/80 mmHg for those with diabetes or chronic kidney disease. Initial drug therapy typically involves thiazide diuretics alone or combined with other classes of drugs depending on individual risk factors and medical conditions. Special considerations are given to treating hypertension in pregnancy, kidney disease, heart disease and other compelling indications.
The document discusses hypertension (high blood pressure) and its role in cardiovascular disease risk. It summarizes several studies showing that controlling hypertension, through lifestyle changes and medication such as diuretics, ACE inhibitors, and ARBs, can significantly reduce the risks of heart attack, stroke, heart failure, and death. The use of combination drug therapy to control blood pressure is often more effective than single drug therapy alone.
This document discusses hypertension (high blood pressure). It defines hypertension as a systolic blood pressure over 140 mm Hg or a diastolic over 90 mm Hg. It classifies blood pressure levels and discusses the causes, risk factors, diagnosis, and management of hypertension through lifestyle modifications and pharmacological treatments. Specific populations discussed include those with diabetes, pregnancy, children, emergencies, and geriatrics. The goal is to treat hypertension to reduce risks of heart disease and stroke through safe and effective medical care.
This document discusses the pharmacotherapy of hypertension. It defines hypertension and classifies blood pressure readings. The main types of drugs used to treat hypertension work by decreasing cardiac output and/or total peripheral resistance. These include diuretics, sympathoplegic agents like methyldopa and beta blockers, vasodilators, ACE inhibitors, and calcium channel blockers. The document provides details on the mechanisms and uses of these drug classes and recommends treatment approaches based on hypertension severity.
This document discusses the stages, phenotypes, and treatment of heart failure. It describes:
1) The stages of heart failure from A to D, with stages C and D involving structural changes and previous or current symptoms where drug therapies are routinely used.
2) The phenotypes of heart failure with reduced ejection fraction (HFrEF) and heart failure with preserved ejection fraction (HFpEF) along with their respective treatment goals.
3) The pharmacological management of stage C HFrEF which involves the routine use of diuretics, ACE inhibitors, beta blockers, and aldosterone antagonists to control symptoms, improve quality of life, and reduce mortality and hospitalizations.
The document provides information on antihypertensive agents including their classifications, mechanisms of action, effects, and uses. It discusses classes such as diuretics, agents affecting adrenergic function, vasodilators, and agents affecting the renin-angiotensin system. Within each class, specific drugs are outlined with details about their mechanisms, effects, adverse effects, pharmacokinetics, and clinical applications for treating hypertension.
Nearly 1/3 of Indians have high blood pressure, with urban rates higher than rural. Only 25% of rural and 42% of urban hypertensive Indians are aware of their condition, and even fewer (25% rural, 38% urban) are receiving treatment. Lifestyle modifications like weight loss, following a DASH diet, reducing sodium, increasing physical activity, and limiting alcohol can all help to lower blood pressure. Medical management involves drug classes that target the renin-angiotensin system, calcium channels, adrenergic receptors, and vasodilation to control blood pressure. The goal of treatment is to prevent complications through achieving and maintaining a blood pressure under 140/90 mmHg.
This document summarizes guidelines for treating hypertension. It defines hypertension and classifications of blood pressure. The goals of treatment are to reduce risks of stroke, heart disease, heart failure, and kidney disease. Lifestyle changes and medication are used to achieve a target blood pressure of less than 140/90 mmHg or 130/80 mmHg for those with diabetes or chronic kidney disease. Initial drug therapy typically involves thiazide diuretics alone or combined with other classes of drugs depending on individual risk factors and medical conditions. Special considerations are given to treating hypertension in pregnancy, kidney disease, heart disease and other compelling indications.
The document discusses hypertension (high blood pressure) and its role in cardiovascular disease risk. It summarizes several studies showing that controlling hypertension, through lifestyle changes and medication such as diuretics, ACE inhibitors, and ARBs, can significantly reduce the risks of heart attack, stroke, heart failure, and death. The use of combination drug therapy to control blood pressure is often more effective than single drug therapy alone.
This document discusses hypertension (high blood pressure). It defines hypertension as a systolic blood pressure over 140 mm Hg or a diastolic over 90 mm Hg. It classifies blood pressure levels and discusses the causes, risk factors, diagnosis, and management of hypertension through lifestyle modifications and pharmacological treatments. Specific populations discussed include those with diabetes, pregnancy, children, emergencies, and geriatrics. The goal is to treat hypertension to reduce risks of heart disease and stroke through safe and effective medical care.
This document discusses the pharmacotherapy of hypertension. It defines hypertension and classifies blood pressure readings. The main types of drugs used to treat hypertension work by decreasing cardiac output and/or total peripheral resistance. These include diuretics, sympathoplegic agents like methyldopa and beta blockers, vasodilators, ACE inhibitors, and calcium channel blockers. The document provides details on the mechanisms and uses of these drug classes and recommends treatment approaches based on hypertension severity.
This document discusses the stages, phenotypes, and treatment of heart failure. It describes:
1) The stages of heart failure from A to D, with stages C and D involving structural changes and previous or current symptoms where drug therapies are routinely used.
2) The phenotypes of heart failure with reduced ejection fraction (HFrEF) and heart failure with preserved ejection fraction (HFpEF) along with their respective treatment goals.
3) The pharmacological management of stage C HFrEF which involves the routine use of diuretics, ACE inhibitors, beta blockers, and aldosterone antagonists to control symptoms, improve quality of life, and reduce mortality and hospitalizations.
Hypertension, or high blood pressure, is defined as a systolic blood pressure over 140 mm Hg or a diastolic blood pressure over 90 mm Hg. It can be caused by primary or secondary factors and is a major risk factor for cardiovascular disease. Treatment involves lifestyle modifications like diet, exercise, and weight loss as well as pharmacological therapies including diuretics, ACE inhibitors, calcium channel blockers, and others. Management may differ in special populations such as pregnant women, children, the elderly, and those with diabetes or kidney disease.
Three large international hypertension trials involving over 80,000 patients will improve understanding of hypertension management. The trials compare different drug classes and treatment strategies. They found that diuretics are as effective as newer drugs in lowering blood pressure and risk of cardiovascular events. The trials also showed tight blood pressure control, below 130/80 mmHg, provides better outcomes.
Dt benh THA và chien luoc phoi hop thuoc nham dat muc tieu dt - Cn cac khuye...thito6
The document discusses guidelines and strategies for treating hypertension, including:
1) 2017 guidelines from Canada, the US, Europe, and the American Society of Hypertension recommend initiating treatment with two drugs if blood pressure is more than 20 mmHg systolic or 10 mmHg diastolic above target to improve control.
2) Combination therapy using two first-line drug classes is recommended, such as a thiazide diuretic with an ACE inhibitor, ARB, CCB, or beta-blocker.
3) For patients with diabetes and hypertension, the target blood pressure is below 130/80 mmHg, and more than three drugs may be needed to achieve control.
Beyond mountains there are mountains (Haitian Proverb)
The document discusses guidelines for diagnosing and treating hypertension from the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7). It outlines classifications for normal blood pressure and stages of hypertension based on systolic and diastolic readings. It also provides recommendations on lifestyle modifications, drug therapies, treatment goals, and monitoring for hypertensive patients.
The document discusses guidelines and strategies for treating hypertension from various medical organizations. It provides recommendations on initiating treatment with single-drug monotherapy versus dual therapy, and optimal targets for blood pressure control in different patient populations such as those with diabetes or heart disease. Combination drug treatments are recommended to help achieve blood pressure control, including common effective combinations such as ACE inhibitors with diuretics, ARBs with diuretics, or ACE inhibitors with calcium channel blockers.
This document provides an overview of hypertension including:
1. Definitions of hypertension and classifications of blood pressure levels.
2. Techniques for measuring blood pressure such as in-office or ambulatory monitoring.
3. Epidemiology and risk factors for hypertension including increased prevalence with age.
4. Approaches to evaluating and managing patients with hypertension including lifestyle modifications, pharmacologic treatments, and treatment goals.
This document discusses the diagnosis and treatment of resistant hypertension. It begins with definitions of uncontrolled and resistant hypertension, and discusses their epidemiology. It then outlines the diagnostic algorithm for evaluating resistant hypertension, including identifying pseudo-resistance and screening for secondary causes. Finally, it discusses new therapeutic options for resistant hypertension, including the use of mineralocorticoid receptor antagonists like spironolactone as additional treatment.
The drug that is absolutely contraindicated in pregnancy is losartan, an angiotensin II receptor blocker (ARB). While all antihypertensives should be used cautiously in pregnancy, ARBs like losartan are contraindicated due to the risk of fetal harm, including the possibility of fetal death. Atenolol, methyldopa, nifedipine and propranolol can be used in pregnancy with appropriate monitoring by an obstetrician. The answer is B.
This document discusses new perspectives on diagnosing and treating resistant hypertension. It begins with defining resistant hypertension as blood pressure that remains above goal despite treatment with three or more antihypertensive medications. The document then outlines the appropriate steps to diagnose and manage a case of resistant hypertension, including identifying and addressing lifestyle factors, screening for secondary causes, and optimizing pharmacological treatment.
The document discusses guidelines from JNC 7 and ESH/ESC for treating hypertension. JNC 7 recommends initially treating stage 1 hypertension with thiazide diuretics and considering other drug classes. For stage 2 hypertension, it recommends starting with a two-drug combination, usually including a thiazide. ESH/ESC guidelines state that most patients will require two or more drugs to reach blood pressure goals and recommend considering initial therapy with a low-dose two-drug combination. Both emphasize lifestyle changes and medication combinations or adjustments to achieve blood pressure control.
The document summarizes the key changes between the 2014 hypertension guidelines (JNC 8) and previous guidelines (JNC 7). The 2014 guidelines lower treatment thresholds based on rigorous evidence from randomized controlled trials. They recommend initiating treatment at SBP/DBP of 140/90 mmHg for those under 60, and 150/90 mmHg for those 60 and over. For those with diabetes or chronic kidney disease, the goal is SBP/DBP under 140/90 mmHg. Thiazide-type diuretics, ACE inhibitors, ARBs, calcium channel blockers are first-line treatments depending on population. The guidelines note limitations around scope and costs/adherence.
Hypertension, or high blood pressure, is caused by increased cardiac output and peripheral vascular resistance. It is classified as essential (primary) hypertension which is idiopathic or secondary which has an identifiable cause. Risk factors include family history, race, stress, obesity, sodium intake, alcohol, and tobacco use. Complications affect the heart, brain, kidneys and eyes. Diagnosis involves medical history, physical exam, and tests like ECG and bloodwork. Treatment focuses on lifestyle modifications and may include diuretics, beta blockers, ACE inhibitors, and other medications. Nursing care educates on compliance, diet, exercise and monitoring.
Hypertension is defined as elevated systolic or diastolic blood pressure. It is a major risk factor for cardiovascular disease. The document outlines guidelines for classifying and managing hypertension based on blood pressure readings. Lifestyle modifications and pharmacologic treatment with diuretics, ACE inhibitors, ARBs, beta-blockers, or calcium channel blockers are recommended to reduce blood pressure to recommended goal levels based on patient risk factors. Special considerations are discussed for treating hypertension in various patient populations.
Combination Therapy In Hypertension - Dr Vivek Baliga PresentationDr Vivek Baliga
Dr Vivek Baliga of Baliga Diagnostics, Bangalore, discusses the common combination therapies used in the management of hypertension in clinical practice.
This document discusses the management of hypertension. Some key points include:
- Above 115/75 mmHg, cardiovascular disease risk doubles with each 20/10 mmHg increase in blood pressure.
- Prehypertension is defined as systolic BP of 120-139 mmHg or diastolic BP of 80-89 mmHg. Lifestyle modifications are recommended.
- Most patients require two or more drugs to achieve blood pressure goal. Initial drug therapy for most includes a thiazide-type diuretic.
- Lifestyle modifications like weight loss, adopting the DASH diet, reducing sodium intake, and increasing physical activity can significantly lower blood pressure.
Essential hypertension management and treatmentFabio Grubba
This document discusses hypertension (high blood pressure), including its classification, causes, symptoms, diagnosis, and treatment. It defines the different stages of hypertension according to blood pressure readings. Lifestyle modifications are recommended initially, including diet changes and exercise. If lifestyle changes do not control blood pressure, medications such as diuretics, beta-blockers, calcium channel blockers, ACE inhibitors, and other drug classes may be used. The goal of treatment is to prevent complications in target organs like the heart, brain, and kidneys by maintaining a blood pressure below 140/90 mmHg.
Hypertension is a global health issue that is responsible for many deaths worldwide each year. Combination therapy using two or more antihypertensive drugs from different classes is often necessary to control blood pressure, especially for patients with co-morbid conditions like diabetes or heart disease. Guidelines recommend starting with a combination of first-line drugs like a diuretic, calcium channel blocker, angiotensin converting enzyme inhibitor, or angiotensin receptor blocker based on the individual's condition. Single pill combinations have advantages over free drug combinations in terms of adherence, efficacy, and tolerability. The appropriate combination of antihypertensives depends on any associated diseases and should target relevant organ systems and pathways.
This document discusses hypertension and its treatment with antihypertensive drugs. It defines hypertension and describes the types of hypertension. It explains the need to treat hypertension to prevent target organ damage like eye, brain, kidney and heart disease. It then discusses the normal blood pressure regulation mechanisms involving the heart, blood vessels, kidneys, baroreflex and renin-angiotensin system. The rest of the document summarizes the mechanisms, uses, and side effects of major classes of antihypertensive drugs like diuretics, beta-blockers, calcium channel blockers, ACE inhibitors, and angiotensin receptor blockers. It emphasizes that these drugs work by interfering with the normal blood pressure regulating mechanisms.
Moins Lecture Collection(Update Management of Hypertension 3).pdfMoinul Islam
This document provides guidance on the management of hypertension from the 2020 ISH Global Hypertension Practice Guidelines. It discusses definitions of hypertension, classification based on blood pressure levels, goals of therapy, and non-pharmacological and pharmacological treatment approaches. For treatment, it recommends initial lifestyle modifications and monotherapy before considering sequential monotherapy or combination drug therapy if blood pressure remains uncontrolled. It also provides guidance for specific circumstances like resistant hypertension, secondary hypertension, hypertension in pregnancy, and hypertensive emergencies.
Moins medical lecture-3(HTN in pregnancy (1)).pdfMoinul Islam
Hypertension is a common complication in pregnancy affecting 10-15% of pregnancies worldwide. It can be classified as chronic hypertension, gestational hypertension, preeclampsia, or chronic hypertension with superimposed preeclampsia. The presentation, complications, and management of hypertension in pregnancy were discussed. Preeclampsia in particular can lead to serious maternal and fetal complications if not properly managed. The goal of management is stabilization of blood pressure and timely delivery to prevent complications.
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Hypertension, or high blood pressure, is defined as a systolic blood pressure over 140 mm Hg or a diastolic blood pressure over 90 mm Hg. It can be caused by primary or secondary factors and is a major risk factor for cardiovascular disease. Treatment involves lifestyle modifications like diet, exercise, and weight loss as well as pharmacological therapies including diuretics, ACE inhibitors, calcium channel blockers, and others. Management may differ in special populations such as pregnant women, children, the elderly, and those with diabetes or kidney disease.
Three large international hypertension trials involving over 80,000 patients will improve understanding of hypertension management. The trials compare different drug classes and treatment strategies. They found that diuretics are as effective as newer drugs in lowering blood pressure and risk of cardiovascular events. The trials also showed tight blood pressure control, below 130/80 mmHg, provides better outcomes.
Dt benh THA và chien luoc phoi hop thuoc nham dat muc tieu dt - Cn cac khuye...thito6
The document discusses guidelines and strategies for treating hypertension, including:
1) 2017 guidelines from Canada, the US, Europe, and the American Society of Hypertension recommend initiating treatment with two drugs if blood pressure is more than 20 mmHg systolic or 10 mmHg diastolic above target to improve control.
2) Combination therapy using two first-line drug classes is recommended, such as a thiazide diuretic with an ACE inhibitor, ARB, CCB, or beta-blocker.
3) For patients with diabetes and hypertension, the target blood pressure is below 130/80 mmHg, and more than three drugs may be needed to achieve control.
Beyond mountains there are mountains (Haitian Proverb)
The document discusses guidelines for diagnosing and treating hypertension from the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7). It outlines classifications for normal blood pressure and stages of hypertension based on systolic and diastolic readings. It also provides recommendations on lifestyle modifications, drug therapies, treatment goals, and monitoring for hypertensive patients.
The document discusses guidelines and strategies for treating hypertension from various medical organizations. It provides recommendations on initiating treatment with single-drug monotherapy versus dual therapy, and optimal targets for blood pressure control in different patient populations such as those with diabetes or heart disease. Combination drug treatments are recommended to help achieve blood pressure control, including common effective combinations such as ACE inhibitors with diuretics, ARBs with diuretics, or ACE inhibitors with calcium channel blockers.
This document provides an overview of hypertension including:
1. Definitions of hypertension and classifications of blood pressure levels.
2. Techniques for measuring blood pressure such as in-office or ambulatory monitoring.
3. Epidemiology and risk factors for hypertension including increased prevalence with age.
4. Approaches to evaluating and managing patients with hypertension including lifestyle modifications, pharmacologic treatments, and treatment goals.
This document discusses the diagnosis and treatment of resistant hypertension. It begins with definitions of uncontrolled and resistant hypertension, and discusses their epidemiology. It then outlines the diagnostic algorithm for evaluating resistant hypertension, including identifying pseudo-resistance and screening for secondary causes. Finally, it discusses new therapeutic options for resistant hypertension, including the use of mineralocorticoid receptor antagonists like spironolactone as additional treatment.
The drug that is absolutely contraindicated in pregnancy is losartan, an angiotensin II receptor blocker (ARB). While all antihypertensives should be used cautiously in pregnancy, ARBs like losartan are contraindicated due to the risk of fetal harm, including the possibility of fetal death. Atenolol, methyldopa, nifedipine and propranolol can be used in pregnancy with appropriate monitoring by an obstetrician. The answer is B.
This document discusses new perspectives on diagnosing and treating resistant hypertension. It begins with defining resistant hypertension as blood pressure that remains above goal despite treatment with three or more antihypertensive medications. The document then outlines the appropriate steps to diagnose and manage a case of resistant hypertension, including identifying and addressing lifestyle factors, screening for secondary causes, and optimizing pharmacological treatment.
The document discusses guidelines from JNC 7 and ESH/ESC for treating hypertension. JNC 7 recommends initially treating stage 1 hypertension with thiazide diuretics and considering other drug classes. For stage 2 hypertension, it recommends starting with a two-drug combination, usually including a thiazide. ESH/ESC guidelines state that most patients will require two or more drugs to reach blood pressure goals and recommend considering initial therapy with a low-dose two-drug combination. Both emphasize lifestyle changes and medication combinations or adjustments to achieve blood pressure control.
The document summarizes the key changes between the 2014 hypertension guidelines (JNC 8) and previous guidelines (JNC 7). The 2014 guidelines lower treatment thresholds based on rigorous evidence from randomized controlled trials. They recommend initiating treatment at SBP/DBP of 140/90 mmHg for those under 60, and 150/90 mmHg for those 60 and over. For those with diabetes or chronic kidney disease, the goal is SBP/DBP under 140/90 mmHg. Thiazide-type diuretics, ACE inhibitors, ARBs, calcium channel blockers are first-line treatments depending on population. The guidelines note limitations around scope and costs/adherence.
Hypertension, or high blood pressure, is caused by increased cardiac output and peripheral vascular resistance. It is classified as essential (primary) hypertension which is idiopathic or secondary which has an identifiable cause. Risk factors include family history, race, stress, obesity, sodium intake, alcohol, and tobacco use. Complications affect the heart, brain, kidneys and eyes. Diagnosis involves medical history, physical exam, and tests like ECG and bloodwork. Treatment focuses on lifestyle modifications and may include diuretics, beta blockers, ACE inhibitors, and other medications. Nursing care educates on compliance, diet, exercise and monitoring.
Hypertension is defined as elevated systolic or diastolic blood pressure. It is a major risk factor for cardiovascular disease. The document outlines guidelines for classifying and managing hypertension based on blood pressure readings. Lifestyle modifications and pharmacologic treatment with diuretics, ACE inhibitors, ARBs, beta-blockers, or calcium channel blockers are recommended to reduce blood pressure to recommended goal levels based on patient risk factors. Special considerations are discussed for treating hypertension in various patient populations.
Combination Therapy In Hypertension - Dr Vivek Baliga PresentationDr Vivek Baliga
Dr Vivek Baliga of Baliga Diagnostics, Bangalore, discusses the common combination therapies used in the management of hypertension in clinical practice.
This document discusses the management of hypertension. Some key points include:
- Above 115/75 mmHg, cardiovascular disease risk doubles with each 20/10 mmHg increase in blood pressure.
- Prehypertension is defined as systolic BP of 120-139 mmHg or diastolic BP of 80-89 mmHg. Lifestyle modifications are recommended.
- Most patients require two or more drugs to achieve blood pressure goal. Initial drug therapy for most includes a thiazide-type diuretic.
- Lifestyle modifications like weight loss, adopting the DASH diet, reducing sodium intake, and increasing physical activity can significantly lower blood pressure.
Essential hypertension management and treatmentFabio Grubba
This document discusses hypertension (high blood pressure), including its classification, causes, symptoms, diagnosis, and treatment. It defines the different stages of hypertension according to blood pressure readings. Lifestyle modifications are recommended initially, including diet changes and exercise. If lifestyle changes do not control blood pressure, medications such as diuretics, beta-blockers, calcium channel blockers, ACE inhibitors, and other drug classes may be used. The goal of treatment is to prevent complications in target organs like the heart, brain, and kidneys by maintaining a blood pressure below 140/90 mmHg.
Hypertension is a global health issue that is responsible for many deaths worldwide each year. Combination therapy using two or more antihypertensive drugs from different classes is often necessary to control blood pressure, especially for patients with co-morbid conditions like diabetes or heart disease. Guidelines recommend starting with a combination of first-line drugs like a diuretic, calcium channel blocker, angiotensin converting enzyme inhibitor, or angiotensin receptor blocker based on the individual's condition. Single pill combinations have advantages over free drug combinations in terms of adherence, efficacy, and tolerability. The appropriate combination of antihypertensives depends on any associated diseases and should target relevant organ systems and pathways.
This document discusses hypertension and its treatment with antihypertensive drugs. It defines hypertension and describes the types of hypertension. It explains the need to treat hypertension to prevent target organ damage like eye, brain, kidney and heart disease. It then discusses the normal blood pressure regulation mechanisms involving the heart, blood vessels, kidneys, baroreflex and renin-angiotensin system. The rest of the document summarizes the mechanisms, uses, and side effects of major classes of antihypertensive drugs like diuretics, beta-blockers, calcium channel blockers, ACE inhibitors, and angiotensin receptor blockers. It emphasizes that these drugs work by interfering with the normal blood pressure regulating mechanisms.
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This document provides guidance on the management of hypertension from the 2020 ISH Global Hypertension Practice Guidelines. It discusses definitions of hypertension, classification based on blood pressure levels, goals of therapy, and non-pharmacological and pharmacological treatment approaches. For treatment, it recommends initial lifestyle modifications and monotherapy before considering sequential monotherapy or combination drug therapy if blood pressure remains uncontrolled. It also provides guidance for specific circumstances like resistant hypertension, secondary hypertension, hypertension in pregnancy, and hypertensive emergencies.
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Hypertension is a common complication in pregnancy affecting 10-15% of pregnancies worldwide. It can be classified as chronic hypertension, gestational hypertension, preeclampsia, or chronic hypertension with superimposed preeclampsia. The presentation, complications, and management of hypertension in pregnancy were discussed. Preeclampsia in particular can lead to serious maternal and fetal complications if not properly managed. The goal of management is stabilization of blood pressure and timely delivery to prevent complications.
Moins medical book-2(Davidson's-Principle-and-Practice-of-Medicine-24th-Editi...Moinul Islam
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2) The first edition was published in 1952 and was praised for its clarity, uniformity of style, modest size, and for being sufficiently comprehensive and up-to-date.
3) More than half a century later, the textbook continues to inform and educate medical students, doctors, and health professionals around the world, having sold over 2.5 million copies total.
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The document provides guidelines for residency exams in Bangladesh. It outlines the eligibility requirements, exam structure, and selection process. Some key points:
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These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Kat...rightmanforbloodline
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
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Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
2. Lecture Outline
Hypertension
Definition, classification
Prevalence
Complications
Contributing factors
Update on VIIth report of the JNC
Drugs that lower blood pressure
3. Blood Pressure Classification
Classification SBP (mmHg) DBP (mmHg)
______________________________________________________
Normal <120 and <80
Prehypertension 120–139 or 80–89
Hypertension >140/90
Stage 1 Hypertension 140–159 or 90–99
Stage 2 Hypertension >160 or >100
_____________________________________________
4. Essential Hypertension
In 90–95% of cases the cause isn't
known = ESSENTIAL HYPERTENSION
Symptomatic treatment, i.e. reduce
blood pressure. No real cure yet.
5. Identifiable Causes of
Secondary Hypertension
Sleep apnea
Drug-induced or related causes
Chronic kidney disease
Primary aldosteronism
Renovascular disease
Chronic steroid therapy and Cushing’s
syndrome
Pheochromocytoma
Coarctation of the aorta
Thyroid or parathyroid disease
6. Prevalence
High in this country: 50% of adults,
60% of whites, 71% of African
Americans, 61% Mexican Americans
over the age of 60
More prevalent in men than in
women
Highest prevalence in elderly
African-American females
10. National Heart Lung Blood Institute
National High Blood Pressure
Education Program
The Seventh Report of the Joint
National Committee on Prevention,
Detection, Evaluation, and Treatment
of High Blood Pressure (JNC 7, 2003)
http://www.nhlbi.nih.gov/guidelines/hypertension
/index.htm
11. Why Guidelines for
Hypertension?
50 million people with hypertension
in USA 10 years ago – 1:4 overall
(Currently 31 %), half of people > age
60
Only 1 in 2 on drug treatment
to lower BP
Only 1 in 4 age 18-74 controlled to
<140/<90 in USA
12.
13. New BP Goals
<140/<90 and lower if tolerated
<130/<80 in diabetics
<130/<85 in cardiac failure
<130/<85 in renal failure
<125/<75 in renal failure with
proteinuria>1.0 g/24 hours
14. Highlights of Current
Guidelines
JNC, WHO/ISH, BHS,
Canada, and More
New aggressive treatment
strategies based on a patient’s
medical profile
Treat to goal and hit the target,
not to be satisfied with less
15. Treatment Overview
Goals of therapy
Lifestyle modification
Pharmacologic treatment
Algorithm for treatment of
hypertension
Classification and management of
BP for adults
Follow-up and monitoring
17. DASH Diet
Dietary
Approaches
to
Stop
Hypertension
• Emphasizes: Fruits,
vegetables, low fat dairy
foods, and reduced
sodium intake
• Includes whole grains,
poultry, fish, nuts
• Reduced amounts of red
meat, sugar, total and
saturated fat, and
cholesterol
Sacks FM et al: NEJM 344;3-10, 2001
18. Algorithm for Treatment of Hypertension
Not at Goal Blood Pressure (<140/90 mmHg)
(<130/80 mmHg for those with diabetes or chronic kidney disease)
Initial Drug Choices
Drug(s) for the compelling
indications
Other antihypertensive drugs
(diuretics, ACEI, ARB, BB, CCB)
as needed.
With Compelling
Indications
Lifestyle Modifications
Stage 2 Hypertension
(SBP >160 or DBP >100 mmHg)
2-drug combination for most (usually
thiazide-type diuretic and
ACEI, or ARB, or BB, or CCB)
Stage 1 Hypertension
(SBP 140–159 or DBP 90–99 mmHg)
Thiazide-type diuretics for most.
May consider ACEI, ARB, BB, CCB,
or combination.
Without Compelling
Indications
Not at Goal
Blood Pressure
Optimize dosages or add additional drugs
until goal blood pressure is achieved.
Consider consultation with hypertension specialist.
20. Mean Arterial Pressure
MAP = CO
CO = HR X SV
SNS Blood volume
Heart contactility
Venous tone
X PVR
myogenic tone
vascular responsivenes
nervous control
vasoactive metabolites
endothelial factors
circulating hormones
22. Diuretics
Used as initial therapy alone or in combination with
drugs from other groups
Adverse effects: renin secretion due to volume and Na
depletion
Thiazides: chlorothiazide, hydrochorothiazide
Loop Diuretics: furosemide, bumetanide
Potassium sparing diuretics: spironolactone,
triamterene, amiloride
23. About Diuretics
Antihypertensive and Lipid Lowering Treatment to
Prevent Heart Attack Trial (ALLHAT): Diuretics
have been virtually unsurpassed in preventing the
cardiovascular complications of hypertension.
Diuretics enhance the antihypertensive efficacy of
multidrug regimens, can be useful in achieving BP
control, and are more affordable than other anti-
hypertensive agents.
Despite these findings, diuretics remain under-
utilized.
24. Agents that affect
adrenergic function
a) Agents that prevent adrenergic
transmission (reserpine, guanethedine,
guanadrel)
b) Selective alpha-1 adrenergic receptor
blockers (prazosin, terazosin, doxazosin)
c) Beta-adrenergic blocking agents
(propranolol and others)
d) Agents that act on the CNS (methyldopa,
clonidine, guanabenz, guanfacine)
25. a) Agents that prevent adrenergic
transmission: Reserpine
Mechanism: depletes neurotransmitters (NE,
DA, 5HT) in the storage vesicle of the central
and peripheral nerve endings
Main effects: depress SNS function centrally
and peripherally decreased HR, contractility
and PVR
Adverse effects: depression, insomnia,
nightmares, ulcers, diarrhea, abdominal
cramping, nasal stuffiness, orthostatic
hypotension, dry mouth, impotence
Pharmacokinetics: onset is slow and full effect
is seen in weeks
Use: infrequently
26. Mechanism: Depletes the nerve ending of NE
in the periphery
Main effects: decrease in PVR and decrease
in HR → decrease in BP
Adverse effects: Orthostatic hypotension, Na+
and water retention. Other side-effects
similar to reserpine except the CNS effects
Pharmacokinetics: Poorly absorbed from the
G.I. Onset slow (1-2 weeks). Metabolites
excreted in urine
Use: Not used anymore because of severe
side effects
a) Agents that prevent adrenergic
transmission: Guanethedine
27. Mechanism and main effects Similar to
guanethidine
Adverse effects are less than gunethidine:
less orthostatic hypotension, less diarrhea,
less effect on sexual function.
Pharmacokinetics: better absorption, rapid
onset, shorter duration of action than
guanethidine
a) Agents that prevent adrenergic
transmission: Guanadrel
28. b) Selective alpha-1 adrenergic
receptor blockers
(prazosin, terazosin, doxazosin)
They favorably influence plasma lipid profile, and do not
interfere with glucose metabolism.
Mechanism: block α1 receptors in vasculature
Main effects: decreased PVR decrease BP
Adverse effects: 1st dose phenomenon, fluid
retention, dizziness, headache
Pharmacokinetics: t1/2= 4.5, 12, 20,
respectively
Use: used in stage 1 and stage 2 HT in
combination with a diuretic and a β-blocker
31. Propranolol
Mechanism:
Block cardiac β1 receptors lower CO
Block renal β1 receptors lower renin, lower PVR
Main effects: decrease HR and PVR
Adverse effects: bradycardia, depression, β2
blockade in airways, glucose and lipid
metabolism, vasoconstriction in extremities
Pharmacokinetics: GI, 30-50% metabolized in the
first-pass in liver. T1/2: 3-5 hours, Slow- release
propranolol available
Use: used in stage 1 and 2 HT alone or in
combinations with a diuretic and/or vasodilator
Drug Interactions: verapamil, diltiazem, digitalis
(caution AV Block)
32. Labetalol
A combined alpha-1, beta-1, and
beta-2 blocker. Beta blocking
action is more prominent. It also
has some ISA property.
Can be given i.v. for hypertensive
emergencies
33. d) Agents that act on the CNS
(α−methyldopa, clonidine)
Favorable effect: lower PRA
Mechanism: α-me-dopa metabolized to α-me-
norepinephrine, an α-2 agonist, that suppresses
SNS output from the CNS. Others are α-2 agonist
themselves.
Main effects: decreases PVR and HR
Adverse effects: sedation, drowsiness, dry mouth,
impotence, bradycardia, withdrawal syndrome
(rebound HT), false (+) Coombs’ antiglobulin test
Pharmacokinetics: oral or parenteral, transdermal;
T1/2 = 2, 10, 6, 14-17 h, respectively
Use: stage 1 and 2 HT
34. Vasodilator Drugs
Common adverse effects: fall in BP reflex
tachycardia, also fall in BP renin Na/H2O
retention
a) Calcium entry blockers (nifedipine
and others)
b) Potassium channel openers
(minoxidil, diazoxide i.v., pinacidil)
c) Direct acting vasodilators
(hydralazine, Na-nitroprusside i.v.)
35. a) Calcium entry blockers
mechanism: inhibit Ca entry through L-type
voltage gated channels
Non- Dihydropyridines : verapamil,
diltiazem
Dihydropyridines: nifedipine,
nicardapine, amlodipine
36. Nifedipine
Mech: selective blockade of vascular Ca
channels
Main effect: vasodilatation lower PVR
lower BP
Adverse effects: headache, flushing,
nausea, ankle edema, dizziness, reflex
tachycardia with short acting version (now
have Procardia SR)
(no reflex tachycardia with verapamil and
diltiazem)
Use: Hypertension (more effective in African-
Americans), angina. Not useful as an
antiarrhythmic drug
37. Verapamil and Diltiazem
Mechanism: Blockade of Ca channels in the
vasculature, heart muscle and the AV node
Main effects: same as nifedipine group
Adverse effects: Similar to nifedipine except
that they do not cause reflex tahycardia
Drug interactions: Caution for AV block with
beta blockers, and digitalis
Use: Hypertension, angina, arrhythmias
38. b) Potassium channel openers
(minoxidil, diazoxide i.v)
Mechanism: open K-channels of vascular
smooth muscle cells K-efflux
hyperpolarization vasodilatation
Main effect: vasodilation lower PVR
lower BP
Adverse effects: reflex tachycardia, Na and
fluid retention, (minoxidil: hirsutism-
Rogaine. Diazoxide: hyperuricemia,
hyperglycemia –used in hypoglycemia)
Use: Diazoxide i.v. in hypertensive
emergencies
39. c) Direct acting vasodilators
(Na-nitroprusside)
Mechanism: metabolite is nitric oxide
cGMP. NO is a rapid acting venous and
arteriolar vasodilator
Main effect: vasodilation lower PVR
lower BP
Adverse Effects: Reflex tachycardia, severe
hypotension, possible cyanide poisoning
Pharmacokinetics: rapid acting, i.v. drip,
short plasma half-life
Use: Hypertensive emergencies
40. c) Direct acting vasodilators
(hydralazine)
Mechanism: Direct vasodilator of arterioles
Main effect: vasodilation lower PVR
lower BP
Adverse effects: reflex tachycardia, Na
retention, hirsutism, lupus–like syndrome
Pharmacokinetics: oral, slow onset
Use: with a beta blocker and a diuretic
41. Angitensin Converting Enzyme
ACE
Angiotensin I Angiotensin II
ACE
Bradykinin (vasodilator) Inactive peptide
ANGIOTENSIN I ANGIOTENSIN II
ACE
→
ANGIOTENSIN I ANGIOTENSIN II
ACE
→
BRADYKININ (vasodialtor) INACTIVE PEPTIDE
ACE
→
BRADYKININ (vasodialtor) INACTIVE PEPTIDE
ACE
→
42. Agents that affect RAS
a) ACE inhibitors
captopril, enalapril, lisinopril
b) Angiotensin II receptor
blockers (ARB)
losartan, valsartan, irbesartan
43. a) ACE inhibitors
captopril, enalapril, lisinopril, rampiril)
No adverse effects on plasma lipids, glucose, sexual
function. Drug of choice in diabetes-related early stage
proteinuria. Contraindicated in pregnancy. Not as effective in
African-Americans
Mechanism: inhibit ACE low circulating Ang II
decreased PVR
Main effects: decreased PVR decreased BP
Adverse effects: skin rash, taste, cough, hyperkalemia
Pharmacokinetics: T1/2 = 3, 11, 12, respectively
Use: used in stage 1 and 2 HT; also for congestive heart
failure
44. b) Angiotensin II receptor blockers
(ARB) (losartan-Coozar, valsartan-Diovan,
irbesartan-Avapro)
Mechanism: selectively block Ang II AT-1
receptor decrease PVR decrease BP
Adverse effects: No Cough, very few
adverse similar to ACE inhibitors
45. BP ↓
BV ↓
Na+ depletion
NE release
from nerve
ending
RENIN RELEASE
BP ↑
BV ↑
Na+ retention
+ -
Vasoconstriction
Aldosterone
secretion
Angiotensin release
+
+ +
+
+
+
Stimulants for ADH
1) ↓ ECF volume
2) osmolality of plasma
+