The document discusses hypertension in Malaysia, including:
1) The prevalence of hypertension in Malaysia is 25.7% overall, affecting 1 in 4 adults aged 25-64, with known hypertensives numbering 1.4 million and newly diagnosed at 1.7 million.
2) Control rates remain low with only 8% of hypertensives in Malaysia achieving blood pressure control, compared to over 30% in the United States.
3) Recommendations are made to improve management of hypertension through risk stratification, emphasis on first-line therapies such as ACE inhibitors, ARBs, diuretics and calcium channel blockers, and addressing concomitant conditions through appropriate drug selections.
Diabetes mellitus (DM) is a significant public health problem associated with many debilitating health conditions
This presentation will briefly tackle management of Diabetes
Diabetes mellitus (DM) is a significant public health problem associated with many debilitating health conditions
This presentation will briefly tackle management of Diabetes
Our aim is to alleviate human suffering related to diabetes and its complications among those least able to withstand the burden of the disease. From 2002 to March 2017, the World Diabetes Foundation provided USD 130 million in funding to 511 projects in 115 countries. For every dollar spent, the Foundation raises approximately 2 dollars in cash or as in-kind donations from other sources. The total value of the WDF project portfolio reached USD 377 million, excluding WDF’s own advocacy and strategic platforms.
Many have troubles choosing the proper insulin type and dosing for their patients.. Here is a quick presentation that introduce you to different studies in that matter.
This presentation is intended for healthcare prfessionals
Discussion will be on the demographics, risk factors, signs and symptoms and basic treatment plans of diabetes with emphasis on lifestyle modifications regarding diet and exercise for famlies of troops.
Themes of previous World Diabetes Day campaigns have focused on different factors that influence the risk of diabetes and its complications. The theme for 2021–2023 is Access to Diabetes Care. Taking charge of your diabetic care with knowledge of informed decisions.
Epidemiology , diagnosis and treatment of Hypertension Toufiqur Rahman
Hypertension, Blood pressure, Systolic Hypertension, Diastolic Hypertension, Epidemiology, Classification of hypertention, Type of hypertension, aetiology of hypertension, Clinical features, complications of hypertension, ambulatory blood pressure monitoring, Resistant hypertension, anti hypertensives,
Our aim is to alleviate human suffering related to diabetes and its complications among those least able to withstand the burden of the disease. From 2002 to March 2017, the World Diabetes Foundation provided USD 130 million in funding to 511 projects in 115 countries. For every dollar spent, the Foundation raises approximately 2 dollars in cash or as in-kind donations from other sources. The total value of the WDF project portfolio reached USD 377 million, excluding WDF’s own advocacy and strategic platforms.
Many have troubles choosing the proper insulin type and dosing for their patients.. Here is a quick presentation that introduce you to different studies in that matter.
This presentation is intended for healthcare prfessionals
Discussion will be on the demographics, risk factors, signs and symptoms and basic treatment plans of diabetes with emphasis on lifestyle modifications regarding diet and exercise for famlies of troops.
Themes of previous World Diabetes Day campaigns have focused on different factors that influence the risk of diabetes and its complications. The theme for 2021–2023 is Access to Diabetes Care. Taking charge of your diabetic care with knowledge of informed decisions.
Epidemiology , diagnosis and treatment of Hypertension Toufiqur Rahman
Hypertension, Blood pressure, Systolic Hypertension, Diastolic Hypertension, Epidemiology, Classification of hypertention, Type of hypertension, aetiology of hypertension, Clinical features, complications of hypertension, ambulatory blood pressure monitoring, Resistant hypertension, anti hypertensives,
Weight diabetes and metabolic problems in patients taking atypical antipsycho...Alex J Mitchell
Free slide show on weight gain, diabetes and metabolic problems in those taking atypical antipsychotic medication in schizophrenia, bipolar disorder and related conditions. Image credits retained by original authors. Please give correct acknolwedgements if you present any material from here.
Knowledge, attitude and practice about hypertension among adultMd.Nahian Rahman
Hypertension (HTN or HT), also known as high blood pressure (HBP), is a long-term medical condition in which the blood pressure in the arteries is persistently elevated.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
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.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
How STIs Influence the Development of Pelvic Inflammatory Disease.pptx
Hypertension
1. Hypertension in Malaysia
Assoc. Prof. Dr. Rashidi Ahmad
MD(USM), MMed(EM)(USM),FADUSM,
AM(Mal), Clinical Fellow (Cardio)(NHI)
School of Medical Sciences, USM, KB, Kelantan
5. SITTING ARM SUPPORT IN
STANDING
KOROTKOFF PHASE:
SBP 1 CLEAR TAPPING SOUNDS
FIRST APPEAR
DBP 5 THE DISAPPEARANCE OF
SOUND
6. Important rules
Check BP both arms – coarctation of
aorta, arterial anomaly
Lying & standing – postural drop in
elderly, diabetics
Beware of auscultatory gap
9. Keep thinking of secondary causes
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
17. Benefits of Lowering BP
Average Percent Reduction
Stroke incidence 35–40%
Myocardial infarction 20–25%
Heart failure 50%
18.
19.
20.
21. Magnitude of HPT
Affects about 50 million people in the US and
approximately 1 billion worldwide.
Prevalence increases with age: individuals
who are normotensive at age 55 still face a
90% lifetime risk of developing HPT.
The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation,
and Treatment of High Blood Pressure: the JNC 7 report. JAMA 2003;289:2560-72.
Residual lifetime risk for developing hypertension in middle-aged women and men:
The Framingham Heart Study. JAMA 2002;287:1003-10.
22. Chan
1997: 10%
Lim,et al
1991: 13.8%
Prevalence rates from Srinavas, et al
Different years and 1998: 25.6%
Different populations Nawawi
2002: 31.2%
Liew, et al.
1997: 42.8%
23. Hypertension in Malaysia
Prevalence: 25.7%.
Men vs women - 26.3% vs 25.0%.
1 in 4 adults aged 25-64 years had HPT.
Known hypertensives: 1.4 million
Newly diagnosed:1.7 million.
Chinese (31.0%), Malays (23.4%) and
Indians (21.6%).
24. Prevalence of HPT by sex and race amongst Malaysian residents
aged ≥ 18 years in 2006 (N=33,976)
Sex, % (95% CI)
Age (Years)
Male Female Both sexes
All races 33.3 (31.6, 32.8) 31.0 (30.3, 31.7) 32.2 (31.6, 32.8)
Malay 33.7 (32.5, 34.8) 34.1 (33.1, 35.1) 33.9 (33.1 34.7)
Chinese 35.0 (33.2, 36.8) 29.8 (28.2, 31.4) 32.4 (31.1, 33.8)
Indians 30.9 (28.2, 33.8) 27.8 (25.6, 30.1) 29.4 (27.5,31.2)
Bumi Sabah 36.0 (33.0, 39.1) 26.4 (24.1, 28.8) 31.1 (29.2, 33.2)
Bumi Sarawak 35.6 (31.0,40.4) 33.3 (29.5,37.3) 34.4 (31.0,38.1)
25. Prevalence of HPT by sex and race amongst Malaysian
residents aged ≥ 30 years in 2006 (N=24,796)
Sex, % (95% CI)
Age (Years)
Male Female Both sexes
All races 41.7 (40.7, 42.8) 43.4 (42.5, 44.4) 42.6 (41.8, 43.3)
Malay 45.8 (44.4, 47.1) 51.2 (50.0, 52.4) 45.4 (44.3, 46.4)
Chinese 47.4 (45.4, 49.4) 42.3 (40.4, 44.3) 40.6 (39.0, 42.1)
Indians 44.1 (40.8, 47.4) 42.7 (39.9, 45.5) 40.0 (37.7, 42.3)
Bumi Sabah 36.0 (33.0, 39.1) 26.4 (24.1, 28.8) 31.1 (29.2, 33.2)
Bumi Sarawak 35.6 ( 31.0,40.4) 33.3 (29.5,37.3) 34.4 (31.0,38.1)
27. The Malaysian Rule
All hypertensives
64% 36% Aware
12% 88% Treated
74% 26% controlled
28. The ‘Malaysian Rule’
100 All hypertensives
64 36 Aware
69 31 Treated
92 8 Controlled
29. Overall BP Control by ethnicity
Indian 12.2% ( 10.0,14.7)
Chinese 11.5% ( 10.1,12.9)
Malays 7.0% ( 6.4,7.7)
30. Comparison with NHMS 11 ( > 30 years )
1996 2006
Prevalence 33% 43%
Aware 33 % 36%
Diagnosed & Rx 23% 88%
Rx and controlled 26% 26%
Overall control 6% 8%
31. Hypertension Control in the
Asia Pacific Region
Prev Aware Treat Control
Thailand (2003-4) 22.2% 28.6% 23.7% 8.6%
China 2002 18.8% 30.2% 24.7% 6.1%
Korea 2001 22.9% 30.2% 22.9% 10.7%
Malaysia 2006 32.2% 35.8% 31% 8.2%
USA 2004 29.9% 66.5% 53.7% 33.1%
32.
33. Clinical Aspects – Current Status
( IHM MOH 2006 )
National Essential Hypertension Audit
- rates of control
Hospital with specialist 31.2%
Hospital without specialist 26.6%
Clinics with FMS/ MO 28.8%
Clinics without FMS/MO 26.9%
34. Clinical Aspects – Current Status
( IHM MOH 2006 )
National Essential Hypertension Audit
- rates of control by ethnicity
Malay 24.3%
Indian 30.8%
Chinese 37.6%
Others 30.8%
35. Clinical Aspects – Current Status
( IHM MOH 2006 )
National Essential Hypertension Audit
- rates of control by age
30-39 19.4%
40-49 27.1%
50-59 29.1%
>60 29.2%
36. Points to ponder!
Patients’ non compliance
Doctors not sure when to treat and what
the treatment goals are
Doctors not using the right drug/drugs
Patients has undiagnosed secondary
hypertension or complications of
hypertension which makes optimum
control difficult
37. What are the better ways to
manage hypertensive patients
in Malaysia?
38. Risk Stratification
Co-existing Condition No RF TOD TOC Previous MI
No TOD or or or
No TOC RF (1 – 2) RF (≥ 3) Previous stroke
BP Levels No TOC or or
(mmHg) Clinical Diabetes
atherosclerosis
SBP 120 – 139 and/or Low Medium High Very high
DBP 80 – 89
SBP 140 – 159 and/or Low Medium High Very high
DBP 90 – 99
SBP 160 – 179 and/or Medium High Very high Very high
DBP 100 – 109
SBP 180 – 209 and/or High Very high Very high Very high
DBP 110 – 119
SBP ≥ 210 and/or Very high Very high Very high Very high
DBP ≥ 120
Risk Level Risk of Major CV Event in 10 years Management
Low < 10% Lifestyle changes
Medium 10 – 20% Drug treatment and lifestyle changes
High 20 – 30% Drug treatment and lifestyle changes
Very high > 30% Drug treatment and lifestyle changes
39. First line therapy
NICE / BHS
ACEi / ARB/ diuretics/ CCB
ESH/ESC
ACEi /ARB/diuretics/CCB/Beta blockers
WHO/ISH
Low dose diuretics/ ACEi/CCB
MSH
ACEi / ARB/diuretics/CCB
Chinese
ACEi /ARB/diuretics/CCB/Beta blockers
40. Choice of anti-hypertensive drugs in patients
with concomitant conditions
Concomitant disease Diuretics β- ACEIs CCBs Peripheral ARBs
blockers α-blockers
Diabetes mellitus + +/- +++ + +/- ++
(without nephropathy)
Diabetes mellitus (with ++ +/- +++ ++* +/- +++
nephropathy)
Gout +/- + + + + +
Dyslipidaemia +/- +/- + + + +
Coronary heart disease + +++ +++ ++ + +
Heart failure +++ +++# +++ +@ + +++
Asthma + - + + + +
Peripheral vascular + +/- + + + +
disease
Non-diabetic renal ++ + +++ +* + ++
impairment
Renal artery stenosis + + ++$ + + ++$
Elderly with no co-morbid +++ + + +++ +/- +
conditions
The grading of recommendation from (+) to (+++) is based on increasing levels of evidence and/or current widely accepted practice
+/- Use with care
- Contraindicated
* Only non-dihydropyridine CCB
# Metoprolol, bisoprolol, carvedilol – dose needs to be gradually titrated
@ Current evidence available for amlodipine and felodipine only
$ Contraindicated in bilateral renal artery stenosis
41.
42. ESH/ESC Guidelines 2007
monotherapy vs combination therapy
Mild BP elevation Choose between Marked BP elevation
Low / moderate CV risk High / very high CV risk
Conventional BP target Lower BP target
Single agent Two-drug combination
at low dose at low dose
If goal BP not achieved
Previous agent Switch to different agent Previous combination Add a third drug
at full dose at low dose at full dose at low dose
If goal BP not achieved
Two-to three-drug Full dose Two-three-drug combination
combination at full dose monotherapy at full dose
ESH/ESC Guidelines 2007 J Hypertens. 2007;25:1105-1187
43. Newly diagnosed, uncomplicated patients with
hypertension with no compelling indication
First line monotherapy
Blockers of the renin system ( ACEi, ARB )
Calcium channel blockers
Diuretics
44. WHO/ISH
JNC-6
Effects of diuretics and ß-blockers on
cardiovascular mortality
Treatment Treatment
Better Worse
Drug Dose No. RR (95% CI)
Diuretics High 11 0.78 (0.62-0.97)
Diuretics Low 4 0.76 (0.65-0.89)
ß-blockers 4 0.89 (0.76-1.05)
0.4 0.7 1.0
RR (95% CI)
45.
46. Combination therapy
BP >160/90 mmHg
Include diuretics as part of combination
therapy (ACEI + Diuretic)
Consider fixed dose combination if
compliance is an issue
51. What predicts BP control ?
By univariate analysis
Odds p
Statin on admission 2.53 0.000
Presence of IHD 2.21 0.001
Diuretics on admission 2.12 0.002
ACE I on admission 1.97 0.006
> 2 drugs 1.92 0.007
52. What predicts BP control ?
By multivariate analysis
Odds p
Statin on admission 1.79 0.030
Diuretics on admission 1.77 0.033
53. The Raub
Heart Study
Prevalence of Hypertension,
Diabetes and Obesity
1993 1998
Males
Hypertension 26.2 30.6
Diabetes 4.4 4.7
Obesity 3.1 5.2
Overweight 17.7 30.9
Females
Hypertension 29.4 31.7
Diabetes 3.5 7.5
Obesity 10.5 12.3
Overweight 25.3 31.1
54. Blood pressure and vascular risk in diabetes
Best evidence: 2000
UK Prospective Diabetes Study
58. Conclusion
Hypertension is getting more prevalent in
Malaysia
Awareness and control rates are still poor
Understanding the profile of our patients is
important for optimum management
59. A typical Malaysian Hypertensive
- Back to Reality !
Diagnosed late
Has other concomitant cardiovascular
risk factors
Has complications of hypertension
including target organ damage and target
organ complications
BP not optimally controlled
We have more works to do?