The document discusses hypertension in several special situations. It describes how hypertension commonly co-exists with conditions like diabetes, cerebrovascular disease, renal disease, and congestive heart failure. It provides guidelines on evaluating and managing blood pressure in these situations. For example, it recommends that antihypertensive therapy aims to reduce stroke risk in cerebrovascular disease and slow renal disease progression when hypertension is present with renal problems. The document also examines hypertension among different demographic groups like women, pregnant women, and the elderly.
Hypertension: New Concepts, Guidelines, and Clinical Management Hypertensio...MedicineAndFamily
This document summarizes guidelines for diagnosing and treating hypertension. It discusses the prevalence of hypertension and cardiovascular disease in the US population. It reviews risk factors for hypertension and cardiovascular events. It also summarizes findings from clinical trials demonstrating the benefits of treating hypertension, including reduced risks of stroke, heart failure, and myocardial infarction. Thiazide diuretics are recommended as first-line treatment based on their effectiveness and lower costs.
Beta blockers are the most effective therapy for heart failure according to clinical trials. Long term use of beta blockers such as bisoprolol, carvedilol, and sustained release metoprolol succinate can reduce mortality, heart failure hospitalizations, and improve ejection fraction and symptoms of heart failure. While initiation requires slow uptitration, discontinuation of beta blockers during heart failure hospitalization is generally not necessary and may worsen outcomes.
This document summarizes information about LCZ696, an angiotensin receptor neprilysin inhibitor (ARNI). It provides mechanisms of action, summarizes clinical trial results, and discusses the potential of LCZ696 as a new treatment for heart failure. Key points include:
1) LCZ696 provides both neprilysin inhibition to increase natriuretic peptides and blockade of the renin-angiotensin-aldosterone system through AT1 receptor blockade.
2) In clinical trials, LCZ696 reduced blood pressure more than valsartan alone and reduced cardiovascular death and heart failure hospitalization more than enalapril in heart failure patients.
3) LCZ696 may offer
International Society of Hypertension 2020 guidlinesJAFAR ALSAID
The document outlines key points from a presentation on hypertension given by Dr. Jafar Alsaid at the Iraqi Hypertension Conference in November 2021. It discusses the global burden of hypertension, challenges in low-income countries, definitions and classifications of hypertension, measuring blood pressure, common risk factors, target organ damage, lifestyle modifications, pharmacological treatments, and the importance of patient education.
The EMPEROR-Preserved trial evaluated whether empagliflozin reduces cardiovascular death or hospitalization for heart failure in adults with either heart failure with mid-range or preserved ejection fraction. The trial randomized over 5,000 patients to empagliflozin 10 mg daily or placebo, with a median follow up of 26 months. Empagliflozin reduced the primary composite outcome of cardiovascular death or hospitalization for heart failure by 21% compared to placebo, driven mainly by a 29% lower risk of hospitalization for heart failure.
This document presents Orbapin 5/20, a combination drug of amlodipine and olmesartan to treat hypertension. It notes the price and dosage of Orbapin, compares its active ingredients to existing olmesartan drugs on the market, and provides market data and growth rates for olmesartan generics and combinations. The document outlines the indication, dosage, administration and target doctors for Orbapin 5/20.
1. A Case report of Heart Failure
2. Discussion on Heart Failure
3. Role of Peptides in Heart Failure
4. Importance of 30 days in heart failure
5. Role of ENTRESTO in Stable Heart Failure patient (PARADIGM-HF study)(HFrEF)
6. Biomarkers in Heart Failure
7. Role of ARNI in Hospitalized Heart Failure patient (PIONEER-HF study)
8. Role of ARNI in HFpEF (PARAMOUNT Trial)
9. Safety and usefulness of ACEI/ARB/ARNI
10. Role of SGPL2 inhibitors in HF with/without DM
The document discusses hypertension in several special situations. It describes how hypertension commonly co-exists with conditions like diabetes, cerebrovascular disease, renal disease, and congestive heart failure. It provides guidelines on evaluating and managing blood pressure in these situations. For example, it recommends that antihypertensive therapy aims to reduce stroke risk in cerebrovascular disease and slow renal disease progression when hypertension is present with renal problems. The document also examines hypertension among different demographic groups like women, pregnant women, and the elderly.
Hypertension: New Concepts, Guidelines, and Clinical Management Hypertensio...MedicineAndFamily
This document summarizes guidelines for diagnosing and treating hypertension. It discusses the prevalence of hypertension and cardiovascular disease in the US population. It reviews risk factors for hypertension and cardiovascular events. It also summarizes findings from clinical trials demonstrating the benefits of treating hypertension, including reduced risks of stroke, heart failure, and myocardial infarction. Thiazide diuretics are recommended as first-line treatment based on their effectiveness and lower costs.
Beta blockers are the most effective therapy for heart failure according to clinical trials. Long term use of beta blockers such as bisoprolol, carvedilol, and sustained release metoprolol succinate can reduce mortality, heart failure hospitalizations, and improve ejection fraction and symptoms of heart failure. While initiation requires slow uptitration, discontinuation of beta blockers during heart failure hospitalization is generally not necessary and may worsen outcomes.
This document summarizes information about LCZ696, an angiotensin receptor neprilysin inhibitor (ARNI). It provides mechanisms of action, summarizes clinical trial results, and discusses the potential of LCZ696 as a new treatment for heart failure. Key points include:
1) LCZ696 provides both neprilysin inhibition to increase natriuretic peptides and blockade of the renin-angiotensin-aldosterone system through AT1 receptor blockade.
2) In clinical trials, LCZ696 reduced blood pressure more than valsartan alone and reduced cardiovascular death and heart failure hospitalization more than enalapril in heart failure patients.
3) LCZ696 may offer
International Society of Hypertension 2020 guidlinesJAFAR ALSAID
The document outlines key points from a presentation on hypertension given by Dr. Jafar Alsaid at the Iraqi Hypertension Conference in November 2021. It discusses the global burden of hypertension, challenges in low-income countries, definitions and classifications of hypertension, measuring blood pressure, common risk factors, target organ damage, lifestyle modifications, pharmacological treatments, and the importance of patient education.
The EMPEROR-Preserved trial evaluated whether empagliflozin reduces cardiovascular death or hospitalization for heart failure in adults with either heart failure with mid-range or preserved ejection fraction. The trial randomized over 5,000 patients to empagliflozin 10 mg daily or placebo, with a median follow up of 26 months. Empagliflozin reduced the primary composite outcome of cardiovascular death or hospitalization for heart failure by 21% compared to placebo, driven mainly by a 29% lower risk of hospitalization for heart failure.
This document presents Orbapin 5/20, a combination drug of amlodipine and olmesartan to treat hypertension. It notes the price and dosage of Orbapin, compares its active ingredients to existing olmesartan drugs on the market, and provides market data and growth rates for olmesartan generics and combinations. The document outlines the indication, dosage, administration and target doctors for Orbapin 5/20.
1. A Case report of Heart Failure
2. Discussion on Heart Failure
3. Role of Peptides in Heart Failure
4. Importance of 30 days in heart failure
5. Role of ENTRESTO in Stable Heart Failure patient (PARADIGM-HF study)(HFrEF)
6. Biomarkers in Heart Failure
7. Role of ARNI in Hospitalized Heart Failure patient (PIONEER-HF study)
8. Role of ARNI in HFpEF (PARAMOUNT Trial)
9. Safety and usefulness of ACEI/ARB/ARNI
10. Role of SGPL2 inhibitors in HF with/without DM
The document discusses World Hypertension Day, which is observed annually on May 17th to raise awareness about hypertension. It provides information on understanding hypertension, including risk factors and health implications. The presentation's objectives are to raise awareness, promote prevention, encourage collaboration, share resources, and inspire action to address the growing issue of hypertension worldwide.
Treatment Of Hypertension In Special Situation Modified Fina Lcdrmisbah83
This document discusses hypertension, including its types, causes, investigations, management, treatment in special situations, complications, and global mortality. It notes that hypertension is a major risk factor for heart disease and stroke worldwide. Treatment involves lifestyle changes and medications, with goals of controlling blood pressure to reduce cardiovascular risks and events.
Vymada Tablet (ARNI: Angiotensin Receptor Neprilysin Inhibitor) is an anti-hypertensive drug used in combination with Sacubitril & Valsartan to reduce the risk of cardiovascular events in patients with chronic heart failure (NYHA Class II-IV) and reduced ejection fraction.
Effects of Sodium Glucose contransporter (SGLT2) inhibition on renal outcomes in patients with (diabetic) chronic kidney disease.
Presentation given during the East by Southwest, Annual Update in Nephrology, September 17th 2017, Santa Fe, NM
http://medicine.unm.edu/academic-divisions/nephrology/east-by-southwest.html
2021 ESC Guidelines for Heart Failure - What's New and How much to AdaptDr. Md. Samiul Haque
The 2021 ESC Guidelines for Heart Failure include several changes: a new term for HFmrEF, simplified treatment algorithms for HFrEF and according to phenotypes, modified classification for acute HF, and updated treatments for comorbidities. Key recommendations include treating HFrEF with ACE-I/ARNI, beta-blockers, MRAs, and SGLT2 inhibitors. For HFmrEF, ACE-I/ARNI, beta-blockers, and MRAs may be considered. Treatment of acute HF focuses on diuretics, inotropes, and short-term mechanical circulatory support.
Heart Failure with Preserved Ejection Fraction(HFpEF).ptxSarfraz Saleemi
Heart failure with preserved ejection fraction (HFpEF) is not one disease but a clinical syndrome presenting with symptoms of Heart Failure with a left ventricular ejection fraction (LVEF) ≥50 percent and evidence of cardiac diastolic dysfunction. (abnormal LV filling pattern and elevated filling pressures)
It is more common among older patients and women, and results from abnormalities of active ventricular relaxation and passive ventricular compliance. HFpEF should be part of differential diagnosis in patients with typical symptoms such as fatigue, weakness, dyspnea, orthopnea, paroxysmal nocturnal dyspnea, edema and clinical signs of chronic heart failure. Echocardiography features of normal ejection fraction with impaired diastolic function confirm the diagnosis.
The document outlines a presentation on hypertension and hypertensive disorders for allied health workers. It begins with an introduction and outline covering hypertension and hypertensive disorders of pregnancy. The outline discusses risk factors and diagnosis of hypertension, as well as management of hypertensive crisis. Guidelines for diagnosing and treating hypertension from sources like the 2020 Philippine CPG are also summarized.
Management of hypertension in acute strokeSudhir Kumar
Hypertension is an important and common risk factor for brain stroke- both ischemia and hemorrhagic subtypes. Appropriate management of blood pressure is crucial for good recovery rom acute stroke, and prevent recurrence of stroke. This presentation looks at the role played by hypertension in causing first ever and recurrent strokes. The current guidelines are also discussed.
1) For stroke prevention, intensive blood pressure lowering is recommended, with the lower the better. The target is below 115/75 mmHg for those under 60 and below 140/90 mmHg for those over 60.
2) In patients with acute ischemic stroke, it is unnecessary to lower blood pressure in the first 7 days unless systolic blood pressure is over 220 mmHg.
3) In intracerebral hemorrhage patients, the target systolic blood pressure is below 140 mmHg. More aggressive lowering to 120 mmHg is not necessary.
Management of hypertensive condition in 2020 according to AHA/ASA guidelines. We will discuss the presentation, clinical assessment, investigations, and management of hypertension along with major randomized controlled trials and guidelines.
Creatinine clearance: When Does It Matter?PASaskatchewan
This document provides information on estimating kidney function and adjusting drug dosing in patients with chronic kidney disease (CKD). It describes the differences between creatinine clearance (CrCl), estimated glomerular filtration rate (eGFR), and their respective formulas (Cockcroft-Gault and MDRD/CKD-EPI). While both CrCl and eGFR can be used to estimate kidney function and guide drug dosing, CrCl may be preferred in the elderly and for drugs with a narrow therapeutic index. The document reviews drug classes that commonly require dosage adjustments in CKD and provides an example case of adjusting anticoagulation therapy in a patient with CKD.
What are anti-coagulants?
What are the difference between antiplatelet, anticoagulants and thrombolytics?
Coagulation cascade
Virchows Triad
Classification of anti-coagulants?
Indications of anti-coagulants?
Mechanism and site of action of different anti-coagulants?
AF 2023 ACC guidelines half atrial fibrillationRajeshPonnada3
This document summarizes guidelines for atrial fibrillation (AF) from 2023. It finds that the incidence and prevalence of AF are increasing due to an aging population and rising obesity rates. Having AF increases the risk of mortality, stroke, dementia, heart failure, myocardial infarction, chronic kidney disease, peripheral artery disease, and sudden cardiac death. Risk factor modification through treating conditions like obesity, diabetes, and hypertension can help prevent AF. Anticoagulation medication is recommended for AF patients based on their risk of stroke as assessed by tools like CHA2DS2-VASc score. Doacs have been shown to be as effective as warfarin for stroke prevention with lower risks of bleeding.
This document provides a summary of a presentation on statins. It discusses the benefits of statins in reducing cardiovascular events and mortality in both primary and secondary prevention. It addresses several controversies around statins, including their association with diabetes, cognitive impairment, cancer, and hemorrhagic stroke. While some modest risks are noted, the overall benefits of statins in reducing cardiovascular risk are found to outweigh these potential risks. The document emphasizes the importance of statin adherence to achieve optimal outcomes and addresses targets for LDL and non-HDL cholesterol levels according to recent guidelines.
Updated Hypertension Management – ESH 2023.pdfDr. Nayan Ray
Hypertension is the most prevalent CV disorder in the world and according to the WHO, it affects 1.28 billion adults aged 30–79 years worldwide, two-thirds living in low-income and middle-income countries.
In 2019, the global age-standardized average prevalence of hypertension in adults aged 30–79 years was reported to be 34% in men and 32% in women.
At younger ages (<50 years), hypertension is more prevalent in men, whereas a steeper increase of SBP in women from their third decade (and more so following menopause) makes the prevalence of hypertension greater in women in older age categories (>65 years).
Rule of Halves
Half the people with high blood pressure are not known (“rule 1”),
Half of those known are not treated (“rule 2”) and
Half of those treated are not controlled (“rule 3”)'
Definition:
Hypertension is defined based on repeated office SBP values ≥ 140 mmHg and/or DBP ≥ 90 mmHg.
Hypertension is common in diabetics, affecting 20-60% of those with diabetes. It is the leading cause of morbidity and mortality worldwide. While only 25% of hypertensive patients have adequate blood pressure control, tight control of both blood pressure and glucose levels can significantly reduce cardiovascular and mortality risks for diabetics. Hypertension and diabetes frequently occur together due to their shared risk factors and pathophysiology, with each condition increasing the risks associated with the other. Proper management of both is important for preventing diabetes and hypertension-related complications.
#flozins
🫀DAPA 🆚placebo in HFpEF
Now we have a positive trial!
⬇️18% in CV☠️ death or
worsening HF among LVEF>40%
⬇️ 21%heart failure
💥Results same for LVEF> 60% 🆚LVEF<60%
Sacubitril is a neprilysin inhibitor that is used in combination with valsartan for the treatment of heart failure. The combination drug sacubitril/valsartan inhibits neprilysin and blocks the angiotensin receptor. It was shown in the PARADIGM-HF trial to reduce cardiovascular death and heart failure hospitalizations compared to enalapril. Current guidelines recommend sacubitril/valsartan as a replacement for ACE inhibitors or ARBs in patients with HFrEF who are already on such therapy.
This document provides an overview of the management of hypertension, including hypertensive emergencies. It discusses the prevalence and pathophysiology of hypertension, outlines treatment goals, and reviews pharmacologic treatment options. Key points include:
1) Hypertensive emergencies require rapid blood pressure control to prevent end-organ damage, while avoiding precipitous drops in pressure.
2) Intravenous antihypertensive agents discussed include labetalol, esmolol, nicardipine, sodium nitroprusside, and fenoldopam.
3) Nicardipine is highlighted as an effective option for hypertensive emergencies due to its rapid onset, titratability, and limited
This document discusses hypertension management and cardiovascular health. It begins by defining normal blood pressure and examining hypertension as a risk factor for cardiovascular disease. It then explores guidelines for diagnosing and treating hypertension from the US, Taiwan, and China. The document outlines methods for measuring blood pressure and deriving hemodynamic parameters from pulse wave analysis. Examples are given of how hemodynamic profiling can help personalize hypertension treatment. Lifestyle factors that can impact blood pressure and cardiovascular health are also discussed. The document promotes using an online health diary to track metrics and receive advice from doctors.
The document discusses World Hypertension Day, which is observed annually on May 17th to raise awareness about hypertension. It provides information on understanding hypertension, including risk factors and health implications. The presentation's objectives are to raise awareness, promote prevention, encourage collaboration, share resources, and inspire action to address the growing issue of hypertension worldwide.
Treatment Of Hypertension In Special Situation Modified Fina Lcdrmisbah83
This document discusses hypertension, including its types, causes, investigations, management, treatment in special situations, complications, and global mortality. It notes that hypertension is a major risk factor for heart disease and stroke worldwide. Treatment involves lifestyle changes and medications, with goals of controlling blood pressure to reduce cardiovascular risks and events.
Vymada Tablet (ARNI: Angiotensin Receptor Neprilysin Inhibitor) is an anti-hypertensive drug used in combination with Sacubitril & Valsartan to reduce the risk of cardiovascular events in patients with chronic heart failure (NYHA Class II-IV) and reduced ejection fraction.
Effects of Sodium Glucose contransporter (SGLT2) inhibition on renal outcomes in patients with (diabetic) chronic kidney disease.
Presentation given during the East by Southwest, Annual Update in Nephrology, September 17th 2017, Santa Fe, NM
http://medicine.unm.edu/academic-divisions/nephrology/east-by-southwest.html
2021 ESC Guidelines for Heart Failure - What's New and How much to AdaptDr. Md. Samiul Haque
The 2021 ESC Guidelines for Heart Failure include several changes: a new term for HFmrEF, simplified treatment algorithms for HFrEF and according to phenotypes, modified classification for acute HF, and updated treatments for comorbidities. Key recommendations include treating HFrEF with ACE-I/ARNI, beta-blockers, MRAs, and SGLT2 inhibitors. For HFmrEF, ACE-I/ARNI, beta-blockers, and MRAs may be considered. Treatment of acute HF focuses on diuretics, inotropes, and short-term mechanical circulatory support.
Heart Failure with Preserved Ejection Fraction(HFpEF).ptxSarfraz Saleemi
Heart failure with preserved ejection fraction (HFpEF) is not one disease but a clinical syndrome presenting with symptoms of Heart Failure with a left ventricular ejection fraction (LVEF) ≥50 percent and evidence of cardiac diastolic dysfunction. (abnormal LV filling pattern and elevated filling pressures)
It is more common among older patients and women, and results from abnormalities of active ventricular relaxation and passive ventricular compliance. HFpEF should be part of differential diagnosis in patients with typical symptoms such as fatigue, weakness, dyspnea, orthopnea, paroxysmal nocturnal dyspnea, edema and clinical signs of chronic heart failure. Echocardiography features of normal ejection fraction with impaired diastolic function confirm the diagnosis.
The document outlines a presentation on hypertension and hypertensive disorders for allied health workers. It begins with an introduction and outline covering hypertension and hypertensive disorders of pregnancy. The outline discusses risk factors and diagnosis of hypertension, as well as management of hypertensive crisis. Guidelines for diagnosing and treating hypertension from sources like the 2020 Philippine CPG are also summarized.
Management of hypertension in acute strokeSudhir Kumar
Hypertension is an important and common risk factor for brain stroke- both ischemia and hemorrhagic subtypes. Appropriate management of blood pressure is crucial for good recovery rom acute stroke, and prevent recurrence of stroke. This presentation looks at the role played by hypertension in causing first ever and recurrent strokes. The current guidelines are also discussed.
1) For stroke prevention, intensive blood pressure lowering is recommended, with the lower the better. The target is below 115/75 mmHg for those under 60 and below 140/90 mmHg for those over 60.
2) In patients with acute ischemic stroke, it is unnecessary to lower blood pressure in the first 7 days unless systolic blood pressure is over 220 mmHg.
3) In intracerebral hemorrhage patients, the target systolic blood pressure is below 140 mmHg. More aggressive lowering to 120 mmHg is not necessary.
Management of hypertensive condition in 2020 according to AHA/ASA guidelines. We will discuss the presentation, clinical assessment, investigations, and management of hypertension along with major randomized controlled trials and guidelines.
Creatinine clearance: When Does It Matter?PASaskatchewan
This document provides information on estimating kidney function and adjusting drug dosing in patients with chronic kidney disease (CKD). It describes the differences between creatinine clearance (CrCl), estimated glomerular filtration rate (eGFR), and their respective formulas (Cockcroft-Gault and MDRD/CKD-EPI). While both CrCl and eGFR can be used to estimate kidney function and guide drug dosing, CrCl may be preferred in the elderly and for drugs with a narrow therapeutic index. The document reviews drug classes that commonly require dosage adjustments in CKD and provides an example case of adjusting anticoagulation therapy in a patient with CKD.
What are anti-coagulants?
What are the difference between antiplatelet, anticoagulants and thrombolytics?
Coagulation cascade
Virchows Triad
Classification of anti-coagulants?
Indications of anti-coagulants?
Mechanism and site of action of different anti-coagulants?
AF 2023 ACC guidelines half atrial fibrillationRajeshPonnada3
This document summarizes guidelines for atrial fibrillation (AF) from 2023. It finds that the incidence and prevalence of AF are increasing due to an aging population and rising obesity rates. Having AF increases the risk of mortality, stroke, dementia, heart failure, myocardial infarction, chronic kidney disease, peripheral artery disease, and sudden cardiac death. Risk factor modification through treating conditions like obesity, diabetes, and hypertension can help prevent AF. Anticoagulation medication is recommended for AF patients based on their risk of stroke as assessed by tools like CHA2DS2-VASc score. Doacs have been shown to be as effective as warfarin for stroke prevention with lower risks of bleeding.
This document provides a summary of a presentation on statins. It discusses the benefits of statins in reducing cardiovascular events and mortality in both primary and secondary prevention. It addresses several controversies around statins, including their association with diabetes, cognitive impairment, cancer, and hemorrhagic stroke. While some modest risks are noted, the overall benefits of statins in reducing cardiovascular risk are found to outweigh these potential risks. The document emphasizes the importance of statin adherence to achieve optimal outcomes and addresses targets for LDL and non-HDL cholesterol levels according to recent guidelines.
Updated Hypertension Management – ESH 2023.pdfDr. Nayan Ray
Hypertension is the most prevalent CV disorder in the world and according to the WHO, it affects 1.28 billion adults aged 30–79 years worldwide, two-thirds living in low-income and middle-income countries.
In 2019, the global age-standardized average prevalence of hypertension in adults aged 30–79 years was reported to be 34% in men and 32% in women.
At younger ages (<50 years), hypertension is more prevalent in men, whereas a steeper increase of SBP in women from their third decade (and more so following menopause) makes the prevalence of hypertension greater in women in older age categories (>65 years).
Rule of Halves
Half the people with high blood pressure are not known (“rule 1”),
Half of those known are not treated (“rule 2”) and
Half of those treated are not controlled (“rule 3”)'
Definition:
Hypertension is defined based on repeated office SBP values ≥ 140 mmHg and/or DBP ≥ 90 mmHg.
Hypertension is common in diabetics, affecting 20-60% of those with diabetes. It is the leading cause of morbidity and mortality worldwide. While only 25% of hypertensive patients have adequate blood pressure control, tight control of both blood pressure and glucose levels can significantly reduce cardiovascular and mortality risks for diabetics. Hypertension and diabetes frequently occur together due to their shared risk factors and pathophysiology, with each condition increasing the risks associated with the other. Proper management of both is important for preventing diabetes and hypertension-related complications.
#flozins
🫀DAPA 🆚placebo in HFpEF
Now we have a positive trial!
⬇️18% in CV☠️ death or
worsening HF among LVEF>40%
⬇️ 21%heart failure
💥Results same for LVEF> 60% 🆚LVEF<60%
Sacubitril is a neprilysin inhibitor that is used in combination with valsartan for the treatment of heart failure. The combination drug sacubitril/valsartan inhibits neprilysin and blocks the angiotensin receptor. It was shown in the PARADIGM-HF trial to reduce cardiovascular death and heart failure hospitalizations compared to enalapril. Current guidelines recommend sacubitril/valsartan as a replacement for ACE inhibitors or ARBs in patients with HFrEF who are already on such therapy.
This document provides an overview of the management of hypertension, including hypertensive emergencies. It discusses the prevalence and pathophysiology of hypertension, outlines treatment goals, and reviews pharmacologic treatment options. Key points include:
1) Hypertensive emergencies require rapid blood pressure control to prevent end-organ damage, while avoiding precipitous drops in pressure.
2) Intravenous antihypertensive agents discussed include labetalol, esmolol, nicardipine, sodium nitroprusside, and fenoldopam.
3) Nicardipine is highlighted as an effective option for hypertensive emergencies due to its rapid onset, titratability, and limited
This document discusses hypertension management and cardiovascular health. It begins by defining normal blood pressure and examining hypertension as a risk factor for cardiovascular disease. It then explores guidelines for diagnosing and treating hypertension from the US, Taiwan, and China. The document outlines methods for measuring blood pressure and deriving hemodynamic parameters from pulse wave analysis. Examples are given of how hemodynamic profiling can help personalize hypertension treatment. Lifestyle factors that can impact blood pressure and cardiovascular health are also discussed. The document promotes using an online health diary to track metrics and receive advice from doctors.
Contraversies in hypertension managementShyam Jadhav
Blood pressure is the force of blood against artery walls and is determined by cardiac output and peripheral resistance. It is usually measured indirectly using a sphygmomanometer. Hypertension is defined as high blood pressure and is a major risk factor for cardiovascular disease. Lifestyle modifications such as weight loss, reduced sodium intake, and increased physical activity can help lower blood pressure. While all drug classes lower blood pressure, thiazide diuretics are recommended as first-line therapy due to evidence of reduced morbidity and mortality from clinical trials. Controversies remain regarding optimal measurement techniques, treatment of prehypertension, and combination of antihypertensive drug classes.
This document outlines the components of a thorough patient history. It discusses gathering personal information, the chief complaint, present illness history, past medical history, treatment history, family history, and reviewing all body systems. For the chief complaint, it emphasizes analyzing onset, course, duration, location, character, aggravating/relieving factors, and associated symptoms. For the present illness and past histories, it provides examples of thoroughly exploring symptoms in each relevant body system. The goal is to collect a full accounting of the patient's medical background and current issues.
This document provides an overview of guidelines for the management of hypertension, including the JNC 8 guidelines. It discusses recommendations for classifying and treating hypertension according to different guidelines. It also presents several case scenarios to demonstrate how the guidelines would apply to different patient presentations and compares approaches between guidelines. The document aims to help understand, analyze, and apply clinical practice guidelines for hypertension.
This document discusses ambulatory blood pressure monitoring (ABPM). It describes how ABPM is used to diagnose conditions like white coat hypertension and nocturnal hypertension. ABPM provides important information about blood pressure over 24 hours that can help guide treatment, especially in elderly patients and those with treatment-resistant hypertension. The document outlines how to perform ABPM, interpret the results, and use ABPM to monitor patients and adjust antihypertensive treatment.
The document summarizes guidelines from JNC 8 (2014) on the management of hypertension. It provides 3 key recommendations from JNC 8:
1) Treatment should begin for general population aged ≥60 years with SBP ≥150 mmHg or DBP ≥90 mmHg, and for those <60 years with SBP ≥140 mmHg or DBP ≥90 mmHg.
2) The treatment goal for non-diabetic, non-CKD patients is SBP <150 mmHg and DBP <90 mmHg. Lower goals may apply if no adverse effects.
3) Initial treatment should include ACE inhibitors, angiotensin receptor blockers, calcium channel blockers or thiaz
This document discusses hypertension, also known as high blood pressure. It notes that hypertension is very common, affecting over 1 billion people worldwide and causing millions of deaths annually. While prevalence varies globally, rates as high as 30% of the adult population have been observed in some areas. The document outlines lifestyle modifications that can help prevent and control hypertension, such as maintaining a healthy weight, following a healthy diet low in salt and saturated fat, engaging in regular physical activity, and reducing stress. Prevention and control of hypertension is emphasized as the most cost-effective approach.
This document provides an overview of hypertension (HTN) presented by Dr. Alim Al Razy. It defines HTN and describes the different types. Primary or essential HTN has unknown causes but is associated with genetic and lifestyle factors. Secondary HTN has identifiable causes like alcohol, obesity, or kidney disease. Management of HTN involves lifestyle modifications and medication choices depending on comorbidities. Antihypertensive drug classes discussed include diuretics, beta blockers, ACE inhibitors, calcium channel blockers, and more. Complications of uncontrolled HTN are also reviewed.
This document discusses ambulatory blood pressure monitoring (ABPM) and whether it should be routine. It provides an overview of ABPM, including how it is measured, interpreted, and its prognostic value. ABPM can detect masked hypertension, identify non-dippers, and guide therapy. It should be considered for suspected white coat hypertension, resistant hypertension, and hypotensive symptoms on medications. While not recommended for routine screening, ABPM provides useful clinical information in certain situations.
This document summarizes current management of hypertension. It begins by stating the high worldwide prevalence of hypertension and its attributable risk for death. It then discusses definitions and classifications of hypertension according to guidelines. Target blood pressure goals for optimal management are outlined, along with evaluating for target organ damage. The importance of lifestyle modifications and pharmacological therapy to reduce cardiovascular events is emphasized.
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.
Este documento describe los antagonistas del calcio, incluyendo sus tipos, mecanismos de acción, indicaciones y efectos secundarios. Los antagonistas del calcio inhiben el flujo de calcio a través de los canales de calcio de la membrana celular y se usan para tratar afecciones cardiovasculares como angina y arritmias, así como espasmos y migrañas. Algunos efectos secundarios comunes incluyen palpitaciones, sofocos y estreñimiento.
Hypertension, or high blood pressure, is a global health problem that affects nearly 1 billion people worldwide. It is poorly controlled, with less than 25% of cases controlled in developed countries and less than 10% in developing countries. If left untreated, hypertension can lead to heart attacks, heart failure, strokes and kidney disease.
The goals of hypertension treatment are to reduce cardiovascular and renal morbidity and mortality by achieving blood pressure targets. Lifestyle modifications such as weight loss, following a diet low in sodium and high in fruits/vegetables, engaging in physical activity, and quitting smoking can help lower blood pressure. When lifestyle changes are not enough, antihypertensive medications including diuretics, ACE inhibitors,
Este documento resume las propiedades y usos de diferentes tipos de calcio antagonistas. Explica que inhiben el flujo de calcio extracelular a través de los canales de calcio tipo L, causando vasodilatación. Compara los antagonistas de calcio dihidropiridínicos y no dihidropiridínicos, y describe las propiedades y usos de medicamentos como diltiazem, verapamilo, nifedipino y amlodipino. Resalta los beneficios cardiovasculares demostrados de los antagonistas de calcio dihidropirid
BLOQUEANTES DE LOS CANALES DE CALCIO O CALCIOANTAGONISTASjcastilloperez
Los bloqueadores de los canales de calcio se utilizan para tratar la angina de pecho, la hipertensión y las arritmias cardíacas, al bloquear la entrada de iones de calcio en las células musculares cardiacas y vasculares, lo que reduce la contractilidad cardíaca y la presión arterial. Algunos también tienen propiedades antiarrítmicas. Los efectos adversos más comunes incluyen cefalea, edema y estreñimiento.
Hypertension, or high blood pressure, affects over 1 billion people worldwide and 65 million Americans. It increases the risk of heart attack, stroke, heart disease, and kidney disease. The document defines hypertension as a systolic blood pressure of 140 mmHg or higher or a diastolic blood pressure of 90 mmHg or higher. Risk factors include age, family history, obesity, smoking, excessive alcohol, stress, and a diet high in salt. Preventing hypertension involves maintaining a healthy weight, exercising regularly, reducing salt intake, moderating alcohol, and regular blood pressure screenings.
Hypertension, or high blood pressure, has been documented as far back as 2600 BC. It was not until the early 18th century that methods for measuring blood pressure were developed. Blood pressure is determined by cardiac output and systemic vascular resistance. Sustained elevated blood pressure is defined as hypertension. Primary hypertension has no identifiable cause, while secondary hypertension is caused by an underlying condition. Lifestyle modifications and medication are used to treat hypertension and reduce complications like heart disease, stroke, and kidney damage. Accurate measurement and long-term management require a collaborative approach between patients and healthcare providers.
Ambulatory blood pressure monitoring (ABPM) provides a more accurate assessment of a patient's blood pressure over time compared to office readings alone. For patients with chronic kidney disease (CKD), ABPM is especially important as it can identify issues like white coat hypertension, masked hypertension, nocturnal hypertension, and lack of dipping which are risk factors for further kidney function decline and cardiovascular disease. The report from ABPM monitors blood pressure readings taken every 20-30 minutes over 24 hours to establish average blood pressure levels during daytime and nighttime periods and determine if dips in blood pressure at night are occurring.
The document discusses pharmacological treatment for hypertension. It recommends using thiazide-type diuretics as first-line treatment for most hypertensives, in combination with other drug classes where multiple drugs are required. Clinical trial data indicates that lowering blood pressure with antihypertensive drugs effectively reduces cardiovascular outcomes. Outcome benefits have been seen particularly with regimens based on ACE inhibitors, ARBs, CCBs, and diuretics like chlorthalidone. RAS agents have also been shown to be beneficial in patients with conditions like CAD, diabetes, or CKD. Tight blood pressure control through pharmacological treatment is fundamental for preventing cardiovascular disease.
CARDIAC COMPLICATIONS & ITS MANAGEMENT OF CKDMohd Tariq Ali
Uremic cardiomyopathy is the primary manifestation of cardiac complications in patients with chronic kidney disease. It results from the combined effects of pressure and volume overload on the heart from conditions like hypertension as well as the uremic state itself. This leads to left ventricular hypertrophy initially as an adaptive response but later maladaptive changes like cardiomyocyte death, fibrosis, and dilated cardiomyopathy if left unmanaged. Early initiation of hemodialysis, preferably non-conventional daily or nocturnal dialysis, can help halt progression of uremic cardiomyopathy while kidney transplantation has been shown to reverse it.
hypertension anesthesia, general management. antihypertensive pharmacologyAbayneh Belihun
This document outlines a presentation on hypertension given at Aksum University in February 2016. It discusses the significance of hypertension for anesthetists, including how familiarity with antihypertensive drugs is important. It also notes that hypertension commonly occurs during anesthesia and its recognition depends on correctly functioning monitors. The document provides definitions of hypertension and outlines its classification, as well as general management approaches including non-pharmacological and pharmacological treatment. It discusses various drug classes used to treat hypertension and their mechanisms of action.
Masked hypertension is defined as having elevated blood pressure based on ambulatory or home monitoring, despite normal clinic or office readings. It is common in patients with chronic kidney disease, diabetes, and cardiovascular risk factors. Ambulatory blood pressure monitoring is recommended to accurately diagnose masked hypertension, as treatment based solely on office readings may miss elevated out-of-office pressures. Masked hypertension is associated with increased target organ damage and cardiovascular risk.
This document discusses drugs used to treat heart failure. It defines heart failure and provides global statistics on prevalence. The goals of pharmacotherapy are to relieve symptoms, improve cardiac function, prevent disease progression and prolong survival. Drugs discussed include ACE inhibitors, ARBs, beta-blockers, aldosterone antagonists, ARNIs, diuretics, digoxin, ivabradine, and omega-3 fatty acids. Recommendations are provided on use of these drugs for heart failure with reduced ejection fraction based on guidelines. The document also briefly discusses treatment of heart failure with preserved ejection fraction.
Guideline directed medical therapy for “Chronic Heart Failure“Arindam Pande
Medica Lab is NABL accredited for guideline directed medical therapy for chronic heart failure. Dr. Arindam Pande discusses recent guidelines for the treatment of chronic heart failure, including recommendations for pharmacological therapies such as ACE inhibitors, beta-blockers, MRAs, and the new drug sacubitril-valsartan. Clinical trials are underway to evaluate the SGLT2 inhibitor empagliflozin for reducing heart failure hospitalizations and cardiovascular death.
This document discusses chronic kidney disease (CKD), including its pathophysiology, risk factors, and treatment strategies to slow progression. It notes that CKD progression involves both hemodynamic and non-hemodynamic mechanisms, such as activation of the renin-angiotensin-aldosterone system leading to inflammation and fibrosis. Blocking the RAAS through ACE inhibitors, ARBs, and blood pressure control has been shown to slow CKD progression by reducing proteinuria, glomerular hypertension, and inflammation. The document reviews several landmark clinical trials that established the renoprotective effects of RAAS inhibition in diabetic and non-diabetic kidney diseases.
Untreated high blood pressure can lead to serious health complications. The 2017 guidelines from the American College of Cardiology and American Heart Association recommend evaluating and diagnosing hypertension based on multiple blood pressure readings on separate occasions. Once diagnosed, lifestyle changes and medication are recommended for management. First-line drug options include thiazide diuretics, calcium channel blockers, ACE inhibitors, and ARBs. The guidelines aim to help prevent disability and death from hypertension-related conditions like heart disease and stroke.
Resistant hypertension is defined as blood pressure that remains above goal despite concurrent use of three antihypertensive agents of different classes, one of which should be a diuretic. It has a prevalence of 0.5-24.7% depending on the population. Causes include nonadherence, lifestyle factors like obesity and sleep apnea, secondary causes like primary aldosteronism and renal artery stenosis, and drug interactions. Evaluation involves assessing medication adherence, lifestyle behaviors, screening for secondary causes with tests like the aldosterone-renin ratio, and imaging of the kidneys and arteries. Management consists of optimizing lifestyle modifications, adjusting medications like adding mineralocorticoid receptor antagonists, and treating any identified
The document discusses fractional flow reserve (FFR), a technique used in coronary catheterization to measure pressure differences across a coronary artery stenosis to determine if it impedes blood flow. FFR is measured using intracoronary pressure wires during maximal hyperemia induced by intravenous adenosine. While FFR allows real-time assessment of lesion severity, it does not provide information on plaque morphology and requires an invasive procedure.
Approach to the severe hypertension (3)AnjaniJha10
This document discusses the management of severe hypertension. It defines severe hypertension as blood pressure above 180/110 mmHg that can cause acute organ damage, termed a hypertensive emergency. The main points are:
1. Severe hypertension requires immediate treatment to prevent progressive organ injury, while less severe high blood pressure without organ damage can be managed in an outpatient setting.
2. Intravenous drugs like nicardipine and labetalol are used to lower blood pressure by no more than 25% in the first hour and to 160/100 mmHg in the next 2-6 hours to avoid hypotension.
3. Oral antihypertensives should be started 6-12 hours after intravenous
Hypertensive crisis in pregnancy by dr alka mukherjee dr apurva mukherjee nag...alka mukherjee
Hypertension affects 10% of pregnancies, many with underlying chronic hypertension, and approximately 1–2% will undergo a hypertensive crisis at some point during their lives. Hypertensive crisis includes hypertensive urgency and emergency; the American College of Obstetricians and Gynecologists describes a hypertensive emergency in pregnancy as persistent (lasting 15 min or more), acute-onset, severe hypertension, defined as systolic BP greater than 160 mmHg or diastolic BP >110 mmHg in the setting of pre-eclampsia or eclampsia. Pregnancy may be complicated by hypertensive crisis, with lower blood pressure threshold for end-organ damage than non-pregnant patients. Maternal assessment should include a thorough history. Fetal assessment should include heart rate tracing, ultrasound for growth and amniotic assessment, and Doppler evaluation if growth restriction is suspected. Initial management of hypertensive emergency (systolic BP >160 mmHg or diastolic BP >110 mmHg in the setting of pre-eclampsia or eclampsia) generally includes the rapid reduction of blood pressure through the use of intravenous antihypertensive medications, with goal systolic blood pressure between 140 mmHg and 150 mmHg and diastolic pressure between 90 mmHg and 100 mmHg. First-line intravenous drugs include labetalol and hydralazine, but other agents may be used, including esmolol, nicardipine, nifedipine, and, as a last resort, sodium nitroprusside. Among patients with hypertensive urgency, slower blood pressure reduction can be provided with oral agents. The objective of this article is to review the current understanding, diagnosis, and management of hypertensive crisis during pregnancy and the postpartum period.
The document discusses a clinical trial that evaluated the use of nesiritide in patients with acute decompensated heart failure. The trial found that nesiritide reduced pulmonary capillary wedge pressure and improved dyspnea within 3 hours compared to placebo. However, later studies raised concerns about nesiritide potentially worsening renal function and increasing mortality. While initially approved by the FDA in 2001 based on its vasodilatory effects shown in trials, the risks of nesiritide remain controversial.
This document summarizes management of renal artery stenosis and discusses various treatment options. It outlines moderators and departments from Govt Royapettah Hospital and Kilpauk Medical College in Chennai. It then discusses goals of treatment, the role of revascularization, protocols for medical vs interventional management, and results from studies on angioplasty, stenting, and surgery. Complications and patient selection criteria for different procedures are also outlined.
Renal function is greatly important in risk stratification, pharmacologic therapy, and the prognosis of patients with heart failure (HF).
The deterioration of heart function can result in the worsening renal function (WRF) and vice versa.
Besides the heart function itself, the Pharmacologic Treatment of HF is closely related to renal function as regards initiation, titration, and discontinuation, making the situation more complex.
Acs0621 Renovascular Hypertension And Stenosismedbookonline
This document discusses the diagnosis and management of renovascular disease. It begins by outlining the approach to suspected renovascular disease, including initial screening with duplex ultrasonography. If duplex ultrasonography is positive for renal artery stenosis, further imaging such as CTA or MRA is recommended to confirm before considering treatment such as angioplasty and stenting. The document then discusses the incidence and risk factors for renovascular disease, as well as investigative screening studies and various imaging modalities used in diagnosis such as contrast arteriography, CTA, MRA and duplex ultrasonography.
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,
The document discusses hypertension, including its definition, classification, epidemiology, etiology, pathophysiology, and treatment. Some key points:
- Hypertension is defined as persistent elevation of blood pressure above 140/90 mmHg. It becomes more prevalent with age.
- Risk factors for hypertension include genetics, obesity, sodium intake, activation of the renin-angiotensin-aldosterone system, and sympathetic overactivity.
- Treatment involves lifestyle modifications like weight loss, diet changes, and exercise, as well as pharmacological therapy including diuretics, ACE inhibitors, calcium channel blockers, and others. Combination therapy is often used for more severe cases.
Empagliflozin in Heart Failure with a Preserved Ejection FractionFadolMohamed2
The document summarizes a clinical trial that compared the effectiveness of three drug combinations for treating hypertension in black patients in sub-Saharan Africa: amlodipine plus hydrochlorothiazide, amlodipine plus perindopril, and hydrochlorothiazide plus perindopril. The trial found that both amlodipine plus hydrochlorothiazide and amlodipine plus perindopril were more effective at reducing blood pressure than hydrochlorothiazide plus perindopril, as measured by changes in 24-hour ambulatory blood pressure and rates of controlled office blood pressure. The results provide support for guidelines recommending calcium channel blockers like amlodipine in combination with di
Similar to Hypertension- Management in special situation (20)
Cebu city in the Philippines was visited in February 2013. The document appears to be a travel log or diary from a trip to Cebu city in the Philippines in February 2013, as it lists the location and date but does not provide any other details about the trip.
The document describes a visit to Cebu City in the Philippines in February 2013. It mentions Cebu City and the email address drtoufiq19711@yahoo.com, but does not provide any other details about the visit or activities.
This document provides information about an echo evaluation for undergraduates and postgraduate fellows conducted by Dr. Md. Toufiqur Rahman, an associate professor of cardiology. It lists Dr. Rahman's academic credentials and positions at various hospitals and healthcare centers. It concludes by thanking all participants and providing Dr. Rahman's email for contact.
This document provides information about an ECG evaluation for undergraduates and post graduates fellows led by Dr. Md. Toufiqur Rahman, an associate professor of cardiology. It lists Dr. Rahman's academic qualifications and positions at various institutions including the National Institute of Cardiovascular Diseases. It concludes by thanking participants and providing Dr. Rahman's email for contact.
This document provides information about an echo evaluation training session for undergraduates and post graduates led by Dr. Md. Toufiqur Rahman. It lists his academic credentials and positions at various institutions including as an Associate Professor of Cardiology at the National Institute of Cardiovascular Diseases. The document concludes by thanking all participants and providing Dr. Rahman's email for contact.
Dr. Md. Toufiqur Rahman is an associate professor of cardiology at the National Institute of Cardiovascular Diseases in Dhaka, Bangladesh. He holds numerous medical certifications and acts as a consultant at several hospitals and clinics in Dhaka, including Medinova, Apollo Hospital, and STS Life Care Centre. His contact email is provided.
Cardio-cerebral resuscitation is a new approach for treating patients experiencing primary cardiac arrest that emphasizes minimizing interruptions to chest compressions, passive ventilation, and early epinephrine administration. It has been shown to significantly increase survival rates compared to traditional CPR, which focused more on ventilations and allowed for interruptions in chest compressions. Cardiac arrest is a major public health problem, and solutions require accurately measuring the effectiveness of local resuscitation systems of care through data collection.
The document outlines parameters for reporting on the left ventricle based on echocardiography findings. It describes assessing and reporting on cavity size, wall thickness, ventricular mass, shape, systolic and diastolic function, thrombus, mass, and ventricular septal defects. Measurement of ejection fraction and fractional shortening are outlined for evaluating systolic function, and diastolic filling patterns are described for assessing diastolic function. The document provides detailed guidelines for documenting the presence, size, location and characteristics of any abnormalities found.
This document provides guidelines for reporting echocardiography exams. It recommends that reports contain three sections: 1) Demographic and identifying information about the patient and exam, 2) A detailed echocardiographic and Doppler evaluation of cardiac structures and measurements, and 3) A summary. The demographic section should include patient name, age, gender, indications for the test, and physician information. The evaluation section describes assessing structures like the ventricles, valves, and vessels and providing quantitative measurements when possible. Measurements of structures like ventricular size and function, valvular stenosis or regurgitation, and cardiac shunts are recommended.
This document discusses techniques for coronary angiography including cannulating coronary arteries and grafts, angiographic views, and interpreting angiograms. Key points include different techniques for cannulating the left and right coronary arteries as well as grafts like saphenous veins and internal mammary arteries. Common angiographic views are described for visualizing different coronary segments. The document also covers quantitatively and visually assessing coronary narrowings and diagnosing coronary spasm.
This document discusses procedures for achieving hemostasis after vascular access procedures. It describes applying gentle pressure to the puncture site when removing catheters and sheaths. Firm pressure should then be applied for 15-30 minutes to achieve manual hemostasis. Adhesive bandages can then be used to cover the wound. Vascular closure devices can also help achieve hemostasis more quickly and allow for earlier ambulation. Protamine may be given to reverse heparin effects before sheath removal if needed. Precautions are discussed for patients receiving insulin. Radial access hemostasis involves using a pressurized bracelet over the puncture site.
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This particular slides consist of- what is hypotension,what are it's causes and it's effect on body, risk factors, symptoms,complications, diagnosis and role of physiotherapy in it.
This slide is very helpful for physiotherapy students and also for other medical and healthcare students.
Here is the summary of hypotension:
Hypotension, or low blood pressure, is when the pressure of blood circulating in the body is lower than normal or expected. It's only a problem if it negatively impacts the body and causes symptoms. Normal blood pressure is usually between 90/60 mmHg and 120/80 mmHg, but pressures below 90/60 are generally considered hypotensive.
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1. Hypertension –Management in
special situation
Dr. Md.Toufiqur Rahman
MBBS, FCPS, MD, FACC, FESC, FRCPE, FSCAI,
FAPSC, FAPSIC, FAHA, FCCP, FRCPG
Associate Professor of Cardiology
National Institute of Cardiovascular Diseases,
Sher-e-Bangla Nagar, Dhaka-1207
Consultant, Medinova, Malibagh branch
Honorary Consultant, Apollo Hospitals, Dhaka and
STS Life Care Centre, Dhanmondi
drtoufiq19711@yahoo.com
22. Summary
"Hypertensive urgency" is the situation in which a patient's DBP is >120 mm Hg. If there is acute or rapidly
worsening target-
organ damage, then the term used is "hypertensive emergency." Hypertensive urgency can be
managed as an outpatient, but hypertensive emergency requires admission to a unit with cardiovascular
monitoring facilities, for parenteral antihypertensive therapy.
There are many causes of secondary hypertension, including primary aldosteronism and RAS. Primary
aldosteronism may be caused by an aldosteroneproducing adenoma of the adrenal gland, or by bilateral adrenal
hyperplasia. There is suppressed PRA, increased urinary potassium loss, often but not always with
hypokalemia,and hypertension. Screening for primary aldosteronism is appropriate in patients with hypertension
andspontaneous hypokalemia, or in any patient with treatment-
resistant hypertension. The screening test of choice isthe morning PAC to PRA ratio, which if >20 (with a PAC
of ≥12 ng/dl) is suggestive of primary
hyperaldosteronism,and if >70 with a PAC of ≥15 ng/dl and a PRA of ≤1 ng/ml/h is virtually diagnostic.
Highresolution CT of the adrenal glands completes the workup.
.
drtoufiq19711@yahoo.com
23. Summary
RAS may result in hypertension and/or ischemic nephropathy. Most cases are
due to atherosclerosis, but about10% are due to fibromuscular dysplasia,
which affects younger persons, particularly women.
The most powerful predictors of the presence of RAS are:
age,
atherosclerotic cardiovascular disease elsewhere,
the presence of an
abdominal bruit,
recent onset of hypertension or recent loss of BP control,
unilateral small kidney,
a largeincrease in serum creatinine after an ACE inhibitor or ARB,
hypercholesterolemia,
cigarette smoking, and
absence of a family history of hypertension
drtoufiq19711@yahoo.com
24. Summary
A workup for atherosclerotic RAS should be done only if there is resistant hypertension or if there is
worseningrenal function, and if there is no contraindication to an invasive procedure (renal angi
oplasty or revascularizationsurgery), and if the patient is willing to accept revascularization. Oth
erwise, only medical management is advised.
Measurement of peripheral venous PRA at rest or following stimulation with ACE inhibitors lacks the
sensitivityand specificity to be useful in screening for RAS.
Useful tests for RAS include radioisotope scanning with ACEinhibition (captopril scintigraphy), Doppl
er ultrasound, MRA, CTA, and renal arteriography.
In atherosclerotic renovascular hypertension, BP control may be achieved in >90% of cases with
medical therapyalone, usually with a combination of antihypertensive drugs, but more invasive man
agement is indicated if thehypertension is refractory to medical therapy with multiple antihyper
tensive agents at maximum dose, or if there isprogressive deterioration of renal function.
By contrast, in fibromuscular hyperplasia, renal artery angioplasty isthe treatment of choice.
OSA is characterized by repetitive interruption of ventilation for 10 seconds or more during sleep ca
used bycollapse of the pharyngeal airway, and with associated respiratory effort. Persons with
hypertension and theclinical features/predisposing factors for OSA, particularly loud snoring,
daytime sleepiness, or witnessedapneas, should undergo formal overnight sleep testing ("polys
omnography") to make the diagnosis.
Therapy is behavioral, medical, and surgical.
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