First-line medications used in the treatment of hypertension include diuretics, angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs), beta-blockers, and calcium channel blockers (CCBs). Some patients will require 2 or more antihypertensive medications to achieve their BP target. As per special consideration, modified treatment is given in the presentation.
ARBs (Angiotensin receptor blockers) are the most widely used anti hypertensive throughout the world. A solid knowledge related to ARB will make our practice more patients friendly & benefit will be maximum.
hypertension is a condition arrising due to increased symphathetic tone so drugs therapies are administered for minimising disease sevearity and further complications. Drug therapy includes drugs like alpha blockers, beta blockers, ACE INHIBITORS, ARBs, vasodilators,direct renin inhibitors, reserpine,prostaglandin analogs, calcium channel blockers for minimising excessive pressure and increased contractility of the heart.
Beta Blockers in current cardiovascular practice Praveen Nagula
betablockers are the drug of choice for prevention of progression of heart failure with mortality benefit, after the evolution of neurohormonal regulation as pathogenesis of heart failure
ARBs (Angiotensin receptor blockers) are the most widely used anti hypertensive throughout the world. A solid knowledge related to ARB will make our practice more patients friendly & benefit will be maximum.
hypertension is a condition arrising due to increased symphathetic tone so drugs therapies are administered for minimising disease sevearity and further complications. Drug therapy includes drugs like alpha blockers, beta blockers, ACE INHIBITORS, ARBs, vasodilators,direct renin inhibitors, reserpine,prostaglandin analogs, calcium channel blockers for minimising excessive pressure and increased contractility of the heart.
Beta Blockers in current cardiovascular practice Praveen Nagula
betablockers are the drug of choice for prevention of progression of heart failure with mortality benefit, after the evolution of neurohormonal regulation as pathogenesis of heart failure
ACE inhibitors block the angiotensin-converting enzyme found throughout vascular tissue that converts angiotensin I to angiotensin II. Let us know how do ACE Inhibitors work?
Role of the Renin–Angiotensin–Aldosterone System Inhibition Beyond BP Reductionmagdy elmasry
Hypertension Mediated Organ Damage : How We Prevent It?The Role Of RAAS In Cardiovascular Continuum.Changes in Arterial Diameter in Patients with Arteriosclerosis or Atherosclerosis.Not All Angiotensin-Converting Enzyme Inhibitors Are Equal.Question : ACEIs vs. ARBsIs One Class Better For Cardiovascular Diseases?BP Variability .Central BP
.
Vascular Age &
Arterial Stiffness.Achieving BP Goals.
anti epileptics drugs is a part of pharmacology. the topic contain information regarding epilepsy and their drug. ppt is short and simple and have correct information
ACE inhibitors block the angiotensin-converting enzyme found throughout vascular tissue that converts angiotensin I to angiotensin II. Let us know how do ACE Inhibitors work?
Role of the Renin–Angiotensin–Aldosterone System Inhibition Beyond BP Reductionmagdy elmasry
Hypertension Mediated Organ Damage : How We Prevent It?The Role Of RAAS In Cardiovascular Continuum.Changes in Arterial Diameter in Patients with Arteriosclerosis or Atherosclerosis.Not All Angiotensin-Converting Enzyme Inhibitors Are Equal.Question : ACEIs vs. ARBsIs One Class Better For Cardiovascular Diseases?BP Variability .Central BP
.
Vascular Age &
Arterial Stiffness.Achieving BP Goals.
anti epileptics drugs is a part of pharmacology. the topic contain information regarding epilepsy and their drug. ppt is short and simple and have correct information
Antihypertensives are a class of drugs that are used to treat hypertension (high blood pressure). Antihypertensive therapy seeks to prevent the complications of high blood pressure, such as stroke and myocardial infarction.
The science of dosage or posology (from Greek posos, how much, and logos, study) is a branch of pharmacology and therapeutics concerned with ‘treatment dosage’ and ‘dosage regimen’. Establishing optimum dosage underpins every clinical development plan for novel therapeutic candidates. Failure to select the adequate drug dose is a leading culprit for regulatory delays or denial of initial applications for new drugs and, more generally, inadequate dose selection contributes to the high attrition rate of pivotal clinical trials.
Gaseous dosage forms are packed in a container which gets released upon applying pressure. The gas inside contains therapeutically active medicaments. The containers have valve systems with continuous or limited delivery. They are used for topical application on skin and as local application into nose and mouth.
Sprays
Vaporizer
Aerosols
Nebulizer or atomizer
Inhalers
Semisolid dosage forms are neither solid nor liquid, however, they are a combination or mixture of both, and they used for both local and systemic effects. Pharmaceutical semisolid dosage forms such as creams, ointments, gels, suppositories, and paste are used for topical application. Semisolid dosage forms are intended used as drug carriers that are transported topically through the skin, buckle tissue, rectal tissue, outer ear lining nasal mucosa, urethral membrane, vagina, and cornea. The semisolid may adhere adequately before washing on the surface of the application; this helps to extend the supply of drugs on the application site.
Liquid dosage forms are effective pharmaceutical products containing a mixture of active pharmaceutical ingredients (API/Drug) and non drug components (excipients). It is a dose of a drug used as a medicine for consumption or administration. Many liquid dosage forms are used in the pharmacy, but the most commonly used are syrup, suspension, and elixirs. The general category of liquid oral doses includes a broad range of dosage forms, broadly classified as monophasic and biphasic. Whereas dosage forms in both types comprise at least one drug, monophasic forms are homogeneous and completely dissolve in liquid, whereas biphasic forms in a vehicle do not dissolve.
Dosage forms come in many types, depending on the method or route of administration. Solid dosage forms, semi-solid dosage forms, liquid dosage forms, and gaseous dosage forms are used for the diagnosis or treatment of the disease by various routes. Solid dosage forms are the most significant dosage forms in pharmaceuticals; it has one or more unit dose of medicament. The solid dosage form is the most commonly used and prescribed by doctors as compared to other dosage forms. It can be administered orally in the form of tablets, capsules, powders, etc. Of these, the tablet is one of the most commonly used oral solid dosage forms.
Dosage forms (also called unit doses) are pharmaceutical drug products in the form in which they are marketed for use, with a specific mixture of active ingredients and inactive components (excipients), in a particular configuration (such as a capsule shell, for example), and apportioned into a particular dose. For example, two products may both be amoxicillin, but one is in 500 mg capsules and another is in 250 mg chewable tablets. The term unit dose can also sometimes encompass non-reusable packaging as well (especially when each drug product is individually packaged
Pharmaceutics is the area of study concerned with the formulation,
manufacturing stability and effectiveness of pharmaceutical dosage form. In
the previous unit various communicable, non-communicable disorders were
described. In this unit we will study how the drugs are administered in the body
to be effective. Drugs are rarely used alone. They are used as a part of a
formulation with other non-drug substances. These non-drug substances or
additives serve specific function. The drugs presented in the dosage form are
given in a specific quantity i.e. dose for a specific period. These dosage forms
are available in various forms as required for a specific disease condition.
Packaging of dosage form is another important aspect as the dosage form
should not degrade during storage. A good packaging is necessary to protect
the drug component from any type of deterioration till it reaches the consumer.
Many semisynthetic derivatives of belladonna
alkaloids and a large number of synthetic compounds have been introduced with the aim of
producing more selective action on certain
functions. Most of these differ only marginally
from the natural alkaloids, but some recent ones
appear promising.
Non-pharmacological interventions help reduce the daily dose of antihypertensive medication and delay the progression from prehypertension to hypertension stage. Non-pharmacological interventions include lifestyle modifications like dietary modifications, exercise, avoiding stress, and minimizing alcohol consumption.
Heart sounds are the noises generated by the beating heart and the resultant flow of blood through it. Specifically, the sounds reflect the turbulence created when the heart valves snap shut. In cardiac auscultation, an examiner may use a stethoscope to listen for these unique and distinct sounds that provide important auditory data regarding the condition of the heart.
In healthy adults, there are two normal heart sounds, often described as a lub and a dub that occur in sequence with each heartbeat. These are the first heart sound (S1) and second heart sound (S2), produced by the closing of the atrioventricular valves and semilunar valves, respectively. In addition to these normal sounds, a variety of other sounds may be present including heart murmurs, adventitious sounds, and gallop rhythms S3 and S4.
Once a drug has gained access to the bloodstream,
it gets distributed to other tissues that initially
had no drug, concentration gradient being in the
direction of plasma to tissues. T
Absorption is the movement of the drug from its site
of administration into circulation. Not only
the fraction of the administered dose that gets
absorbed but also the rate of absorption is
important. Except when given i.v., the drug has
to cross biological membranes; absorption is
governed by the above-described principles.
Pulmonary function tests (PFTs) are noninvasive tests that show how well the lungs are working. The tests measure lung volume, capacity, rates of flow, and gas exchange. This information can help your healthcare provider diagnose and decide the treatment of certain lung disorders.
Complementary and Alternative Medicine in Association with Type 2 Diabetes Me...PranatiChavan
Type 2 Diabetes Mellitus is a clinical condition that is associated with energy metabolism, particularly carbohydrate and fat management in the organism. An increase in the prevalence of diabetic population and the association of decreasing patient compliance and medication adherence leads to prefer a new concept for the management of disease complications.
The use of complementary and alternative medicine (CAM) has proved to be effective for controlling diabetes.
Objectives: The purpose of this review is to perform an overview of CAM use, to emphasize its importance for managing diabetic complications and to get outfits of CAM.
Discussion: A literature survey was done by using various articles related to CAM and Diabetes mellitus. The focus was kept on
the frequency of CAM use, the methods they use, the factors related to the use of CAM, the sources of information about CAM
treatment, and the effect of the method used for disease management.
Conclusion: This review concluded that CAM therapy found to have adept at reducing blood glucose, maintaining a healthy
body, and relieving symptoms of DM. From the study, the relevance of CAM for managing Diabetic complications was verified
And the future need to perform scientific researches on CAM use was analyzed.
Clinical research is a branch of healthcare science that determines the safety and effectiveness (efficacy) of medications, devices, diagnostic products, and treatment regimens intended for human use. These may be used for prevention, treatment, diagnosis, or for relieving symptoms of a disease. here some basic terms associated with clinical research are mentioned in the presentation, which proves helpful to understand the basic knowledge about research.
Open Education Resource: Flipping the classroom with MOODLEPranatiChavan
Open Education Resource: Flipping the classroom with MOODLE
Work done as part of AICTE approved FDP on the Use of ICT in Education for Online and Blended Learning.
Present OER is licensed under the Creative Commons Attribution-Share A like 4.0 International License. You are free to use, distribute and modify it, including for commercial purposes, provided you acknowledge the source and share-alike. To view a copy of this license, visit http://creativecommons.org/licenses/by-sa/4.0/
Most oral contraceptives contain a combination of 2 types of hormones: an estrogen and a progestin. Both of these hormones are naturally found in women’s bodies. There are many different types of estrogens and progestins, and different types of pills contain different combinations, but they all work similarly. Some pills contain only progestin, sometimes called the “mini-pill.”
The two main sex hormones — estrogen and testosterone — have wide-ranging effects in the body. Produced primarily by the ovaries (estrogen) and testes (testosterone), these hormones affect not just your sexual function but also your bones, brain, and blood vessels.
Bacterial conjunctivitis is a common type of pink eye, caused by bacteria that infect the eye through various sources of contamination. The bacteria can be spread through contact with an infected individual, exposure to contaminated surfaces or through other means such as sinus or ear infections.The most common types of bacteria that causes bacterial conjunctivitis includes Staphylococcus aureus, Haemophilus influenzae, Streptococcus pneumoniae and Pseudomonas aeruginosa. Bacterial conjunctivitis usually produces a thick eye discharge or pus and can affect one or both eyes.
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
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Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
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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!
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
- 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
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
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
2. LEFT VENTRICULAR DYSFUNCTION (SYSTOLIC
HEART FAILURE)
ACE inhibitor + diuretic therapy = first-line regimen
of choice ----reduced CV morbidity and mortality.
Diuretics ---symptomatic relief of edema by
inducing diuresis.
Loop diuretics ---patients with more advanced
disease.
Because of the high renin status of patients with
heart failure, ACE inhibitors should be initiated at
low doses to avoid orthostatic hypotension.
3. β-Blocker therapy ---modify disease in LV
dysfunction and is a component of this first-line
regimen (standard therapy) for these patients.
Titration of low to high dose as per tolerability due
to the risk of exacerbating heart failure
Bisoprolol, carvedilol, and metoprolol succinate are
the only β-blockers proven to be beneficial in LV
dysfunction
4. POSTMYOCARDIAL INFARCTION
β-Blocker (without ISA) and ACE inhibitor therapy is
recommended.
βBlockers decrease cardiac adrenergic stimulation
and reduce the risk of a subsequent MI or sudden
cardiac death.
ACE inhibitors improve cardiac function and reduce
CV events after MI.
ARBs are alternatives to ACE inhibitors in
postmyocardial patients with LV dysfunction.
5. The aldosterone antagonist eplerenone reduces CV
morbidity and mortality in patients soon after an
acute MI (within 3 to 14 days) in patients with
Hypertension symptoms of acute LV dysfunction.
Its use should be limited to selected patients, and
then with diligent monitoring of serum potassium.
6. CORONARY ARTERY DISEASE
β-Blockers (without ISA) --- first-line therapy in chronic
stable angina ---reduce BP, improve myocardial
consumption, and decrease demand.
Long-acting CCBs are either alternatives (the
nondihydropyridines verapamil and diltiazem) or add-on
therapy (dihydropyridines) to β-blockers in chronic
stable angina.
Once ischemic symptoms are controlled with β-blocker
and/or CCB therapy, other antihypertensive drugs (e.g.,
ACE inhibitor, ARB) can be added to provide additional
CV risk reduction.
7. Thiazide diuretics may be added thereafter to
provide additional BP lowering and further reduce
CV risk.
For acute coronary syndromes, first-line therapy
should consist of a βblocker and ACE inhibitor; the
combination lowers BP, controls acute ischemia,
and reduces CV risk.
8. DIABETES MELLITUS
The BP goal <130/80 mm Hg.
diabetes and hypertension treatment ---either an
ACE inhibitor or an ARB---nephroprotection and
reduced CV risk.
A thiazide-type diuretic ---second agent to lower BP
and provide additional CV risk reduction.
9. CCBs ---add-on agents for BP control in
hypertensive patients with diabetes.
β-Blockers ---reduce CV risk in patients with
diabetes ---add-on therapy with other standard
agents or to treat another compelling indication
(e.g., postmyocardial infarction).
10. masking the symptoms of hypoglycemia (tremor,
tachycardia, and palpitations but not sweating) in
tightly controlled patients, delay recovery from
hypoglycemia, and produce elevations in BP due to
vasoconstriction caused by unopposed α-receptor
stimulation during the hypoglycemic recovery
phase.
Despite these potential problems, β-blockers can
be used safely in patients with diabetes.
11. CHRONIC KIDNEY DISEASE
ACE inhibitor or ARB --- first-line therapy to control
BP and preserve kidney function in chronic kidney
disease.
Because these patients usually require multiple-
drug therapy, diuretics and a third antihypertensive
drug class (e.g., β-blocker, CCB) are often needed.
12. RECURRENT STROKE PREVENTION
The combination of an ACE inhibitor and thiazide
diuretic --- reduces the incidence of recurrent stroke
in patients with a history of ischemic stroke or
transient ischemic attacks.
Reductions in risk of recurrent ischemic stroke have
also been seen with ARB-based therapy.
13. SPECIAL POPULATIONS
OLDER PEOPLE
Elderly patients may present with either isolated
systolic hypertension or an elevation in both SBP
and DBP.
Diuretics and ACE inhibitors provide significant
benefits and can be used safely in the elderly, but
with dosage titrations
Centrally acting agents and β-blockers should
generally be avoided or used with caution because
of dizziness and postural hypotension.
14. CHILDREN AND ADOLESCENTS
Secondary hypertension --much more common---
Kidney disease (e.g., pyelonephritis,
glomerulonephritis) is the most common cause
Coarctation of the aorta can also produce
secondary hypertension. Medical or surgical
management of the underlying disorder usually
restores normal BP.
Nonpharmacologic treatment (particularly weight
loss in obese children) is the cornerstone of therapy
of primary hypertension.
15. ACE inhibitors, ARBs, β-blockers, CCBs, and
thiazide-type diuretics are all acceptable drug
therapy choices.
ACE inhibitors, ARBs, and direct renin inhibitors are
contraindicated in sexually active girls because of
potential teratogenic effect or with bilateral renal
artery stenosis or unilateral stenosis in a solitary
kidney.
16. PREGNANT WOMEN
Preeclampsia, defined as BP ≥140/90 mm Hg that
appears after 20 weeks’ gestation accompanied by
new-onset proteinuria (≥300 mg/24 hours)
Definitive treatment of preeclampsia ---delivery, and
this is indicated if pending or frank eclampsia
(preeclampsia and convulsions) is present.
Otherwise, management consists of restricting
activity, bedrest, and close monitoring.
17. Chronic hypertension is defined as elevated BP that
was noted before pregnancy began.
Methyldopa ---drug of choice
β-Blockers, labetalol, and CCBs ---reasonable
alternatives.
ACE inhibitors and ARBs are known teratogens and
are absolutely contraindicated.
The direct renin inhibitor aliskiren also should not
be used in pregnancy.
18. AFRICAN AMERICANS
Hypertension is more common and more severe in
African Americans than in those of other races.
Differences in electrolyte homeostasis, glomerular
filtration rate, sodium excretion and transport
mechanisms, plasma renin activity, and BP
response to plasma volume expansion have been
noted.
Lifestyle modifications are recommended to
augment drug therapy.
19. Thiazide diuretics ---first-line drug therapy for most
patients, but recent guidelines aggressively promote
combination therapy.
Two drugs are recommended in patients with SBP
values ≥15 mm Hg from goal.
Thiazides and CCBs are particularly effective in
African Americans.
Antihypertensive response is significantly increased
when either class is combined with a β-blocker, ACE
inhibitor, or A
20. PULMONARY DISEASE AND PERIPHERAL
ARTERIAL DISEASE
Although β-blockers (especially nonselective
agents) avoided in hypertensive patients with
asthma and chronic obstructive pulmonary disease
----cardioselective β-blockers can be used safely.
Consequently, cardioselective agents should be
used to treat a compelling indication (i.e.,
postmyocardial infarction, coronary disease, or
heart failure) in patients with reactive airway
disease.
21. PAD is a coronary artery disease risk equivalent,
and a BP goal of <130/80mmhg is recommonded.
ACE inhibitors may be ideal in patients with
symptomatic lower-extremity PAD; CCBs may also
be beneficial.
B-Blockers ---decreased peripheral blood flow
secondary to unopposed stimulation of α-receptors -
---vasoconstriction.
However, β-blockers are not contraindicated in PAD
and have not been shown to adversely affect
walking capability.
22. DYSLIPIDEMIA
Dyslipidemia is a major CV risk factor, and it should
be controlled in hypertensive patients.
Thiazide diuretics and β-blockers without ISA may
affect serum lipids adversely, but these effects
generally are transient and of no clinical
consequence.
23. The α-blockers have favorable effects (decreased
low-density lipoprotein cholesterol and increased
high-density lipoprotein cholesterol levels).
However, because they do not reduce CV risk as
effectively as thiazide diuretics, this benefit is not
clinically applicable.
ACE inhibitors and CCBs have no effect on serum
cholesterol.
24. HYPERTENSIVE URGENCIES AND
EMERGENCIES
Hypertensive urgencies are ideally managed by
adjusting maintenance therapy by adding a new
antihypertensive and/or increasing the dose of a
present medication.
✓ Acute administration of a short-acting oral drug
(captopril, clonidine, or labetalol) followed by careful
observation for several hours to ensure a gradual
BP reduction is an option.
✓ Oral captopril doses of 25 to 50 mg may be given
at 1- to 2-hour intervals. The onset of action is 15 to
30 minutes.
25. ✓ For treatment of hypertensive rebound after
withdrawal of clonidine, 0.2 mg is given initially,
followed by 0.2 mg hourly until the DBP falls below
110 mm Hg or a total of 0.7 mg has been
administered; a single dose may be sufficient.
✓ Labetalol can be given in a dose of 200 to 400
mg, followed by additional doses every 2 to 3
hours.
26. Hypertensive emergencies require immediate BP
reduction to limit new or progressing target-organ
damage.
The goal is not to lower BP to normal; instead, the
initial target is a reduction in mean arterial pressure
of up to 25% within minutes to hours.
If BP is then stable, it can be reduced toward
160/100– 110 mm Hg within the next 2 to 6 hours.
Precipitous drops in BP may cause end-organ
ischemia or infarction.
If BP reduction is well tolerated, additional gradual
decrease toward the goal BP can be attempted
after 24 to 48 hours
27. Nitroprusside is the agent of choice for minute-to-
minute control in most cases.
It is usually given as a continuous IV infusion at a
rate of 0.25 to 10 mcg/kg/min.
Its onset of hypotensive action is immediate and
disappears within 1 to 2 minutes of discontinuation.
28. When the infusion must be continued longer than
72 hours, serum thiocyanate levels should be
measured, and the infusion should be discontinued
if the level exceeds 12 mg/dL.
The risk of thiocyanate toxicity is increased in
patients with impaired kidney function.
Other adverse effects include nausea, vomiting,
muscle twitching, and sweating.
29. EVALUATION OF THERAPEUTIC
OUTCOMES
Clinic-based BP monitoring
BP response evaluation 2 to 4 weeks after initiating
or making changes in therapy.
BP monitoring can be done every 3 to 6 months,
More frequent evaluations in patients with a history
of poor control, nonadherence, progressive target-
organ damage, or symptoms of adverse drug
effects.
Self-measurements of BP or automatic ambulatory
BP monitoring
30. Patients should be monitored for signs and
symptoms of progressive target-organ disease.
history for chest pain (or pressure), palpitations,
dizziness, dyspnea, orthopnea, headache, sudden
change in vision, one-sided weakness, slurred
speech, and loss of balance to assess for the
presence of complications.
funduscopic changes on eye examination, LV
hypertrophy on ECG, proteinuria, and changes in
kidney function.
31. Monitoring for adverse drug effects should typically
occur 2 to 4 weeks after starting a new agent or
dose increases, and then every 6 to 12 months in
stable patients.
Additional monitoring may be needed for other
concomitant diseases.
Patients taking aldosterone antagonists should have
potassium concentration and kidney function
assessed within 3 days and again at 1 week after
initiation to detect potential hyperkalemia.
Patient adherence, general health perception,
energy level, physical functioning, and overall
satisfaction with treatment.