Beyond mountains there are mountains (Haitian Proverb)
The document discusses guidelines for diagnosing and treating hypertension from the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7). It outlines classifications for normal blood pressure and stages of hypertension based on systolic and diastolic readings. It also provides recommendations on lifestyle modifications, drug therapies, treatment goals, and monitoring for hypertensive patients.
HYPERTENSION- THE LATEST MANAGEMENT
Dr. Awadhesh kumar sharma is a young, diligent and dynamic interventional cardiologist. He did his graduation from GSVM Medical College Kanpur and MD in Internal Medicine from MLB Medical college jhansi. Then he did his superspecilisation degree DM in Cardiology from PGIMER & DR Ram Manoher Lohia Hospital Delhi. He had excellent academic record with Gold medal in MBBS,MD and first class in DM.He was also awarded chief ministers medal in 2009 for his academic excellence by former chief minister of UP Smt Mayawati in 2009.He is also receiver of GEMS international award.He had many national & international publications.He is also in editorial board of international journal- Journal of clinical medicine & research(JCMR).He is also active member of reviewer board of many journals.He is also trainee fellow of American college of cardiology. He is currently working in NABH Approved Gracian Superspeciality Hospital Mohali as Consultant Cardiologist.
Essential Hypertension By Raheef Alatassi
Definition & classifications
Prevention & detection & importance
Causes
HTN in pregnancy
Management
Goals of treatment
Classes of drugs & side effects
Specific management in e.g. IHD,DM
HTN emergency & urgency with management
Webinar on Hypertension- The Silent Killer : Hinduja HospitalHinduja Hospital
Hypertension is a condition in which the force of blood against artery walls is high enough to cause health complications.
The more blood the heart pumps and the narrower the arteries, the higher the blood pressure.
Many a times, you can have hypertension for years without any symptoms. If the blood pressure is uncontrolled, it increases the risk of serious health problems, including heart attack and stroke.
Fortunately, hypertension can be easily detected. And if diagnosed, you can work with your doctor to control it.
To know more, read on Hypertension by our Consultant Internal Medicine, Dr. Anil Ballani.
2017 ACC AHA guidelines on management of systemic hypertensionVasif Mayan
the latest 2017 ACC/AHA guidelines on systemic Hypertension
latest cutoff for systemic hypertension : 130/80 mm Hg
american college of cardiology
american heart association
2017 guidelines
HYPERTENSION- THE LATEST MANAGEMENT
Dr. Awadhesh kumar sharma is a young, diligent and dynamic interventional cardiologist. He did his graduation from GSVM Medical College Kanpur and MD in Internal Medicine from MLB Medical college jhansi. Then he did his superspecilisation degree DM in Cardiology from PGIMER & DR Ram Manoher Lohia Hospital Delhi. He had excellent academic record with Gold medal in MBBS,MD and first class in DM.He was also awarded chief ministers medal in 2009 for his academic excellence by former chief minister of UP Smt Mayawati in 2009.He is also receiver of GEMS international award.He had many national & international publications.He is also in editorial board of international journal- Journal of clinical medicine & research(JCMR).He is also active member of reviewer board of many journals.He is also trainee fellow of American college of cardiology. He is currently working in NABH Approved Gracian Superspeciality Hospital Mohali as Consultant Cardiologist.
Essential Hypertension By Raheef Alatassi
Definition & classifications
Prevention & detection & importance
Causes
HTN in pregnancy
Management
Goals of treatment
Classes of drugs & side effects
Specific management in e.g. IHD,DM
HTN emergency & urgency with management
Webinar on Hypertension- The Silent Killer : Hinduja HospitalHinduja Hospital
Hypertension is a condition in which the force of blood against artery walls is high enough to cause health complications.
The more blood the heart pumps and the narrower the arteries, the higher the blood pressure.
Many a times, you can have hypertension for years without any symptoms. If the blood pressure is uncontrolled, it increases the risk of serious health problems, including heart attack and stroke.
Fortunately, hypertension can be easily detected. And if diagnosed, you can work with your doctor to control it.
To know more, read on Hypertension by our Consultant Internal Medicine, Dr. Anil Ballani.
2017 ACC AHA guidelines on management of systemic hypertensionVasif Mayan
the latest 2017 ACC/AHA guidelines on systemic Hypertension
latest cutoff for systemic hypertension : 130/80 mm Hg
american college of cardiology
american heart association
2017 guidelines
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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!
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
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
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
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.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
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
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
4. Purpose
Why JNC 7?
Publication of many new studies.
Need for a new, clear, and concise guideline useful for
clinicians.
Need to simplify the classification of BP.
5. For persons over age 50, SBP is a more important than DBP as CVD risk
factor.
Starting at 115/75 mmHg, CVD risk doubles with each increment of
20/10 mmHg throughout the BP range.
Persons who are normotensive at age 55 have a 90% lifetime risk for
developing HTN.
Those with SBP 120–139 mmHg or DBP 80–89 mmHg should be
considered prehypertensive who require health-promoting lifestyle
modifications to prevent CVD.
New Features and Key Messages
6. New Features and Key Messages
(Continued)
Thiazide-type diuretics should be initial drug therapy for most, either
alone or combined with other drug classes.
Certain high-risk conditions are compelling indications for other drug
classes.
Most patients will require two or more antihypertensive drugs to
achieve goal BP.
If BP is >20/10 mmHg above goal, initiate therapy with two agents,
one usually should be a thiazide-type diuretic.
7. New Features and Key Messages
(Continued)
The most effective therapy prescribed by the careful clinician will control
HTN only if patients are motivated.
Motivation improves when patients have positive experiences with, and
trust in, the clinician.
Empathy builds trust and is a potent motivator.
The responsible physician’s judgment remains paramount.
9. U.S. Department of
Health and Human
Services
National Institutes
of Health
National Heart, Lung,
and Blood Institute
The Seventh Report of the
Joint National Committee on
Prevention, Detection,
Evaluation, and Treatment of
High Blood Pressure (JNC 7)
10. Blood Pressure Classification
Normal <120 and <80
Prehypertension 120–139 or 80–89
Stage 1 Hypertension 140–159 or 90–99
Stage 2 Hypertension >160 or >100
BP Classification SBP mmHg DBP mmHg
11. CVD Risk
HTN prevalence ~ 50 million people in the United States.
The BP relationship to risk of CVD is continuous, consistent, and
independent of other risk factors.
Each increment of 20/10 mmHg doubles the risk of CVD across the
entire BP range starting from 115/75 mmHg.
Prehypertension signals the need for increased education to reduce
BP in order to prevent hypertension.
12. Benefits of Lowering BP
Average Percent Reduction
Stroke incidence 35–40%
Myocardial infarction 20–25%
Heart failure 50%
13. Benefits of Lowering BP
In stage 1 HTN and additional CVD risk factors, achieving
a sustained 12 mmHg reduction in SBP over 10 years will
prevent 1 death for every 11 patients treated.
14. BP Measurement Techniques
Method Brief Description
In-office Two readings, 5 minutes apart, sitting in
chair. Confirm elevated reading in
contralateral arm.
Ambulatory BP monitoring Indicated for evaluation of “white-coat” HTN.
Absence of 10–20% BP decrease during
sleep may indicate increased CVD risk.
Self-measurement Provides information on response to therapy.
May help improve adherence to therapy and
evaluate “white-coat” HTN.
15. Office BP Measurement
Use auscultatory method with a properly calibrated and validated
instrument.
Patient should be seated quietly for 5 minutes in a chair, feet on the
floor, and arm supported at heart level.
Appropriate-sized cuff should be used to ensure accuracy.
At least two measurements should be made.
Clinicians should provide to patients, verbally and in writing, specific BP
numbers and BP goals.
16. Ambulatory BP Monitoring
ABPM is warranted for evaluation of “white-coat” HTN in the absence of
target organ injury.
Ambulatory BP values are usually lower than clinic readings.
Awake, individuals with hypertension have an average BP of >135/85
mmHg and during sleep >120/75 mmHg.
BP drops by 10 to 20% during the night; if not, signals possible
increased risk for cardiovascular events.
17. Self-Measurement of BP
Provides information on:
1. Response to antihypertensive therapy
2. Improving adherence with therapy
3. Evaluating white-coat HTN
Home measurement of >135/85 mmHg is generally considered to be
hypertensive.
Home measurement devices should be checked regularly.
19. Patient Evaluation
Evaluation of patients with documented HTN has three objectives:
1. Assess lifestyle and identify other CV risk factors or concomitant
disorders that affects prognosis and guides treatment.
2. Reveal identifiable causes of high BP.
3. Assess the presence or absence of target organ damage and CVD.
20. CVD Risk Factors
Hypertension*
Cigarette smoking
Obesity* (BMI >30 kg/m2)
Physical inactivity
Dyslipidemia*
Diabetes mellitus*
Age (older than 55 for men, 65 for women)
*Components of the metabolic syndrome.
21. Identifiable
Causes of Hypertension
Sleep apnea
Drug-induced or related causes
Chronic kidney disease
Primary aldosteronism
Renovascular disease
Chronic steroid therapy and Cushing’s syndrome
Pheochromocytoma
Coarctation of the aorta
Thyroid or parathyroid disease
23. Laboratory Tests
Routine Tests
• Electrocardiogram
• Urinalysis
• Blood glucose
• Serum potassium, creatinine, or the corresponding estimated GFR,
and calcium
• Lipid profile, after 9- to 12-hour fast, that includes high-density and
low-density lipoprotein cholesterol, and triglycerides
27. Treatment
Overview
Goals of therapy
Lifestyle modification
Pharmacologic treatment
• Algorithm for treatment of hypertension
Classification and management of BP for adults
Follow up and monitoring
29. Goals of Therapy
Reduce CVD and renal morbidity and mortality.
Treat to BP <140/90 mmHg or BP <130/80 mmHg in patients
with diabetes or chronic kidney disease.
Target of 125/75mmHg if proteinuric
Achieve SBP goal especially in persons >50 years of age.
30. Lifestyle Modification
Modification Approximate SBP reduction
(range)
Weight reduction 5–20 mmHg/10 kg weight loss
Adopt DASH eating plan 8–14 mmHg
Dietary sodium reduction 2–8 mmHg
Physical activity 4–9 mmHg
Moderation of alcohol
consumption
2–4 mmHg
31.
32.
33.
34.
35. Algorithm for Treatment of Hypertension
Not at Goal Blood Pressure (<140/90 mmHg)
(<130/80 mmHg for those with diabetes or chronic kidney disease)
Initial Drug Choices
Drug(s) for the compelling
indications
Other antihypertensive drugs
(diuretics, ACEI, ARB, BB, CCB)
as needed.
With Compelling
Indications
Lifestyle Modifications
Stage 2 Hypertension
(SBP >160 or DBP >100 mmHg)
2-drug combination for most (usually
thiazide-type diuretic and
ACEI, or ARB, or BB, or CCB)
Stage 1 Hypertension
(SBP 140–159 or DBP 90–99 mmHg)
Thiazide-type diuretics for most.
May consider ACEI, ARB, BB, CCB,
or combination.
Without Compelling
Indications
Not at Goal
Blood Pressure
Optimize dosages or add additional drugs
until goal blood pressure is achieved.
Consider consultation with hypertension specialist.
36. Classification and Management
of BP for adults
BP
classification
SBP*
mmHg
DBP*
mmHg
Lifestyle
modification
Initial drug therapy
Without compelling
indication
With compelling
indications
Normal <120 and <80 Encourage
Prehypertension 120–139 or 80–89 Yes No antihypertensive drug
indicated.
Drug(s) for compelling
indications. ‡
Stage 1
Hypertension
140–159 or 90–99 Yes Thiazide-type diuretics for
most. May consider ACEI,
ARB, BB, CCB, or
combination.
Drug(s) for the
compelling
indications.‡
Other antihypertensive
drugs (diuretics, ACEI,
ARB, BB, CCB) as
needed.
Stage 2
Hypertension
>160 or >100 Yes Two-drug combination for
most† (usually thiazide-type
diuretic and ACEI or ARB or
BB or CCB).
*Treatment determined by highest BP category.
†Initial combined therapy should be used cautiously in those at risk for orthostatic hypotension.
‡Treat patients with chronic kidney disease or diabetes to BP goal of <130/80 mmHg.
37. Followup and Monitoring
Patients should return for follow up and adjustment of medications
until the BP goal is reached.
More frequent visits for stage 2 HTN or with complicating comorbid
conditions.
Serum potassium and creatinine monitored 1–2 times per year.
38. Followup and Monitoring
(continued)
After BP at goal and stable, follow up visits at 3- to 6-month intervals.
Comorbidities, such as heart failure, associated diseases, such as
diabetes, and the need for laboratory tests influence the frequency
of visits.
39.
40. Special Considerations
Compelling Indications
Other Special Situations
• Minority populations
• Obesity and the metabolic syndrome
• Left ventricular hypertrophy
• Peripheral arterial disease
• Hypertension in older persons
• Postural hypotension
• Dementia
• Hypertension in women
• Hypertension in children and adolescents
• Hypertension urgencies and emergencies
43. Minority Populations
In general, treatment similar for all demographic groups.
Socioeconomic factors and lifestyle important barriers to BP control.
Prevalence, severity of HTN increased in African Americans.
African Americans demonstrate somewhat reduced BP responses to
monotherapy with BBs, ACEIs, or ARBs compared to diuretics or
CCBs.
These differences usually eliminated by adding adequate doses of a
diuretic.
44. Left Ventricular Hypertrophy
LVH is an independent risk factor that increases the risk of CVD.
Regression of LVH occurs with aggressive BP management: weight
loss, sodium restriction, and treatment with all classes of drugs except
the direct vasodilators hydralazine and minoxidil.
45. Peripheral Arterial Disease
(PAD)
PAD is equivalent in risk to ischemic heart disease.
Any class of drugs can be used in most PAD patients.
Other risk factors should be managed aggressively.
Aspirin should be used.
46. Hypertension in Older
Persons
More than two-thirds of people over 65 have HTN.
This population has the lowest rates of BP control.
Treatment, including those who with isolated systolic HTN, should
follow same principles outlined for general care of HTN.
Lower initial drug doses may be indicated to avoid symptoms;
standard doses and multiple drugs will be needed to reach BP targets.
47. Postural Hypotension
Decrease in standing SBP >10 mmHg, when associated with
dizziness/fainting, more frequent in older SBP patients with diabetes,
taking diuretics, venodilators, and some psychotropic drugs.
BP in these individuals should be monitored in the upright position.
Avoid volume depletion and excessively rapid dose titration of drugs.
48. Dementia
Dementia and cognitive impairment occur more commonly in people
with HTN.
Reduced progression of cognitive impairment occurs with effective
antihypertensive therapy.
49. Hypertension in Women
Oral contraceptives may increase BP, and BP should be checked
regularly. In contrast, HRT does not raise BP.
Development of HTN—consider other forms of contraception.
Pregnant women with HTN should be followed carefully. Methyldopa,
BBs, and vasodilators, preferred for the safety of the fetus. ACEI and
ARBs contraindicated in pregnancy.
50. Children and Adolescents
HTN defined as BP—95th percentile or greater, adjusted for age,
height, and gender.
Use lifestyle interventions first, then drug therapy for higher levels of
BP or if insufficient response to lifestyle modifications.
Drug choices similar in children and adults, but effective doses are
often smaller.
Uncomplicated HTN not a reason to restrict physical activity.
51. Hypertensive Urgencies
and Emergencies
Patients with marked BP elevations and acute TOD (e.g.,
encephalopathy, myocardial infarction, unstable angina, pulmonary
edema, eclampsia, stroke, head trauma, life-threatening arterial
bleeding, or aortic dissection) require hospitalization and parenteral
drug therapy.
Patients with markedly elevated BP but without acute TOD usually do
not require hospitalization, but should receive immediate combination
oral antihypertensive therapy.
52. Additional Considerations in
Antihypertensive Drug Choices
Potential favorable effects
Thiazide-type diuretics useful in slowing demineralization in
osteoporosis.
BBs useful in the treatment of atrial tachyarrhythmias/fibrillation,
migraine, thyrotoxicosis (short-term), essential tremor, or perioperative
HTN.
CCBs useful in Raynaud’s syndrome and certain arrhythmias.
Alpha-blockers useful in prostatism.
53. Additional Considerations in
Antihypertensive Drug Choices
Potential unfavorable effects
Thiazide diuretics should be used cautiously in gout or a history of
significant hyponatremia.
BBs should be generally avoided in patients with asthma, reactive
airways disease, or second- or third-degree heart block.
ACEIs and ARBs are contraindicated in pregnant women or those likely
to become pregnant.
ACEIs should not be used in individuals with a history of angioedema.
Aldosterone antagonists and potassium-sparing diuretics can cause
hyperkalemia.
55. Strategies for Improving
Adherence to Regimens
Clinician empathy increases patient trust, motivation, and adherence
to therapy.
Physicians should consider their patients’ cultural beliefs and
individual attitudes in formulating therapy.
56. Causes of
Resistant Hypertension
Improper BP measurement
Excess sodium intake
Inadequate diuretic therapy
Medication
• Inadequate doses
• Drug actions and interactions (e.g., nonsteroidal anti-inflammatory
drugs (NSAIDs), illicit drugs, sympathomimetics, oral contraceptives)
• Over-the-counter (OTC) drugs and herbal supplements
Excess alcohol intake
Identifiable causes of HTN
57.
58. Public Health Challenges
and Community Programs
Public health approaches (e.g. reducing calories, saturated fat, and salt
in processed foods and increasing community/school opportunities for
physical activity) can achieve a downward shift in the distribution of a
population’s BP, thus potentially reducing morbidity, mortality, and the
lifetime risk of an individual’s becoming hypertensive.
These public health approaches can provide an attractive opportunity to
interrupt and prevent the continuing costly cycle of managing HTN and
its complications.