The document provides guidelines for the management of preoperative hypertension including:
1. It describes how to assess perioperative cardiac risk using clinical factors and surgery type.
2. It outlines a stepwise approach to preoperative cardiac risk assessment and how comorbidities impact risk.
3. It addresses reducing cardiac risk by discussing continuation or withdrawal of common antihypertensive medications like ACE inhibitors, ARBs, calcium channel blockers, and diuretics before surgery.
This document provides an overview of hypertension including its epidemiology, pathophysiology, risk factors, signs and symptoms, classification, diagnosis, management, and lifestyle modifications. It discusses how both systolic and diastolic blood pressure increase cardiovascular risk. The presentation also reviews the revised definitions of hypertension in American and European guidelines, drug treatment recommendations including initial use of fixed-dose combinations, and potential increased cancer risk with hydrochlorothiazide.
Prevention of stroke - Dự phòng đột quỵ nãodangphucduc
This document provides guidelines for preventing stroke in patients who have had a stroke or transient ischemic attack. It discusses controlling risk factors such as hypertension, dyslipidemia, diabetes, obesity, and atrial fibrillation. It recommends treating hypertension to a target blood pressure under 140/90 mmHg. It suggests statin therapy for patients with atherosclerotic ischemic stroke or TIA. It also recommends screening post-stroke patients for diabetes and obesity. For carotid artery disease, it supports carotid endarterectomy for severe stenosis, and optimal medical therapy for mild-moderate stenosis. The document provides guidance on anticoagulation and antiplatelet therapies for atrial fibrillation and general stroke prevention respectively.
The document discusses hypertension (high blood pressure) as a major public health problem and risk factor for cardiovascular disease. Some key points:
- Hypertension affects over 50 million Americans and 1 billion people worldwide. It is the leading cause of preventable death.
- Even small reductions in blood pressure of 2-5 mmHg can significantly reduce the risk of cardiovascular events like stroke and heart disease.
- Lifestyle modifications like diet, exercise, weight control and limiting alcohol/sodium can help prevent and control hypertension. The DASH diet in particular has been shown to lower blood pressure.
- Guidelines recommend treating hypertension based on risk factors and blood pressure levels, starting with lifestyle changes and adding drug therapy as needed.
Management of hypertension problems in gpAmir Mahmoud
This document discusses the management of two patients. For the first patient, a 47-year-old man with diabetes and hypertension, the goal blood pressure is less than 140/90 mmHg. ACE inhibitors are recommended due to their benefits for patients with diabetes. For the second patient, a 56-year-old woman with uncontrolled hypertension, the doctor's approach will focus on lifestyle modifications and optimizing her medication regimen given her multiple comorbidities.
Hypertension, or high blood pressure, is one of the most common diseases worldwide. It is a major risk factor for heart disease and stroke. The document discusses the definition, classification, evaluation, causes, treatment, and prevention of hypertension. Prevention strategies recommended by WHO include reducing salt intake, maintaining a healthy weight, regular exercise, stress reduction, not smoking, and modifying lifestyle behaviors. Treatment aims to lower blood pressure below 140/90 mmHg through lifestyle changes and lifelong medication if needed.
The document discusses guidelines for the treatment of hypertension from the 2007 European Society of Hypertension. It defines blood pressure levels and cardiovascular risk categories. It outlines factors that influence prognosis like risk factors, diabetes, subclinical organ damage, and established cardiovascular or renal disease. It provides recommendations on lifestyle changes, goals of treatment, choice of antihypertensive drugs, and when to initiate treatment. The primary goal is to reduce blood pressure and lower cardiovascular risk through treatment and controlling associated risk factors.
This document discusses hypertension (high blood pressure). It defines hypertension as a systolic blood pressure over 140 mm Hg or a diastolic over 90 mm Hg. It classifies blood pressure levels and discusses the causes, risk factors, diagnosis, and management of hypertension through lifestyle modifications and pharmacological treatments. Specific populations discussed include those with diabetes, pregnancy, children, emergencies, and geriatrics. The goal is to treat hypertension to reduce risks of heart disease and stroke through safe and effective medical care.
Hypertension, or high blood pressure, is defined as a systolic blood pressure over 140 mm Hg or a diastolic blood pressure over 90 mm Hg. It can be caused by primary or secondary factors and is a major risk factor for cardiovascular disease. Treatment involves lifestyle modifications like diet, exercise, and weight loss as well as pharmacological therapies including diuretics, ACE inhibitors, calcium channel blockers, and others. Management may differ in special populations such as pregnant women, children, the elderly, and those with diabetes or kidney disease.
This document provides an overview of hypertension including its epidemiology, pathophysiology, risk factors, signs and symptoms, classification, diagnosis, management, and lifestyle modifications. It discusses how both systolic and diastolic blood pressure increase cardiovascular risk. The presentation also reviews the revised definitions of hypertension in American and European guidelines, drug treatment recommendations including initial use of fixed-dose combinations, and potential increased cancer risk with hydrochlorothiazide.
Prevention of stroke - Dự phòng đột quỵ nãodangphucduc
This document provides guidelines for preventing stroke in patients who have had a stroke or transient ischemic attack. It discusses controlling risk factors such as hypertension, dyslipidemia, diabetes, obesity, and atrial fibrillation. It recommends treating hypertension to a target blood pressure under 140/90 mmHg. It suggests statin therapy for patients with atherosclerotic ischemic stroke or TIA. It also recommends screening post-stroke patients for diabetes and obesity. For carotid artery disease, it supports carotid endarterectomy for severe stenosis, and optimal medical therapy for mild-moderate stenosis. The document provides guidance on anticoagulation and antiplatelet therapies for atrial fibrillation and general stroke prevention respectively.
The document discusses hypertension (high blood pressure) as a major public health problem and risk factor for cardiovascular disease. Some key points:
- Hypertension affects over 50 million Americans and 1 billion people worldwide. It is the leading cause of preventable death.
- Even small reductions in blood pressure of 2-5 mmHg can significantly reduce the risk of cardiovascular events like stroke and heart disease.
- Lifestyle modifications like diet, exercise, weight control and limiting alcohol/sodium can help prevent and control hypertension. The DASH diet in particular has been shown to lower blood pressure.
- Guidelines recommend treating hypertension based on risk factors and blood pressure levels, starting with lifestyle changes and adding drug therapy as needed.
Management of hypertension problems in gpAmir Mahmoud
This document discusses the management of two patients. For the first patient, a 47-year-old man with diabetes and hypertension, the goal blood pressure is less than 140/90 mmHg. ACE inhibitors are recommended due to their benefits for patients with diabetes. For the second patient, a 56-year-old woman with uncontrolled hypertension, the doctor's approach will focus on lifestyle modifications and optimizing her medication regimen given her multiple comorbidities.
Hypertension, or high blood pressure, is one of the most common diseases worldwide. It is a major risk factor for heart disease and stroke. The document discusses the definition, classification, evaluation, causes, treatment, and prevention of hypertension. Prevention strategies recommended by WHO include reducing salt intake, maintaining a healthy weight, regular exercise, stress reduction, not smoking, and modifying lifestyle behaviors. Treatment aims to lower blood pressure below 140/90 mmHg through lifestyle changes and lifelong medication if needed.
The document discusses guidelines for the treatment of hypertension from the 2007 European Society of Hypertension. It defines blood pressure levels and cardiovascular risk categories. It outlines factors that influence prognosis like risk factors, diabetes, subclinical organ damage, and established cardiovascular or renal disease. It provides recommendations on lifestyle changes, goals of treatment, choice of antihypertensive drugs, and when to initiate treatment. The primary goal is to reduce blood pressure and lower cardiovascular risk through treatment and controlling associated risk factors.
This document discusses hypertension (high blood pressure). It defines hypertension as a systolic blood pressure over 140 mm Hg or a diastolic over 90 mm Hg. It classifies blood pressure levels and discusses the causes, risk factors, diagnosis, and management of hypertension through lifestyle modifications and pharmacological treatments. Specific populations discussed include those with diabetes, pregnancy, children, emergencies, and geriatrics. The goal is to treat hypertension to reduce risks of heart disease and stroke through safe and effective medical care.
Hypertension, or high blood pressure, is defined as a systolic blood pressure over 140 mm Hg or a diastolic blood pressure over 90 mm Hg. It can be caused by primary or secondary factors and is a major risk factor for cardiovascular disease. Treatment involves lifestyle modifications like diet, exercise, and weight loss as well as pharmacological therapies including diuretics, ACE inhibitors, calcium channel blockers, and others. Management may differ in special populations such as pregnant women, children, the elderly, and those with diabetes or kidney disease.
This document discusses hypertension (high blood pressure) including its causes, effects on the heart, treatment targets, and drug treatment options. It notes that primary hypertension accounts for 90-95% of cases and outlines trial findings showing benefits of tight blood pressure control, especially in patients with diabetes. Treatment involves lifestyle changes and medications, typically starting with diuretics, with the goal of controlling blood pressure to under 140/85 mmHg.
Guidelines for the prevention of stroke in patientsNeurologyKota
This document provides guidelines for preventing stroke in patients who have had a stroke or transient ischemic attack (TIA). It discusses risk factors like hypertension, diabetes, dyslipidemia, lifestyle factors, and recommends treatments and lifestyle changes to reduce risk. For hypertension, it recommends blood pressure management and provides evidence from clinical trials supporting treatment. It also recommends statin therapy and lifestyle changes to manage dyslipidemia and other risk factors.
This document discusses hypertension (high blood pressure) including its definition, causes, clinical presentation, assessment, and management. It notes that hypertension is defined as blood pressure above 140/90 mmHg and risks of cardiovascular disease double for every 20/10 mmHg rise. Common complications include stroke, myocardial infarction, heart failure, and renal failure. Treatment involves lifestyle modifications and medication, starting with ACE inhibitors, calcium channel blockers, or thiazides. The goals are to lower blood pressure and reduce cardiovascular risk based on individual patient factors.
This document discusses guidelines for classifying and managing hypertension. It defines classifications of normal, prehypertension, and stages 1 and 2 hypertension based on systolic and diastolic blood pressure levels. It outlines an algorithm for treating hypertension that begins with lifestyle modifications and progresses to adding different classes of drug therapies to reach blood pressure goals. Special considerations are discussed for various patient populations like children, women, and older adults.
This document summarizes guidelines for diagnosing and treating hypertension. It discusses:
- Preferred methods for diagnosing hypertension including ambulatory blood pressure monitoring and home monitoring.
- Lifestyle modifications that are recommended as first-line treatment options such as reducing sodium, weight loss, limiting alcohol, and regular exercise.
- Classes of antihypertensive drugs and their comparative effects, with ACE inhibitors recommended as initial drug therapy.
- Treatment guidelines for hypertension in patients with conditions like heart disease, stroke, and heart failure which emphasize controlling blood pressure and recommend ACE inhibitors in many cases.
1) Patients with diabetes have more than double the risk of major adverse cardiovascular events like myocardial infarction, stroke, and heart failure compared to those without diabetes.
2) Lifestyle changes like diet, exercise, and not smoking along with controlling blood pressure and lipids through medication are more important for reducing cardiovascular risk than glycemic control alone.
3) Cardiovascular disease risk is significantly increased in those with diabetes, with women seeing higher relative risks than men. Multiple factors contribute to diabetes being a major risk factor for cardiovascular disease.
The document discusses guidelines for the treatment of hypertension. It provides a history of changes to major hypertension guidelines over time, including changes in target blood pressure levels and recommendations for first-line treatment options. It also reviews compelling indications for specific antihypertensive drug classes based on concomitant diseases or conditions. The guidelines emphasize lifestyle modifications and use of diuretics, ACE inhibitors, angiotensin receptor blockers, or calcium channel blockers as preferred initial treatment options for most patients with hypertension.
The guidelines provide recommendations for the secondary prevention of stroke in patients with previous ischemic stroke or transient ischemic attack (TIA). Key recommendations include: aggressively treating hypertension, diabetes, dyslipidemia and other vascular risk factors; initiating antiplatelet therapy; and considering carotid endarterectomy for severe carotid stenosis. Lifestyle modifications such as smoking cessation, weight control, diet and exercise are also encouraged. The guidelines were updated from 1999 based on new clinical trial evidence.
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.
High blood pressure is a major risk factor for stroke. About 75% of acute stroke patients have high blood pressure, and tightly controlling it can help reduce the risk of poor health outcomes and further strokes. For acute stroke, blood pressure should be lowered to below 185/110 mmHg before administering clot-busting drugs or surgery. In the long term, the goal is to control blood pressure through lifestyle changes and medications such as diuretics, ACE inhibitors, or calcium channel blockers to reduce further health risks. Multiple drugs may be needed together to adequately lower blood pressure for many patients.
The document outlines guidelines for the management of arterial hypertension from the 2018 ESC/ESH conference. It discusses definitions of hypertension, recommendations for blood pressure measurement, classifications of hypertension, screening and diagnosis, assessment of hypertension-mediated organ damage, and initiation of blood pressure-lowering treatment. Key points include defining hypertension as a blood pressure over 140/90 mmHg, outlining options for office and out-of-office blood pressure measurement, stratifying cardiovascular risk, and recommending prompt initiation of treatment for grade 2 or 3 hypertension or grade 1 hypertension with high risk or organ damage.
This document provides an overview of essential hypertension including its definition, classifications, causes, detection, importance, prevention, management, goals of treatment, classes of drugs and their side effects, and specific management for patients with ischemic heart disease or diabetes. Essential hypertension is high blood pressure where secondary causes are not identified, accounts for 95% of hypertension cases, and needs to be further classified. Lifestyle modifications and pharmacologic treatments can help control blood pressure to reduce health risks.
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.
This document discusses guidelines for diagnosing and treating hypertension. It summarizes findings from the SPRINT and HOPE-3 trials regarding blood pressure targets. The SPRINT trial found that treating systolic blood pressure to under 120 mmHg reduced cardiovascular risks more than treating to under 140 mmHg. However, the HOPE-3 trial found statin therapy reduced risk more than blood pressure medication alone in intermediate-risk patients. The document provides recommendations on lifestyle changes, medication options, special patient populations, and evaluating treatment resistance and secondary causes of hypertension.
This document provides information about hypertension management through a series of questions and presentations. It begins with 3 multiple choice questions about hypertension management goals, recommended first-line drugs, and blood pressure staging. The subsequent presentations define blood pressure, discuss white coat hypertension, screening recommendations, hypertension classification, etiology, duration and incidence. It also covers hypertension evaluation, secondary causes, treatment approaches including lifestyle modifications and pharmacotherapy, special patient considerations, and resistant hypertension.
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.
1. The document discusses guidelines and strategies for the prevention, treatment, and control of hypertension.
2. It outlines 4 stages of intervention for hypertension: preventive, primary, secondary, and resistant hypertension. Treatment approaches differ depending on the stage.
3. The challenges of controlling hypertension include special patient populations, factors influencing drug choice, and issues related to resistant hypertension when blood pressure remains high despite treatment with 3 drug classes.
1) The document compares the 2017 guidelines for hypertension from Hypertension Canada and the American Heart Association/American College of Cardiology.
2) There are some differences in definitions of elevated blood pressure and hypertension thresholds. Hypertension Canada guidelines are more evidence-based while AHA/ACC guidelines are more pragmatic.
3) Both emphasize accurate blood pressure measurement and recommend similar non-pharmacological interventions like weight loss, diet changes, and increased physical activity. However, they differ on when to initiate drug therapy and targets for specific patient groups.
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
This document discusses hypertension (high blood pressure) including its causes, effects on the heart, treatment targets, and drug treatment options. It notes that primary hypertension accounts for 90-95% of cases and outlines trial findings showing benefits of tight blood pressure control, especially in patients with diabetes. Treatment involves lifestyle changes and medications, typically starting with diuretics, with the goal of controlling blood pressure to under 140/85 mmHg.
Guidelines for the prevention of stroke in patientsNeurologyKota
This document provides guidelines for preventing stroke in patients who have had a stroke or transient ischemic attack (TIA). It discusses risk factors like hypertension, diabetes, dyslipidemia, lifestyle factors, and recommends treatments and lifestyle changes to reduce risk. For hypertension, it recommends blood pressure management and provides evidence from clinical trials supporting treatment. It also recommends statin therapy and lifestyle changes to manage dyslipidemia and other risk factors.
This document discusses hypertension (high blood pressure) including its definition, causes, clinical presentation, assessment, and management. It notes that hypertension is defined as blood pressure above 140/90 mmHg and risks of cardiovascular disease double for every 20/10 mmHg rise. Common complications include stroke, myocardial infarction, heart failure, and renal failure. Treatment involves lifestyle modifications and medication, starting with ACE inhibitors, calcium channel blockers, or thiazides. The goals are to lower blood pressure and reduce cardiovascular risk based on individual patient factors.
This document discusses guidelines for classifying and managing hypertension. It defines classifications of normal, prehypertension, and stages 1 and 2 hypertension based on systolic and diastolic blood pressure levels. It outlines an algorithm for treating hypertension that begins with lifestyle modifications and progresses to adding different classes of drug therapies to reach blood pressure goals. Special considerations are discussed for various patient populations like children, women, and older adults.
This document summarizes guidelines for diagnosing and treating hypertension. It discusses:
- Preferred methods for diagnosing hypertension including ambulatory blood pressure monitoring and home monitoring.
- Lifestyle modifications that are recommended as first-line treatment options such as reducing sodium, weight loss, limiting alcohol, and regular exercise.
- Classes of antihypertensive drugs and their comparative effects, with ACE inhibitors recommended as initial drug therapy.
- Treatment guidelines for hypertension in patients with conditions like heart disease, stroke, and heart failure which emphasize controlling blood pressure and recommend ACE inhibitors in many cases.
1) Patients with diabetes have more than double the risk of major adverse cardiovascular events like myocardial infarction, stroke, and heart failure compared to those without diabetes.
2) Lifestyle changes like diet, exercise, and not smoking along with controlling blood pressure and lipids through medication are more important for reducing cardiovascular risk than glycemic control alone.
3) Cardiovascular disease risk is significantly increased in those with diabetes, with women seeing higher relative risks than men. Multiple factors contribute to diabetes being a major risk factor for cardiovascular disease.
The document discusses guidelines for the treatment of hypertension. It provides a history of changes to major hypertension guidelines over time, including changes in target blood pressure levels and recommendations for first-line treatment options. It also reviews compelling indications for specific antihypertensive drug classes based on concomitant diseases or conditions. The guidelines emphasize lifestyle modifications and use of diuretics, ACE inhibitors, angiotensin receptor blockers, or calcium channel blockers as preferred initial treatment options for most patients with hypertension.
The guidelines provide recommendations for the secondary prevention of stroke in patients with previous ischemic stroke or transient ischemic attack (TIA). Key recommendations include: aggressively treating hypertension, diabetes, dyslipidemia and other vascular risk factors; initiating antiplatelet therapy; and considering carotid endarterectomy for severe carotid stenosis. Lifestyle modifications such as smoking cessation, weight control, diet and exercise are also encouraged. The guidelines were updated from 1999 based on new clinical trial evidence.
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.
High blood pressure is a major risk factor for stroke. About 75% of acute stroke patients have high blood pressure, and tightly controlling it can help reduce the risk of poor health outcomes and further strokes. For acute stroke, blood pressure should be lowered to below 185/110 mmHg before administering clot-busting drugs or surgery. In the long term, the goal is to control blood pressure through lifestyle changes and medications such as diuretics, ACE inhibitors, or calcium channel blockers to reduce further health risks. Multiple drugs may be needed together to adequately lower blood pressure for many patients.
The document outlines guidelines for the management of arterial hypertension from the 2018 ESC/ESH conference. It discusses definitions of hypertension, recommendations for blood pressure measurement, classifications of hypertension, screening and diagnosis, assessment of hypertension-mediated organ damage, and initiation of blood pressure-lowering treatment. Key points include defining hypertension as a blood pressure over 140/90 mmHg, outlining options for office and out-of-office blood pressure measurement, stratifying cardiovascular risk, and recommending prompt initiation of treatment for grade 2 or 3 hypertension or grade 1 hypertension with high risk or organ damage.
This document provides an overview of essential hypertension including its definition, classifications, causes, detection, importance, prevention, management, goals of treatment, classes of drugs and their side effects, and specific management for patients with ischemic heart disease or diabetes. Essential hypertension is high blood pressure where secondary causes are not identified, accounts for 95% of hypertension cases, and needs to be further classified. Lifestyle modifications and pharmacologic treatments can help control blood pressure to reduce health risks.
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.
This document discusses guidelines for diagnosing and treating hypertension. It summarizes findings from the SPRINT and HOPE-3 trials regarding blood pressure targets. The SPRINT trial found that treating systolic blood pressure to under 120 mmHg reduced cardiovascular risks more than treating to under 140 mmHg. However, the HOPE-3 trial found statin therapy reduced risk more than blood pressure medication alone in intermediate-risk patients. The document provides recommendations on lifestyle changes, medication options, special patient populations, and evaluating treatment resistance and secondary causes of hypertension.
This document provides information about hypertension management through a series of questions and presentations. It begins with 3 multiple choice questions about hypertension management goals, recommended first-line drugs, and blood pressure staging. The subsequent presentations define blood pressure, discuss white coat hypertension, screening recommendations, hypertension classification, etiology, duration and incidence. It also covers hypertension evaluation, secondary causes, treatment approaches including lifestyle modifications and pharmacotherapy, special patient considerations, and resistant hypertension.
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.
1. The document discusses guidelines and strategies for the prevention, treatment, and control of hypertension.
2. It outlines 4 stages of intervention for hypertension: preventive, primary, secondary, and resistant hypertension. Treatment approaches differ depending on the stage.
3. The challenges of controlling hypertension include special patient populations, factors influencing drug choice, and issues related to resistant hypertension when blood pressure remains high despite treatment with 3 drug classes.
1) The document compares the 2017 guidelines for hypertension from Hypertension Canada and the American Heart Association/American College of Cardiology.
2) There are some differences in definitions of elevated blood pressure and hypertension thresholds. Hypertension Canada guidelines are more evidence-based while AHA/ACC guidelines are more pragmatic.
3) Both emphasize accurate blood pressure measurement and recommend similar non-pharmacological interventions like weight loss, diet changes, and increased physical activity. However, they differ on when to initiate drug therapy and targets for specific patient groups.
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
Our backs are like superheroes, holding us up and helping us move around. But sometimes, even superheroes can get hurt. That’s where slip discs come in.
Osteoporosis - Definition , Evaluation and Management .pdfJim Jacob Roy
Osteoporosis is an increasing cause of morbidity among the elderly.
In this document , a brief outline of osteoporosis is given , including the risk factors of osteoporosis fractures , the indications for testing bone mineral density and the management of osteoporosis
Does Over-Masturbation Contribute to Chronic Prostatitis.pptxwalterHu5
In some case, your chronic prostatitis may be related to over-masturbation. Generally, natural medicine Diuretic and Anti-inflammatory Pill can help mee get a cure.
5. Objectives of these Guidelines
To describe how to assess perioperative cardiac risk using
clinical risk factors and type of surgical procedure
To describe a stepwise approach for pre-operative
cardiac risk assesment
To address the impact of various co-morbidities on
perioperative risk
To describe how to reduce cardiac risk
To be easy to use for practitioners
21. ACEIs or ARBs
The lack of specific data on angiotensin-receptorblockers (ARBs),
the following recommendations apply to ACEIs and ARBs, given
their numerous common pharmacological properties.
Peri-operative use of ACEIs or ARBs carries a risk of severe
hypotension under anaesthesia, in particular following induction
and concomitant beta-blocker use. Hypotension is less frequent
when ACEIs are discontinued the day before surgery.
Although this remains debatable, ACEIs withdrawal should be
considered 24 hours before surgery when they are prescribed for
hypertension.They should be resumed after surgery as soon as
blood volume and pressure are stable.
22. ACEIs or ARBs
The risk of hypotension is at least as high with ARBs as with
ACEIs, and the response to vasopressors may be impaired.
In patients with LV systolic dysfunction, who are in a stable clinical
condition, it seems reasonable to continue treatment with ACEIs
under close monitoring during the peri-operative period.
When LV dysfunction is discovered during pre-operative
evaluation in untreated patients in a stable condition, surgery
should if possible be postponed, to allow for diagnosis of the
underlying cause and the introduction of ACEIs and beta-blockers.
23. Calcium channel blockers
The effect of calcium channel blockers on the balance between
myocardial oxygen supply and demand makes them theoretically
suitable for risk-reduction strategies. It is necessary to distinguish
between dihydropyridines, which do not act directly on heart rate,
and diltiazem or verapamil, which lower the heart rate.
There was a significant reduction in the number of episodes of
myocardial ischaemia and supraventricular tachycardia (SVT) in the
pooled analyses; however, the decrease in mortality and
myocardial infarction reached statistical significance only when both
endpoints were combined in a composite of death and/or
myocardial infarction (relative risk 0.35; 95% CI 0.08– 0.83; P ,
0.02). Subgroup analyses favoured diltiazem.
24. Calcium channel blockers
Another study in 1000 patients undergoing acute or elective aortic
aneurysm surgery showed that dihydropyridine use was
independently associated with an increased incidence of peri-
operative mortality.
The use of short-acting dihydropyridines—in particular, nifedipine
capsules—should be avoided.
Thus, although heart rate-reducing calcium channel blockers are not
indicated in patients with heart failure and systolic dysfunction, the
continuation or introduction of heart rate-reducing calcium channel
blockers may be considered in patients who do not tolerate beta-
blockers.
Additionally, calcium channel blockers should be continued during
non-cardiac surgery in patients with vasospastic angina
25. Alpha2 receptor agonists
Clonidine did not reduce the rate of death or non-fatal myocardial
infarction in general, or in patients undergoing vascular surgery
(relative risk 1.08; 95% Cl 0.93– 1.26; P ¼ 0.29).
On the other hand, clonidine increased the risk of clinically
importanthypotension (relative risk 1.32; 95% Cl 1.24– 1.40; P ,
0.001) and non-fatal cardiac arrest (relative risk 3.20; 95% Cl 1.17–
8.73; P ¼ 0.02).
Therefore, alpha receptor agonists should not be administered to
patients undergoing non-cardiac surgery.
26. Diuretics
diuretics for hypertension should be continued to the day of surgery
and resumed orally when possible.
If blood pressure reduction is required before oral therapy can be
continued, other antihypertensive agents may be considered.
In heart failure, dosage increase should be considered if symptoms or
signs of fluid retention are present.
Dosage reduction should be considered in patients with hypovolaemia,
hypotension, or electrolyte disturbances.
volume status in patients with heart failure should be monitored
carefully and optimized by loop diuretics or fluids.
the use of Kand Mg -sparing aldosterone antagonists reduces therisk
of mortality in severe heart failure.
27.
28.
29.
30. Postponing necessary surgery is usually not warranted in patients
with grade 1 or 2 hypertension, whereas in those with an SBP
>_180 mmHg and/or DBP >_110 mmHg, deferring the intervention
until BP is reduced or controlled is advisable, except for
emergency situations. What seems to be also important is to avoid
large perioperative BP fluctuations.
This approach is supported by the findings from a recent RCT that
has shown that in patients undergoing abdominal surgery, an
individualized intraoperative treatment strategy, which kept BP
values within a 10% difference from the preoperative office SBP,
resulted in reduced risk of postoperative organ dysfunction
31. recently, the question has been raised whether RAS blockers
should be discontinued before surgery to reduce the risk of
intraoperative hypotension.
Preoperative discontinuation of these drugs has also been
supported by a recent international prospective cohort study, in a
heterogenous group of patients, in which withholding ACE
inhibitors or ARBs 24 h before non-cardiac surgery was associated
with a significant reduction in CV events and mortality 30 days
after the intervention.
33. 2018 ESC/ESH Hypertension Guidelines 11
Classification of office BP and
grade
definitions of hypertension
Williams, Mancia et al., J Hypertens 2018;36:1953-2041 and Eur Heart J 2018;39:3021-3104
Category Systolic (mmHg) Diastolic (mmHg)
Optimal < 120 and < 80
Normal 120–129 and/or 80–84
High normal 130–139 and/or 85–89
Grade 1 hypertension 140–159 and/or 90–99
Grade 2 hypertension 160–179 and/or 100–109
Grade 3 hypertension ≥ 180 and/or ≥ 110
Isolated systolic hypertension ≥ 140 and < 90
34. 2018 ESC/ESH Hypertension Guidelines 12
Factors influencing CV risk in patients with hypertension - 1
Williams, Mancia et al., J Hypertens 2018;36:1953-2041 and Eur Heart J 2018;39:3021-3104
Demographic characteristics and laboratory parameters
Sex (men > women)
Age
Smoking – current or past history
Total cholesterol and HDL-C
Uric acid
Diabetes
Overweight or obesity
Family history of premature CVD (men aged < 55 years and women aged < 65 years)
Family or parental history of early onset hypertension
Early onset menopause
Sedentary lifestyle
Psychosocial and socioeconomic factors
Heart rate (resting values > 80 beats per min)
35. 2018 ESC/ESH Hypertension Guidelines 13
Factors influencing CV risk in patients with hypertension - 2
Williams, Mancia et al., J Hypertens 2018;36:1953-2041 and Eur Heart J 2018;39:3021-3104
Asymptomatic HMOD
Arterial stiffening: Pulse pressure (in older people) ≥ 60 mmHg
Carotid–femoral PWV > 10 m/s
ECG LVH
Echocardiographic LVH
Microalbuminuria or elevated albumin–creatinine ratio
Moderate CKD with eGFR 30–59 mL/min/1.73 m2 (BSA)
Ankle−brachial index < 0.9
Advanced retinopathy: haemorrhages or exudates, papilloedema
36. 2018 ESC/ESH Hypertension Guidelines 14
Factors influencing CV risk in patients with hypertension - 3
Williams, Mancia et al., J Hypertens 2018;36:1953-2041 and Eur Heart J 2018;39:3021-3104
Established CV or renal disease
Cerebrovascular disease: ischaemic stroke, cerebral haemorrhage, TIA
CAD: myocardial infarction, angina, myocardial revascularization
Presence of atheromatous plaque on imaging
Heart failure, including HFpEF
Peripheral artery disease
Atrial fibrillation
Severe CKD with eGFR < 30 mL/min/1.73 m2
37. 2018 ESC/ESH Hypertension Guidelines 15
10-year CV risk categories (SCORE system)
• A calculated 10-year SCORE of < 1%
Williams, Mancia et al., J Hypertens 2018;36:1953-2041 and Eur Heart J 2018;39:3021-3104
Very high risk
People with any of the following:
Documented CVD, either clinical or unequivocal on imaging.
• Clinical CVD includes acute myocardial infarction, acute coronary syndrome, coronary or other
arterial revascularization, stroke, TIA, aortic aneurysm and PAD.
• Unequivocal documented CVD on imaging includes significant plaque (i.e. ≥ 50% stenosis)
on angiography or ultrasound. It does not include increase in carotid intima-media thickness.
• Diabetes mellitus with target organ damage, e.g. proteinuria or a with a major risk factor
such as grade 3 hypertension or hypercholesterolaemia
• Severe CKD (eGFR < 30 mL/min/1.73 m2)
• A calculated 10-year SCORE of ≥ 10%
High risk
People with any of the following:
• Marked elevation of a single risk factor, particularly cholesterol > 8 mmol/L (> 310 mg/dL)
e.g. familial hypercholesterolaemia, grade 3 hypertension (BP ≥ 180/110 mmHg)
• Most other people with diabetes mellitus (except some young people with type 1 diabetes
mellitus and without major risk factors, that may be moderate risk)
• Hypertensive LVH
• Moderate CKD (eGFR 30–59 mL/min/1.73 m2)
• A calculated 10-year SCORE of 5–10%
Moderate risk
People with:
• A calculated 10-year SCORE of 1% to < 5%
• Grade 2 hypertension
• Many middle-aged people belong to this category
Low risk
People with:
38. 2018 ESC/ESH Hypertension Guidelines 54
Initiation of BP-lowering treatment
(lifestyle changes and medication) at different initial office BP levels
High normal BP Grade 1 hypertension Grade 2 hypertension Grade 3 hypertension
BP 130-139 / 85-89 BP 140-159 / 90-99 BP 160-179 / 100-109 BP ≥ 180/ 110
Lifestyle advice Lifestyle advice Lifestyle advice Lifestyle advice
Immediate drug
treatment in high
or very high risk
patients with CVD,
renal disease or
HMOD
Consider drug
treatment in very
high risk patients
with CVD,
especially CAD
Immediate drug
treatment in all
patients
Immediate drug
treatment in all
patients
Drug treatment in
low-moderate risk
patients without
CVD, renal disease
or HMOD
after 3-6 months of
lifestyle intervention
if BP not controlled
Aim for BP control
within 3 months
Aim for BP control
within 3 months
Williams, Mancia et al., J Hypertens 2018;36:1953-2041 and Eur Heart J 2018;39:3021-3104
40. 2018 ESC/ESH Hypertension Guidelines 70
Core drug-treatment strategy for
uncomplicated hypertension
The core algorithm is also appropriate for most patients with HMOD, cerebrovascular disease, diabetes, or PAD
Williams, Mancia et al., J Hypertens 2018;36:1953-2041 and Eur Heart J 2018;39:3021-3104
41. Drug-tr
Hypertension and CAD
Core drug-treatmen t strategy for uncomplicated hypertensio n
2018 ESC/ESH Hypertension Guidelines 75
eatment strategies
Hypertension and CKD
Hypertension and HRrEF Hypertension and AF
Williams, Mancia et al., J Hypertens 2018;36:1953-2041 and Eur Heart J 2018;39:3021-3104
42. 2018 ESC/ESH Hypertension Guidelines 76
Office BP treatment target range
treatment
Williams, Mancia et al., J Hypertens 2018;36:1953-2041 and Eur Heart J 2018;39:3021-3104
Age group
Office SBP treatment target ranges (mmHg)
Office DBP
target range
(mmHg)
Hypertension + Diabetes + CKD + CAD + Stroke/TIA
18−65 years
Target to 130
or lower if
tolerated
Not < 120
Target to 130
or lower if
tolerated
Not < 120
Target to
< 140 to 130
if tolerated
Target to 130
or lower if
tolerated
Not < 120
Target to 130
or lower if
tolerated
Not < 120
70-79
65−79 years
Target to
< 140 to 130
if tolerated
Target to
< 140 to 130
if tolerated
Target to
< 140 to 130
if tolerated
Target to
< 140 to 130
if tolerated
Target to
< 140 to 130
if tolerated
70-79
≥ 80 years
Target to
< 140 to 130
if tolerated
Target to
< 140 to 130
if tolerated
Target to
< 140 to 130
if tolerated
Target to
< 140 to 130
if tolerated
Target to
< 140 to 130
if tolerated
70-79
Office DBP
treatment target
range(mmHg)
70-79 70-79 70-79 70-79 70-79