1. Internal Medicine Workshop Series Laos September /October 2009

2.  A 65 year old woman who lives in Sekong comes to the district health center because of pneumonia. You treat her pneumonia but notice that her blood pressure is 150/100 ◦ Will you treat her? ◦ What will you council her? ◦ When will you see her again?

3.  A 50 year old farmer from Sekong comes to hospital with a headache. His blood pressure is 180/110 ◦ Will you treat him? ◦ What medication will you use first? ◦ What medication will you use second? ◦ What is the target blood pressure?

4.  BP > 160/100 on first visit  BP > 140/90 on more than one visit  Any patient with hypertensive crisis

5.  <140/90  Diabetes <130/80  Chronic renal disease <130/80

6.  Aging  Male  Family history

7.  Inactive  Bad eating habits  Obesity  Smoking  Diabetes  Dyslipidemia  Stress

8.  Cerebrovascular disease (stroke, TIA)  Cardiac disease (myocardial infarction, heart failure)  Chronic renal disease  Peripheral artery disease

9.  Stop smoking  Loose weight  Decrease salt in food  Physical activity  Decrease alcohol  Manage stress

10.  Thiazide diuretic  Calcium channel blocker (long acting)  ACE inhibitor (angiotensin converting enzyme)  ARB (angiotensin receptor blocker)  Beta blocker (less than age 60)

11.  Low dose of several drugs better than high dose of 1or 2 drugs  Beta Blockers, ACE and ARB not additive  Best to combine them with a diuretic or calcium channel blocker

12.  Non compliance  Secondary Hypertension  Lifestyle

13.  2/3 patients need 2 drugs  1/3 patients need 3 drugs

14.  A 65 year old woman who lives in Sekong comes to the district health center because of pneumonia. You treat her pneumonia but notice that her blood pressure is 150/100 ◦ Will you treat her? ◦ What will you council her? ◦ When will you see her again?

15.  A 50 year old farmer from Sekong comes to hospital with a headache. His blood pressure is 180/110 ◦ Will you treat him? ◦ What medication will you use first? ◦ What medication will you use second? ◦ What is the target blood pressure?

16.  Do not use ACE and ARB in pregnancy

17.  Methyldopa  Labetolol  Nifedipine (short or long acting)  Hydralazine

18.  Labetolol  Nifedipine XL  Methyldopa  Captopril  Enalapril