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Health with usFIRST MEDICAL CENTER1 Practical Update on Hypertension Dr. Babu Shersad, MD, MACP (USA) Specialist Internal Medicine & Nephrologist Date:

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Presentation on theme: "Health with usFIRST MEDICAL CENTER1 Practical Update on Hypertension Dr. Babu Shersad, MD, MACP (USA) Specialist Internal Medicine & Nephrologist Date:"— Presentation transcript:

1 health with usFIRST MEDICAL CENTER1 Practical Update on Hypertension Dr. Babu Shersad, MD, MACP (USA) Specialist Internal Medicine & Nephrologist Date: 5 th December 2006 Venue : Renaissance Hotel Time : 12:30 PM

2 health with usFIRST MEDICAL CENTER2 Contents: What is Hypertension? Classification of Hypertension. Detection. Evaluation. Treatment. The JNC Algorithm. Hypertension in Diabetes. Resistant Hypertension.

3 health with usFIRST MEDICAL CENTER3 What is Hypertension? Pre Hypertension: blood pressure 120/80 mmHg to 139/89 mmHg not a disease category Hypertension: blood pressure of 140/90 mmHg or above The diagnosis of hypertension should be made only after noting a mean elevation on three readings 6 hours apart

4 health with usFIRST MEDICAL CENTER4 Classification of Hypertension

5 health with usFIRST MEDICAL CENTER5 Detection of Hypertension A. Symptoms of Hypertension No symptoms Non-specific symptoms Headache Morning headache Tinnitus Dizziness Confusion Sleepiness Vision problems Angina Difficulty breathing Irregular heartbeat Blood in the urine Epistaxis Many symptoms occur from complications of hypertension

6 health with usFIRST MEDICAL CENTER6 Contd. B. Signs of Hypertension Vital Signs - Elevated blood pressure, bradycardia, bounding pulse Skin - Flushed, diaphoresis, pallor Cardio-Vascular - Distended neck veins, extremity edema, pulmonary edema Neurologic - Decreased level of consciousness, impaired movement, symmetry of face and extremities, seizures, unequal pupils

7 health with usFIRST MEDICAL CENTER7 Evaluation of Hypertension Three main objectives: 1. To asses lifestyle and other cardiovascular risk or concomitant disorders that may affect prognosis and guide treatment. 2. To reveal identifiable causes of BP 3. To asses the presence or absence of target organ damage and CVD

8 health with usFIRST MEDICAL CENTER8

9 health with usFIRST MEDICAL CENTER9 Identifiable causes of hypertension Sleep apnea Drug induced or related disease Primary aldosteronism Chronic kidney disease Reno-vascular diseases Chronic steroid therapy Cushings syndrome Pheochromocytoma Coarctation of aorta

10 health with usFIRST MEDICAL CENTER10 Physical Evaluation Appropriate BP measurement With verification in the contra-lateral arm Examination of optic fundi BMI Auscultation of carotid, abdominal and femoral bruits Examination of heart, lungs and kidneys Seek abnormal aortic pulse Examination of edema and abnormal pulses in the lower extreme ties Neurological examination

11 health with usFIRST MEDICAL CENTER11 Laboratory tests and diagnostics These are a must (Rule of 9) ECG Urine analysis Blood glucose (9 to 12 hr fasting) Hematocrit Serum potassium Serum creatinine Serum calcium Lipid profile (LDL & HDL with triglycerides) (9 to 12 hr fasting) Albumin creatinine ratio

12 health with usFIRST MEDICAL CENTER12 Treatment of hypertension 1. Non pharmacological management: Life Style changes: reducing salt intake: reduce dietary sodium intake to no more than 100 m mol per day (2.4gm sodium of 6 gm sodium chloride) reducing fat intake losing weight : maintain normal body weight (BMI kg/meter square) getting regular exercise : 30 minutes of daily aerobic exercise quitting smoking : strictly reducing alcohol consumption : not more than 2 drinks / day for men and 1 drink per day for women managing stress DASH Diet: Dietary Approaches to Stop Hypertension - low in saturated fat, cholesterol, and total fat, and that emphasizes fruits, vegetables, and low fat dairy foods, whole grain products, fish, poultry, and nuts

13 health with usFIRST MEDICAL CENTER13 2. Pharmacological management of Hypertension diuretics beta-blockers calcium channel blockers angiotensin converting enzyme inhibitors (ACE inhibitors) alpha-blockers alpha-beta blockers vasodilators peripheral acting adrenergic antagonists centrally acting agonists

14 health with usFIRST MEDICAL CENTER14 Hypertension in Diabetes Diabetes considerably increases the risk of cardiovascular disease if hypertension is also present, so the targets for blood pressure control in diabetes are tighter. For people who don't have diabetes, the treatment goals for blood pressure– 140 / 85 mmHg For people with diabetes, the goals are: if proteinuria is less than 1 gm/24 hrs. – 130 / 80 mmHg if proteinuria is greater than 1 gm/24 hrs. – 125 / 75 mmHg

15 health with usFIRST MEDICAL CENTER15

16 health with usFIRST MEDICAL CENTER16 What is resistant hypertension? Failure to reach goal BP in patients who are adhering to full doses of an appropriate three drug regimen that includes a diuretic Note: This is very common and less tried by clinicians and paramedics.

17 health with usFIRST MEDICAL CENTER17

18 health with usFIRST MEDICAL CENTER18 At the Clinicians consulting room: Doctor: I have some bad news and some very bad news. Patient: Well, might as well give me the bad news first. Doctor: The lab called with your test results. They said you have 24 hours to live. Patient: 24 HOURS! That's terrible! WHAT could be WORSE? What's the very bad news? Doctor: I've been trying to reach you since yesterday. I Hope that I conveyed the message – Dr. Babu Shersad All references from: Joint National Committees 7 th Report

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