1. Hypertension in Family Practice Dr T McD Kluyts MB ChB, MPraxMed, DTO

2. AUGUST 2003T McD Kluyts2 PRE TEST 1. What is the range of diastolic pressure in “ moderate hypertension? ”

3. AUGUST 2003T McD Kluyts3 Choose a range 90 – 99 100 – 109 105 – 114 90 – 104 100 – 114 (100 – 109)

4. AUGUST 2003T McD Kluyts4 2.Which of the following drugs are not recognised EDL drugs for hypertension in PHC? a.Hydrochlorothiazide 25 b.Propranolol 40mg c.Perindopril 4mg d.Spironolactone 25mg e.Reserpine 5mg B, D, E

5. AUGUST 2003T McD Kluyts5 3.Which of the following conditions in a Hypertensive patient would indicate referral to a higher level of care? a.Diastolic pressure >114mmHg b.Depression c.Macroscopic haematuria d.Poliuria e.Visual accuity disturbance

6. AUGUST 2003T McD Kluyts6 Wat is die rol van ABP monitor in die diagnose en hantering van hipertensie? APB speel tans nie ‘n rol in die diagnose van hipertensie nie en diagnostiese kriteria is nie hiervoor vasgelê nie. APB is primêr ‘n navorsingsinstrument en word aangewend om die graad van bloeddruk kontrole wat deur medikasie gehandhaaf word, aan te dui. Dit mag nuttig gebruik word om psigososiale invloede op bloeddruk aan te toon.

7. FOLLOW UP TREATMENT FOR HYPERTENSION IN CLINICAL PRACTICE How to plan your consultation

8. AUGUST 2003T McD Kluyts8 FREQUENCY The frequency of follow up will be dictated by several factors: Clinical Psychosocial Demographic

9. AUGUST 2003T McD Kluyts9 CLINICAL FACTORS Severity of the disease Complications Disease related Concomitant conditions Duration of treatment Degree of control

10. AUGUST 2003T McD Kluyts10 PSYCHOSOCIAL Dependency of patient Age Compliability

11. AUGUST 2003T McD Kluyts11 DEMOGRAPHIC Transport Geographical location Communication facilities available

12. AUGUST 2003T McD Kluyts12 PRESENTING PROBLEM HELP SEEKING BEHAVIOUR ASSOCIATED CONDITIONS HEALTH EDUCATION STOTT’S MODEL

13. AUGUST 2003T McD Kluyts13 MAIN PROBLEM HYPERTENSION CONTROLLED UNCONTROLLED FLUCTUATING CRITICAL

14. AUGUST 2003T McD Kluyts14 HELPSEEKING BEHAVIOUR IS THIS CONSULTATION SCHEDULED? IF NOT, WHAT IS THE REASON? IF YES, IS THERE ANY ADDITIONAL ISSUES?

15. AUGUST 2003T McD Kluyts15 ASSOCIATED CONDITIONS CARDIOVASCULAR ANGINA CHRONIC ULCERATIONS COLD EXTREMITIES RENAL PROTEINURIA HEMATURIA UREMIA POLI / OLIGURIA

16. AUGUST 2003T McD Kluyts16 ASSOCIATED CONDITIONS VISUAL Accuity Peripheral vision Fundoscopy PERIPHERAL CIRCULATION Cappillary filling Aortic bruits Peripheral pulses Oedema

17. AUGUST 2003T McD Kluyts17 ASSOCIATED CONDITIONS HEART Cardiomegaly Additional heart sounds Basal crepitations Altered pulse rate Angina ECG-changes

18. AUGUST 2003T McD Kluyts18 ASSOCIATED CONDITIONS CEREBRAL Change of Consciousness Memory loss Vertigo

19. AUGUST 2003T McD Kluyts19 ASSOCIATED CONDITIONS VITAL SIGNS RESPIRATORY RATE TEMPERATURE PULSE RATE GENERAL SYSTEMIC EXAMINATION

20. AUGUST 2003T McD Kluyts20 ASSOCIATED CONDITIONS LIFESTYLE MODIFICATION EXERCISE RECORD DIET RECORD ADDICTION ISSSUES IF ANY DRUG SIDE EFFECTS ALLERGIES

21. AUGUST 2003T McD Kluyts21 HEALTH EDUCATION Introduce a Q+A session where the patient gets the opportunity to ask any questions that has been bothering him/her. Use this to clear up any misconceptions that might be held by the patient. Review and re-affirm the treatment plan with the patient.

22. AUGUST 2003T McD Kluyts22 REFERENCES 1.Susic D, Frohlich ED. Nephroprotective effect o antihypertensive drugs in essential hypertension. Hypertension 8(3) 2000:14-27 2.Standard treatment guidelines and essential drug list. Pretoria, National Department of Health. 1998.