Internal Medicine Workshop Series Laos September /October 2009.

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Presentation transcript:

Internal Medicine Workshop Series Laos September /October 2009

 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?

 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?

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

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

 Aging  Male  Family history

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

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

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

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

 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

 Non compliance  Secondary Hypertension  Lifestyle

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

 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?

 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?

 Do not use ACE and ARB in pregnancy

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

 Labetolol  Nifedipine XL  Methyldopa  Captopril  Enalapril