Internal Medicine Workshop Series Laos September /October 2009

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Presentation transcript:

Internal Medicine Workshop Series Laos September /October 2009 Hypertension Internal Medicine Workshop Series Laos September /October 2009

Case number 1 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?

Case number 2 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?

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

Target Blood Pressure <140/90 Diabetes <130/80 Chronic renal disease <130/80

Cardiovascular Risk Factors Can’t change Aging Male Family history

Cardiovascular Risk Factors Can change Inactive Bad eating habits Obesity Smoking Diabetes Dyslipidemia Stress

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

Treatment: Lifestyle Stop smoking Loose weight Decrease salt in food Physical activity Decrease alcohol Manage stress

Treatment: Medications 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

If medication is not working think about… Non compliance Secondary Hypertension Lifestyle

Remember 2/3 patients need 2 drugs 1/3 patients need 3 drugs

Case number 1 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?

Case number 2 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?

Hypertension in pregnancy Do not use ACE and ARB in pregnancy

Medication we can use in pregnancy Methyldopa Labetolol Nifedipine (short or long acting) Hydralazine

Medications safe with breastfeeding Labetolol Nifedipine XL Methyldopa Captopril Enalapril