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Kidney Disease :
Renovascular
Renoparenchym
Coarctation of the aorta
Pheochromocytoma
Drug-induced or related causes
Primary aldosteronism
Common Substances Associated With
Hypertension in Humans
Prescription Drugs
Cortisone and other steroids (both cortico- and mineralo-), ACTH
Estrogens (usually just oral contraceptive agents with high estrogenic activity)
Nonsteroidal anti-inflammatory drugs
Phenylpropanolamines and analogues
Cyclosporine and tacrolimus
Erythropoietin
Sibutramine
Food substances
Sodium chloride
Ethanol
Systolic Hypertension
Adjusted relative risk of CHD death according to deciles of baseline SBP and DBP
in men screened for the MRFIT. Relative risk was adjusted for age, race, serum
cholesterol, cigarettes per day, use of medication for diabetes, and income, using
a multiple Cox proportional hazards model.
Risk of Hypertension (2)
Adjusted relative risk of stroke death according to deciles of baseline SBP and DBP in
men screened for the MRFIT. Relative risk was adjusted for age, race, serum
cholesterol, cigarettes per day, use of medication for diabetes, and income, using a
multiple Cox proportional hazards model.
Risk of Hypertension (3)
Medical history
Physical examination
Laboratory tests
Medical History (1)
Duration of the hypertension
Last known normal blood pressure
Course of the blood pressure
Family history
Hypertension
Premature cardiovascular disease or death
Familial diseases : pheochromocytoma, renal disease, diabetes, gout
Concomitant diseases
Asthma bronchiale
Gouty arthritis
Diabetes Mellitus
Dietary history
Weight changes
Fresh vs processed foods
Sodium
Saturated fats
Physical Examination
Patients should be seated with back supported and arm bared and
supported.
Patient group SBP DBP SBP DBP SBP DBP SBP DBP
(mmHg) (mmHg) (mmHg) (mmHg) (mmHg) (mmHg) (mmHg) (mmHg)
Urine analysis
Full blood count
Blood sodium and potassium
Blood glucose
Plasma creatinine
Lipid profile
12-lead electrocardiogram
TREATMENT of HYPERTENSION
Pharmacologic
LIFESTYLE MODIFICATION
Alcohol moderation
Exercise
Smoking cessation
Decrease salt intake
Decrease weight
Increase fruit / vegetables intake
HYPERTENSION STAGE I
(140-159 / 90-99 mmHg)--- at least 3 different measurement
Lifestyle Modifications
Not at Goal
Blood Pressure
Lifestyle Modifications
Initial Drug Choices (one drug)
Not at Goal
Blood Pressure
Age
Demographics
Coexisting diseases and therapies
Hemodynamic profile
Complication of hypertension
Economic considerations
Classes of
Antihypertensive Drugs
ACE inhibitors
-blockers
Angiotensin II receptor blockers
Calcium antagonists
Direct vasodilators
Diuretics
Central symphatolytic
1- blockers
Guidelines for selecting drug treatment of hypertension
a
Grade 2 or 3 atrioventricular block; b Grade 2 or 3 atrioventricular block with verapamil or dil
WHO-ISH. J Hypertens 1999 ; 17 : 1
Patient Education About Treatment
Elicit concerns and questions and provide opportunities for the patient to
state specific behaviors to carry out treatment recommendations
Emphasize:
Need to continue treatment
Control does not mean cure
One cannot tell if BP is elevated by feeling or symptoms; BP must be
measured
THANK YOU