bppcp-150309162202-conversion-gate01.pptx

Hypertension

1. Pharmaceutical care plan HYPERTENSION By: Komal Haleem Pharm -D

2. Hypertension

3. Hypertension, also known as high or raised blood pressure , is a condition in which the blood vessels have persistently raised pressure. The higher the pressure the harder the heart has to pump. When systolic blood pressure is equal to or above 140 mm Hg and/or a diastolic blood pressure equal to or above 90 mm Hg BP is considered to be raised or high . WHO

4. TYPES: 2 major types 4 less frequently found types.

5. Primary or essential hypertension: most common type no obvious or yet identifiable cause diagnosed in the majority of people in about 95% of cases

6. Secondary Hypertension CAUSES: IN MAJORITY OF CASES

7. OTHER TYPES Malignant Hypertension : most severe form Progressive rapidly leads to organ damage Isolated Systolic Hypertension: the systolic blood pressure, (the top number), is consistently above 160 mm Hg, and the diastolic below 90 mm Hg.

8. OTHER TYPES White coat hypertension : anxiety-induced hypertension BP is only high when tested by a health professional. D oesn’t need to be treated. Resistant Hypertension: If blood pressure cannot be reduced to below 140/90 mmHg, despite a triple-drug regimen

9. STAGES

10. CAUSES multifactorial High salt intake or salt sensitivity Genetic predisposition A particular abnormality of the arteries, which results in an increased resistance in arterioles

11. SIGNS AND SYMPTOMS: Often no symptoms Therefore, periodic blood pressure screenings are advised Extremely high blood pressure leads to: Severe headache Fatigue or confusion Dizziness Nausea Problems with vision Chest pains Breathing problems Irregular heartbeat Blood in the urine

12. DIAGNOSTIC TESTS

13. TOOLS FOR MEASURING B.P

14. TREATMENT

15. MANAGEMENT 3 18

16. DRUG INTERACTIONS

17. 2.Lifestyle Changes a aerobic physical activity for at least 30 minutes per day reduces systolic blood pressure by approximately 4 to 9 mmHg

18. Lifestyle Changes Weight reduction lowers systolic blood pressure by 5 to 20 mm Hg per 22 lbs (10 kg) body weight loss

19. Lifestyle Changes LESS NO SMOKING

20. CASE STUDY Name: Mr.Abdul Qayyum Chief Complaint: severe pain in left knee Diagnosis: partially torn ligament Stage 1 hypertension. exercises regularly

21. MEDICAL HISTORY Appears fit. Doesn’t have any chronic medical condition Hasn’t countered any major illnesses in the past 10 years.

22. CURRENT MEDICAL TREATMENT Not taking any drug on regular basis

23. REVIEW OF SYSTEMS Gained 2 pounds in the past 12 months Fatigues easily No headaches or visual disturbances Denies shortness of breath, chest pain or palpitations No history of nausea, vomiting, abdominal pain or change in bowel habits

24. FAMILY HISTORY Father had high blood pressure and died at age of 59 from MI Mother has type 2 DM 2 younger sisters, apparently healthy, but one is obese and her blood glucose level was mildly elevated in a recent evaluation

25. SOCIAL HISTORY   Worked as an attorney for 24 years he joined a firm 5 years ago, where he oversees criminal defense section has 2 adult children doesn’t drink pack-a-day smoker denies ever using illicit drugs

26. Treatment plan?? lifestyle modifications, order blood work .

27. LIFE SYTLE MODIFICATIONS use of DASH diet sodium restriction. Regular exercise weight loss Smoking cessation

28. LABORATORY STUDIES • Fasting plasma glucose (FPG) 150 mg/Dl Total cholesterol (TC) 220 mg/ dL Low-density lipoprotein cholesterol (LDL-C) 150 mg/ dL High-density lipoprotein cholesterol (HDL-C ) 50 mg/ dL Triglycerides (TG) 75 mg/ dL

29. ASSESSMENT: FPG exceeds the WHO threshold marking for type 2 DM So, BP goal should be <130/80 mm Hg LDL-C goal should be <100 mg/ dL .

30. Treatment plan?? Initiate antihypertensive treatment with a thiazide diuretic   Initiate cholesterol-lowering treatment with a statin   Initiate dual therapy with an ACE inhibitor and a statin Initiate treatment of all 3 conditions with metformin , an ACE inhibitor, and a statin   DECISION

31. American Diabetes Association (ADA) guidelines recommendations for patients with newly diagnosed T2DM: lifestyle modifications plus metformin JNC 7 recommends a thiazide diuretic as first-line drug therapy But the presence of T2DM suggests that an ACE inhibitor is a better choice TREATMENT GUIDELINES

32. PATIENT MONITORING AND FOLLOW-UP: 3-month follow-up Nonadherent minimally following the lifestyle modifications Because no symptoms

33. MONITORING LAB WORK: Blood pressure 147/91 mm Hg • FPG 96 mg/ dL • A1C 6.7% • TC 188 mg/Dl • LDL-C 123 mg/ dL • HDL-C 41 mg/ dL • TG 72 mg/ dL

34. • Add a diuretic to the ACE inhibitor & increase the statin dose • Add a calcium channel blocker (CCB) and increase the statin dose • Add a β-blocker • Replace the ACE inhibitor with a thiazide diuretic MODIFICATION OF TREATMENT PLAN?? Decision:

35. TREATMENT ALTERNATIVES: CCB is a good second choice,if diuretic causes side effects

36. PATIENT OUTCOMES: The patients hyperglycemia, hyperlipidemia & hypertension all three issues are well managed.