Hypertension cme -dr.saranya

1. HYPERTENSION Dr.SARANYA VINOTH

2. INTRODUCTION Hypertension (high blood preassure )  also called  silent killer  is a chronic medical condition characterized by constant elevation of the systolic or diastolic pressure above  140/90 mmHg . Because hypertension is almost without symptoms except for headaches in some patients, it hides in the body without knowing it. The fact that hypertension is asymptomatic makes it difficult for patients to accept the diagnosis and comply with treatment.

3. In India more than over 140 million people are believed to be suffering from high blood pressure in the country and the number is expected to cross the 214 million mark in 2030. Hypertension is a major risk factor for cardio-vascular diseases. INTRODUCTION

4. OBJECTIVES At the end of this presentation you should understand Define,classify and diagnosis of hypertension Types of HT Identify risk factors &complications Treatment guidelines Complications and prevention methods

5. DEFINITION Hypertension is defined as a systolic blood pressure (SBP) of 140 mm Hg or more, or a diastolic blood pressure (DBP) of 90 mm Hg.

6. Blood pressure is the force applied against the walls of the arteries as the heart pumps blood through the body. The pressure is determined by the force and amount of blood pumped and the size and flexibility of the arteries.

7. PATHOPHYSIOLOGY

8. CAUSES &RISK FACTORS

9. TYPES Primary Hypertension-unknown etiology Secondary Hypertension-due to some other medical condition Hypertension in pregnancy Malignant Hypertension with end organ damage Paraoxysmal Hypertension

10. SIGNS AND SYMPTOMS Severe headache Nausea or vomiting Bad headache Confusion Changes in your vision Nosebleeds

11. Investigations Blood pressure evaluation Fasting Blood Sugar (FBS) – To diagnose diabetes Lipid Profile – To diagnose dyslipidaemia Renal Profile- Serum Urea, Albumin, Creatinine

12. Measurement of BP The patient must be properly prepared and positioned Caffeine,exercise and smoking should be avoided for atleast 30 minutes before. Average of atleast three readings on three different occassions should be recorded.

13. MANAGEMENT

14. MANAGEMENT LIFE STYLE MODIFICATION Regular physical activity Smoking cessation Salt restriction Alcohol cessation Weight loss

15. MANAGEMENT DIETARY PLAN DASH- D ietary A pproach to S top H ypertension

16. MEDICATIONS

17. A-B-C-D Blood Pressure Medications: A:  ACE inhibitors ( angiotensin converting enzyme)prevent the formation of the hormone angiotensin 2 which causes blood vessels to become narrow making the vessels relax, becoming wider, lowering your blood pressure. B:  Beta Blockers reduce nerve impulses to the heart and blood vessels making the heart beat slower with less force to drop your blood pressure and the heart doesn't work a hard. C:  Calcium channel blockers block calcium from entering the muscle cells of the heart and blood vessels making them relax and lowering your blood pressure. D:  Diuretics, or water pills, work in the kidney by flushing out excess water and sodium from the body.

18. Beta Blocker ATENOLOL Decreases myocardial contractility Fall in cardiac output Decreases blood pressure Additionally it reduces renin secretion Dosage- Atenolol 25-100mg once daily

19. ADVERSE EFFECTS- Bradycardia Congestive heart disease Aggravates asthma Sleep alteration CONTRAINDIATIONS:- Asthma Diabetes mellitus Heart block Hyperlipidemia Beta Blocker

20. ACE INHIBITORS Enalapril Acts by inbiting the conversion of angiotensin 1 to angiotensin 2 thus preventing the vasoconstriction Used in diabetics. Dosage Initial dose (oral): 5 mg orally once a day. Maintenance dose (oral): 10 to 40 mg orally per day in 1 to 2 divided doses.

21. Side effects- First dose hypotension Dry cough Urticaria Contraindiation Renal failure Pregnancy ACE INHIBITORS

22. CALCIUM CHANNEL BLOCKER Amlodipine Acts by relaxing the smooth muscle in the arterial wall, decreasing total peripheral resistance thereby reducing blood pressure; in angina, amlodipine increases blood flow to the heart muscle. Initial dose: 2.5 -5 mg orally once a day Maintenance dose: 5 to 10 mg orally once a day

23. Side effects- Headache Edema Fatigue Nausea Dizziness Muscle cramps Contraindications- Pregnancy Breast feeding CALCIUM CHANNEL BLOCKER

24. TREATMENT IN DIABETICS Blood Pressure            No diabetes      Diabetes                 No diabetes        Diabetes Optimal                          <140/85            <140/80                   <130/80              <130/75 Audit Standard             <150/90             <140/85                  <140/85              <140/80                            Measured in clinic               Mean daytime ABPM                                                                     or home measurement

25. FOLLOW UP Urine analysis- albumin,sugar Complete blood count Lipid profile Glucose levels Ophthalmic examination ECG

26. THANK YOU