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Medical Training

Medical Training . Pharmaco-vigilance. SPC & PIL. Medical Affairs Department. Hypertension. high blood pressure. Definition of Hypertension. Chronic elevation of blood pressure.  140/90 mmHg. “Systemic, Arterial Blood Pressure”. elastic recoil.

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Medical Training

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  1. Medical Training Pharmaco-vigilance SPC & PIL Medical Affairs Department

  2. Hypertension high blood pressure

  3. Definition of Hypertension

  4. Chronic elevation of blood pressure. •  140/90 mmHg • “Systemic, Arterial Blood Pressure”

  5. elastic recoil Blood pressure variation in the left ventricle (Blue line) & aorta(Red line) showing the cyclic variations of systolic and diastolic pressure

  6. Etiology of Hypertension

  7. Primary Hypertension • “Essential Hypertension” • Secondary Hypertension No identifiable cause • 95% • 2ry to another medical condition

  8. Secondary Hypertension Suprarenal: adenoma • Pheochromocytoma catecholamine • Cushing syndrome cortisol

  9. Suprarenal: adenoma Cushing Syndrome

  10. Secondary Hypertension Suprarenal: adenoma Cushing Syndrome

  11. Secondary Hypertension Renal: Tumors • Polycystic Kidney

  12. Secondary Hypertension Renal: Renal Artery Stenosis

  13. Secondary Hypertension Coarctation of Aorta

  14. Liquorice •  11β-hydroxysteroid dehydrogenase enzyme •  mineralocorticoid • BP & •  K+

  15. Secondary Hypertension Drugs • NSAIDs • COX2 selective • Steroids

  16. Secondary Hypertension Pregnancy • PIH • Preclampsia “EPH gestosis”

  17. Secondary Hypertension Sleeping Disturbance • Tonsil enlargement • Postnasal adenoma • DNS • Obesity.

  18. Secondary Hypertension Sleeping Disturbance • Management: • Mandibular Advancement Splint (MAS), tonsillectomy, adenoidectomy, septoplasty or weight loss.

  19. Secondary Hypertension Other Causes: Hyperthyroidism Hypothyroidism Ca

  20. Secondary Hypertension Rebound hypertension • Withdrawal of • Clonidine • BBs

  21. Diagnosis of Hypertension

  22. Korotkoff sounds • K1 • K2 • K3 • K4 • K5

  23. Symptoms & Signs • No symptoms • Symptoms of 1ry Cause (2ry hypertension) • Headache, Fatigue, Blurred Vision, Epistaxis • Nausea – Vomiting. • Retina : copper or silver wire appearance, exudates, hemorrhages or papilledema.

  24. Complications of Hypertension

  25. vasogenic edema Metabolic Syndrome nephrosclerosis

  26. Risk Factors of 1ry Hypertension

  27. Primary Hypertension no identifiable reversible cause Risk Factors • Sedentary lifestyle • Obesity • Insulin resistance • Metabolic syndrome • Aging • Alcohol • Vitamin-D deficiency

  28. Primary Hypertension no identifiable reversible cause Risk Factors • Low birth-weight • Family history • Genetic • Na+ sensitivity • Sympathetic overactivity • Renin overactivity

  29. Pathophysiology Hypertension

  30. Factors Affecting Arterial Blood Pressure

  31. Management of Hypertension

  32. Resistant Hypertension Failure to reduce blood pressure to the appropriate level after taking a 3-drug regimen including thiazide.

  33. Management of Hypertension

  34. Prevention

  35. Lifestyle Changes Lifestyle advice (non-pharmacological control) Should be offered to the patient, before initiation of any drug therapy.

  36. DASHdiet: (dietary approaches to stop hypertension) Rich in fruits & vegetables and low-fat or fat-free dairy foods. Healthy Diet Salt Restriction

  37. Exercise More Exercise Reduce Stresses Weight Reduction

  38. Hypertension Management Guidelines

  39. Lifestyle Changes “American & British Guidelines” suggest that: Lifestyle changes should be explored in all patients who are hypertensive or pre-hypertensive.

  40. Classification of Hypertension

  41. & or or or &

  42. American Guidelines BY STROKE 40% MI 25% HF 50%

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