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Therapeutic Options in Hypertension. Non-pharmacologic approaches. Awareness, Treatment and Control of High Blood Pressure in Canada. 16%. 42%. 23%. 19%. Patients unaware of their high blood pressure 42% Aware but not treated and not controlled 19% Treated but not controlled 23%
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Therapeutic Options in Hypertension Non-pharmacologic approaches © Continuing Medical Implementation …...bridging the care gap
Awareness, Treatment and Control of High Blood Pressure in Canada 16% 42% 23% 19% Patients unaware of their high blood pressure 42% Aware but not treated and not controlled 19% Treated but not controlled 23% Treated and controlled 16% Adapted from: Am J Hypertens 1997; 10:1097-1102. © Continuing Medical Implementation …...bridging the care gap
Lifestyle Modification for Hypertension • Lose Weight (BMI 25) • Limit alcohol < 2 drinks/day • Increase aerobic activity • Reduce sodium intake • Maintain K, Ca, Mg • Smoking cessation • Reduce intake of fats for overall health © Continuing Medical Implementation …...bridging the care gap
Timing the Initiation of Therapy • Confirm diagnosis • Assess risk • Identify target organ damage • Retinopathy • Nephropathy • Vasculopathy-bruits or reduced ABI or pulses • S4 or LVH • Exclude secondary causes © Continuing Medical Implementation …...bridging the care gap
© Continuing Medical Implementation …...bridging the care gap
© Continuing Medical Implementation …...bridging the care gap
© Continuing Medical Implementation …...bridging the care gap
Timing the Initiation of Therapy • Initiate therapy in High Risk andVery HighRiskimmediately & f/u monthly till 2 visits at target • Initiate therapy in Medium Risk after diet/lifestyle trial ~ 3 months & f/u 1-2 monthly • Initiate therapy in Low Risk after diet/lifestyle trial ~ 6 months & f/u 3-6 monthly © Continuing Medical Implementation …...bridging the care gap
© Continuing Medical Implementation …...bridging the care gap
When you come to a fork in the road… ….take it. Yogi Berra
Choice of Anti-hypertensive Therapy • Guidelines • Efficacy • Tolerability • Safety • Specific indications • Contra-indications • Outcome • Cost © Continuing Medical Implementation …...bridging the care gap
Hypertension EvidenceThe Gold standard © Continuing Medical Implementation …...bridging the care gap