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1. JNC 7 “The What, Why & How of Hypertension”
3. What are the most important functions of JNC 7 ? Increase awareness
Control of Hypertension
8. What is the proper way of taking Blood Pressure ? Instruments should be properly calibrated.
Patients should be seated quietly for at least 5 minutes. Seated on a chair with arms supported at heart level and feet planted on the floor.
Appropriate cuff size. (encircling at least 80% of area)
At least two (2) measurements should be made.
12. Identifiable Causes of Hypertension
13. Target Organ Damage
15. Physical Examination Recommended BP measurement / includes contralateral arm
Examination of optic disc
Calculation of BMI (Wt (Kg)/sq (Ht(m))
Auscultation ( carotid, abdominal & femoral bruits)
Palpation of thyroid gland
Examination of Heart & Lungs
Examination of Abdomen
16. Goals in Therapy Reduction of Cardiovascular & Renal Morbidity & Mortality.
2. For >50 year old, the focus is SBP control.
4.<130/80 mmHg for patients with hypertension, DM & renal disease.
18. Life Style Modifications
19. Pharmacologic Treatment
20. Pharmacologic Treatment
21. Clinical Trial & Guideline basis for compelling Indications for individual Drug Classes
22. Algorithm for Treatment of Hypertension
23. Algorithm for Treatment Hypertension
24. Algorithm for Treatment Hypertension
25. Algorithm for Treatment Hypertension
26. Algorithm for Treatment Hypertension
27. ACE, ARB & Kidney Disease
29. In Women & In Pregnancy OCP may increase BP but not HRT
Pregnant women should be followed more closely due to risk for both mother & fetus
ACE I & ARB should be AVOIDED during pregnancy & those who will likely to be pregnant
Methyldopa, BBs, & vasodilators are preferred for pregnancy
30. Hypertensive Emergencies & Urgencies Marked BP Elevation and ACUTE end Organ Damage e.g. encephalopathy, MI, Unstable Angina, pulmonary edema, eclampsia, stroke, head trauma, life threatening arterial bleeding or aortic dissection
NEEDS Hospitalization !!!
31. ADHERENCE TO REGIMENS Patient should be motivated
Patients attitude greatly influenced by culture, beliefs & previous experiences with the healthcare system
Failure to titrate & combine medications
Clinicians & Patients must agree with upon BP goals
Patients may not understand the condition &/or treatment
Lack of patients involvement in the care plan
Cost of medications
All members of the healthcare team must work together to reinforce instructions to improve lifestyle & BP control
32. Resistant Hypertension Failure to reach BP Goal
Adhering to full doses of appropriate 3 drug regimen that includes a diuretic
Exclusion of identifiable cause of HTN
33. Causes of Resistant Hypertension