jnc 7

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What is JNC 7 ?. Joint National Council on the Prevention, Detection , Evaluation

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jnc 7

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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 Prevention Treatment 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 Lower extremities Neurological assessment

16. Goals in Therapy Reduction of Cardiovascular & Renal Morbidity & Mortality. 2. For >50 year old, the focus is SBP control. 3.<140/90 mmHg 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

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