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Introduction III Benefits of Treating to Target

Introduction III Benefits of Treating to Target. Older than 60 with isolated systolic hypertension (SBP  160 mm Hg and DBP < 90 mm Hg) 36% reduction in the risk of stroke 25% reduction in the risk of coronary events. Hypertension. 1. Primary - 90% of all cases

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Introduction III Benefits of Treating to Target

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  1. Introduction IIIBenefits of Treating to Target • Older than 60 with isolated systolic hypertension (SBP  160 mm Hg and DBP < 90 mm Hg) • 36% reduction in the risk of stroke • 25% reduction in the risk of coronary events

  2. Hypertension 1. Primary - 90% of all cases - cause unknown - “essential” or “idiopathic” Benign  gradual onset with prolonged course Malignant  abrupt with short course can be fatal severely damages

  3. Hypertension 2. Secondary cause identifiable - C.V., renal, pregnancy, drugs, corticosteroids - retain Na & H2O

  4. Hypertension Isolated hypertension: If the patient has increased systolic BP with normal diastolic BP

  5. Complications • Heart - CAD -  atherosclerotic changes Angina, M.I., ( C.A. blood flow) CHF -  afterload,  O2 need Arrhythmias • Brain - stroke  microaneurysms  hemorrhage

  6. Complications • Kidneys renal failure • Eyes  visual disturbances blindness • Peripheral Vessels  intermittent claudication dissecting aortic aneurysm

  7. Mechanisms of 1° Hypertension 1. Overactive SNS stimulation - excite  with nonepinephrine -  contractions - vasoconstriction with workload &  B/P

  8. Mechanisms of 1° Hypertension 2. Na & H2O retention by kidneys - excessive secretion of renin - H2O & Na retained -  volume &  perfusion =  B/P - Most likely cause

  9. Hypertension • Causes are however numerous & interrelated - environment - psychological - physiologic

  10. Hypertension • No obvious changes at first • Changes widespread with time • Large vessels sclerosed (narrowed) • Small vessel damage

  11. Vasoconstriction   heart contractions (afterload) to maintain C.O.  chronic overwork  L.V. hypertrophy   coronary insufficiency M.I. 

  12. Con’t LVF eventually   renal perfusion  Na & H2O retention   blood flow to kidneys, heart, eyes, brain  Progressive Impairment

  13. Secondary Hypertension Causes are numerous • diabetes • glomerulonephritis • corticosteroid Rx • Drugs - BCP - Amphetamines - Estrogens - Thyroid hormones

  14. Secondary Hypertension Causes are numerous •  ICP • anemia • aortic regurgitation

  15. Secondary Hypertension Mechanisms 1.  secretion catecholamines 2.  release renin 3.  Na & blood volume Dx: B/P high over severalreadings averages >140 > 90

  16. Assessment 1. Extent of organ involvement 2. Presence of C.V. risk factors 3. ID type

  17. History • Family Hx • Diabetes • Previous  B/P • results of hypertensives • angina, dyspnea hx • use of BCP, alcohol, steroids, diet pills

  18. History con’t • Weight gain • Na intake • stress, cultural food practices • Risk factors   chol. Obesity  history of exercise

  19. Physical Exam • Retina  edema, hemorrhage • Neck  distended veins, bruit • Heart   HR, murmurs • Extremities   p.p., edema

  20. Interventions • Nonpharmacological - weight reduction - exercise -  Na - relaxation - monthly BP checks -  Ethol, coffee - smoking cessation

  21. Non Pharmacologic Recommendations for HypertensionLifestyle: Dietary Dietary Sodium For age over 44, Restricted to a target range of 90-130 mmol/day. (Limitation of salt additives and foods with excessive added salt) Hypertensive patient Fresh fruits, Vegetables, Low fat dairy products, Low fat diet, in accordance with Canada's Guide to Healthy Eating Dietary Potassium Daily dietary intake ≥ 60 mmol Calcium supplementation No conclusive studies for hypertension Magnesium supplementation No conclusive studies for hypertension Jan 18, 2001

  22. Pharmacological Diastolic > 95 1. Diuretics a) thiazides - promote excretion Na & H2O - Diuril, hydrodiuril - hypokalemia possible b) loop diuretics - loop of Henle - minimize H2O & Na reabsorption - Lasix

  23. Pharmacological Diastolic > 95 1. Diuretics c) Potassium sparing - promote H2O & Na excretion - hyperkalemia - aldactone 2. Sympatholytic Agents - interrupt activity SNS with  renin activity - catapres & aldomet

  24. Pharmacological Diastolic >95 3. Vasodilators - dilate peripheral blood vessels - Apresoline, minipres 4. Angiotension converting enzyme inhibitor - inhibit Angio 1 to Angio 2 -  afterload i.e. captopril

  25. Pharmacological Diastolic >95 5. Ca channel blockers -  C.O. &  rate - nipedine

  26. Hypertensive CrisisReduction in BP needed stat • Malignant hypertension • hypertensive encephalopathy -  LOC • heart failure • toxemia • dissecting aneurysm • intracranial hemorrhage

  27. Interventions for Crisis ICU IV Drugs Monitoring Continuous EKG

  28. Management Long-term • Assess Knowledge - disease process - consequences - administration drugs - diet - exercise - home monitoring • Compliance • Ineffective coping

  29. Drugs • Never  dose • Never miss dose • Take on time • Side effects • Never discontinue

  30. Hypotensive Alert • Lie down with legs elevated • No hot baths • No excessive alcohol

  31. Reasons for Noncompliance • Asymptomatic • Difficult lifestyle changes • Annoying side effects • Costs

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