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B lood pressure control in primary health care WORKSHOP

This workshop focuses on blood pressure control in primary health care, with a case presentation and discussion on identifying problems, assessing CVD risk, designing treatment plans, and ensuring compliance. Treatment goals, pharmacological therapy, and non-pharmacological measures will be discussed.

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B lood pressure control in primary health care WORKSHOP

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  1. Blood pressure control inprimary health care WORKSHOP Jurate Klumbiene Kaunas University of Medicine, Kaunas, Lithuania

  2. Workshop agenda • Presentation of a patientcase in which the patienthas hypertension • Identification of the patient’s problems and CVD risk (individual exercise and plenary discussion) • Designing a treatment plan (group work): • Non-pharmacological measures • Treatment goals, pharmacological therapy • Measures to ensure compliance • Presentation of the plans and discussion (plenary presentation)

  3. CASE:Alexander is a 56-year-old driver who schedules a visitas part of a regular health examination. • History: • no significant past medical history, no medicineprescriptions • a regular smoker (20cig/day since 25 years old) • drinks a couple bottles of beer a night and "a bit more on the weekend” • no family history of CVD • Physical examination: • Blood pressure (BP) 146/94 (repeated BP – 144/92, 148/98) • Pulse rate 76, regular • Weight - 102 kg, height – 178 cm • Waist circumference – 110 cm • The remainder of the physical examination was unremarkable • Laboratory investigations • No abnormalities

  4. Task for each participant • Identify the patient’s problems and assess CVD risk. • Use ESH/ESC categorical stratification of cardiovascular risk.

  5. Plenary discussion • The patient’s problems and CVD risk

  6. Tasks for group work Non-pharmacological treatment Treatment goals and pharmacological therapy The measures to ensure compliance

  7. CLASSIFICATION OF BP LEVELS(European Society of Hypertension and Cardiology, 2007) CATEGORIES Systolic BP Diastolic BP Optimal BP < 120 and/or <80 Normal BP 120-129 and/or 80-84 High-normal BP 130-139 and/or 85-89 Grade1 hypertension (mild) 140-159 and/or 90-99 Grade2 hypertension (moderate) 160-179 and/or 100-109 Grade3 hypertension (severe) >180 and/or >110 Isolate systolic hypertension >140 and <90

  8. Stratification of CVD Risk (2007 Guidelines for the management of arterial hypertension, ESH and ESC) BP: blood pressure; CVD: cardiovascular; HT: hypertension. Low, moderate, high, very high risk refers to 10year risk of a CVD fatal or non-fatal event. The term “added” indicates that in all categories risk is greater than average. OD: subclinical organ damage; MS: metabolic syndrome.

  9. Presentation of the treatment plans and discussion

  10. Summary • Blood pressure control

  11. TREATMENT GOALS • To achieve a maximum reduction in the long-term total risk of cardiovascular morbidity and mortality (the treatment of all reversible risk factors identified, including smoking, dyslipidaemia or diabetes and the appropriate management of associated clinical conditions, as well as treatment of high blood pressure per se). • Blood pressure, both systolic and diastolic, should be lowered in all hypertensive patients: • At least below 140/90 mmHg. • It may prudent to recommend lowering blood pressure to values within the range 130-139/80-85 mm Hg (Reappraisal of European guidelines on hypertension management, 2009).

  12. TREATMENT STRATEGIES • Lifestyle measures (non-pharmacological treatment) should be instituted whenever appropriate in all patients, including subjects with high normal blood pressure and patients who require drug treatment. • The purpose of non-pharmacological treatment is to lower blood pressure, to control other risk factors and clinical conditions and to reduce the number and doses of antihypertensive drugs which might be subsequently used.

  13. Initiation of antihypertensive treatment (ESH/ESC, 2007)

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