Hypertension

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HYPERTENSION : 

HYPERTENSION

PRESENTED BY : 

PRESENTED BY Suleman Atique Gondal

Over View : 

Over View Definition Stages Statistics Classification Primary Hypertension Secondary Hypertension Symptoms Diagnosis Managment Role Of Pharmacist

Blood Pressure : 

Blood Pressure Blood pressure is a measure of the pressure or force of the blood against the walls of the blood vessels or arteries. The pressure is measured in units called mm Hg (a measurement that is short for millimeters of mercury).

Categories of Blood Pressure : 

Categories of Blood Pressure

Hypertension/High Blood Pressure : 

Hypertension/High Blood Pressure High blood pressure or hypertension is a condition in which a person's blood pressure is elevated. High blood pressure is a sign that the heart and blood vessels are being overworked.

Stages Of Hypertension : 

Stages Of Hypertension

Statistics /Prevalence Of Hypertension : 

Statistics /Prevalence Of Hypertension World: Over 972 million people in 2000 1 in 3 adults WHO Recent survey ¼ of the global population. 25 to 30 percent population in Kashmir in 2009.

Statistics /Prevalence Of Hypertension: : 

Statistics /Prevalence Of Hypertension: Mortality rate is 56.4 %. 1995 to 2005. Now increased by 25.2 % WHY? Lack of awareness 90-95 % cases. Silent killer may lead to stroke, heart attack, heart failure, kidney failure.

Classification Of Hypertension : 

Classification Of Hypertension Generally, hypertension or high blood pressure is classified according to its cause. Primary hypertension High blood pressure that has no known cause is called primary or essential hypertension. 90 to 95 percent of causes of high blood pressure are primary .

Causes Of Primary Hypertension : 

Causes Of Primary Hypertension Age Race Diet Lifestyle. Others: Obesity; stress; insufficient intake of potassium, calcium, and magnesium; etc.

Secondary Hypertension : 

Secondary Hypertension High blood pressure that is caused by another disease or conditions is known as secondary hypertension.Causes: kidney disease. Tumors . Birth control pills -- specifically those containing estrogen , Medications that constrict blood vessels.

What Causes High Blood Pressure? : 

What Causes High Blood Pressure? 90 to 95% Causes unknown = Primary Hypertension 5 to 10% = Secondary Hypertension

Controllable Risk Factors : 

Controllable Risk Factors Increased salt intake (6g per day=1 teaspoon) Obesity Alcohol Stress Lack of exercise Drug Induced Hypertension e.g NSAIDs,Steriods,

Uncontrollable Risk Factors : 

Uncontrollable Risk Factors Heredity Age Men between age 35 and 50 Women after menopause Race 1 out of every 3 African Americans Higher incidence in non-Hispanic blacks and Mexican Americans

Symptoms : 

Symptoms Usually NO SYMPTOMS! “The Silent Killer” May have: Headache Blurry vision Chest Pain Frequent urination at night

Diagnosis : 

Diagnosis Home Blood Pressure Monitoring Mercury sphygmomanometer Standard for BP monitoring No calibration May be bulky Need a second person to use machine May be difficult for hearing impaired

Measuring Blood Pressure : 

Measuring Blood Pressure Measuring the blood pressure upper arm over brachial artery Cuff applied smoothly over Brachial artery (1 inch above the antecubital area) Place bell over brachial artery. Where is the brachial artery? Inflate the rubber bladder in the Cuff to stop the flow of blood. Release pressure slowly and listen for sounds of heart valve.

Home Blood Pressure Monitoring : 

Home Blood Pressure Monitoring Aneroid equipment Inexpensive, lightweight and portable Two person operation/need stethoscope Delicate mechanism, easily damaged Needs calibration with mercury sphygmomanometer

Home Blood Pressure Monitoring : 

Home Blood Pressure Monitoring Automatic equipment Contained in one unit Portable with easy-to-read digital display Expensive, fragile Must be calibrated Requires careful cuff placement

White Coat Hypertension : 

White Coat Hypertension BP repeatedly higher in physician office or clinic setting than at home or outside office Can affect 20% of patients Encourage home BP monitoring if suspected

Management : 

Management Non Pharmacological Treatment Pharmacological Treatment

Goal Of Therapy : 

Goal Of Therapy Improve quality of life General goal is < 140/90 Goal BP is <130/85 in hypertensive diabetics Goal for pts with renal insufficiency is < 135/85; for pts with > 1 gm/day of urinary protein, goal is < 125/75

Algorithm for Treatment of Hypertension : 

Algorithm for Treatment of Hypertension Not at Goal Blood Pressure (<140/90 mmHg) (<130/80 mmHg for those with diabetes or chronic kidney disease) Initial Drug Choices Lifestyle Modifications

Non-Pharmacological Treatment : 

Non-Pharmacological Treatment Physical Activity Salt Reduction Weight reduction Dietary Approaches Smoking Alcohol Stress

Pharmacologic Treatment : 

Pharmacologic Treatment Diuretics Beta blockers ACE inhibitors Angiotensin receptor blockers Calcium channel blockers Alpha-1 blockers Centrally-acting alpha-2 agonists Direct vasodilators Peripherally Acting Adrenergic Antagonist

Pharmacologic Sites of Action : 

Pharmacologic Sites of Action Heart Arteries Veins

Is It Appropriate To Start 2 Agents? : 

Is It Appropriate To Start 2 Agents? BP reductions is almost similar for all classes. Blood pressure reduction achieved with half standard dose was only 20% lower than standard dose

Drug Combinations : 

Drug Combinations Adverse effects in all drug categories, except ACEI, were dose related. Prevalence of adverse effects in combination was less than additive Conclusion Utilization of low dose combination therapy can effectively reduce blood pressure while limiting the incidence of side effects


Special Conditions : 

Special Conditions

Role of Pharmacist : 

Role of Pharmacist

Role of Pharmacist : 

Role of Pharmacist Counseling > main Role Objective > to increase patient quality of life. Pharmacist counseling is divided into:- Non-Pharmacological parameters Pharmacological parameters

Non-Pharmacological Counseling : 

Non-Pharmacological Counseling Physical Activity Salt Reduction Weight reduction Dietary Approaches Smoking Alcohol Stress

Physical Activity : 

Physical Activity Types of physical activity Aerobic activity Resistance training Flexibility exercises

Aerobic Activity : 

Aerobic Activity This type of movement most benefits the heart. All people should be prescribed 30-60 minutes of moderate intensity dynamic activity 4-7 days per week Dynamic activity includes: walking 3 km in 30 minutes/day walking 1.5 km in 15 minutes two times per day, jogging, cycling or swimming).

Body Mass Index and Blood Pressure : 

Body Mass Index and Blood Pressure HOW DOES BMI EFFECT BLOOD PRESSURE? Maintenance of a healthy body weight (body mass index [BMI] 18.5-24.9 kg/m2 Waist circumference < 102 cm [40"] for men < 88 cm [35"] for women All overweight hypertensive individuals should be advised to lose weight. Weight loss strategies should be long-term.

Dietary Approaches To Stop Hypertension(DASH) : 

Dietary Approaches To Stop Hypertension(DASH)

The DASH Diet Involves : 

The DASH Diet Involves

Salt Reduction : 

Salt Reduction ≤ 1,500 milligrams per day (approximately 1 tsp of table salt) “Hidden" salt content of processed foodssuch as lunch meats, sausage,bacon, and ham canned soups/foods, bouillon, dried soup mixes condiments (catsup, soy sauce, salad dressings) frozen and boxed mixes for potatoes, rice, and pasta snack foods (pretzels,popcorn, peanuts, chips) pickled or marinated foods.

Smoking : 

Smoking “Complete cessation of smoking and avoidance of exposure to second hand smoke is recommended. “ Alcohol Alcohol consumption should be limited to two drinks or less per day. If your blood pressure increases with alcohol, it's best not to drink any alcohol. ,

Stress and Blood Pressure : 

Stress and Blood Pressure Stressful situations release hormone – adrenaline that causes your breathing and heart rate to speed up and your blood pressure to rise. These physical reactions prepare you to deal with the Situations by confronting it or by running away from it – the "fight or flight"response.

How To Decrease Stress? : 

How To Decrease Stress? Attitude Physical well-being Relaxation Support system

Pharmacological CounselingMonitoring parameters : 

Pharmacological CounselingMonitoring parameters Urine strip test for protein and blood Serum creatinine and electrolytes Blood glucose - ideally fasted Blood lipid profile (at least total and high density lipoprotein (HDL) cholesterol) – ideally fasted for consideration of triglycerides Electrocardiogram

Causes for Lack of Responsivenessto Therapy : 

Causes for Lack of Responsivenessto Therapy

Causes for Lack of Responsivenessto Therapy : 

Causes for Lack of Responsivenessto Therapy Drug Related Factors

Ten Commandments For Blood Pressure Control : 

Ten Commandments For Blood Pressure Control Know your blood pressure Know what your weight should be Don’t use excessive salt in cooking or at meals Eat a low-fat diet Don’t smoke cigarettes

10 Commandments For Blood Pressure Control : 

10 Commandments For Blood Pressure Control Take your medicine exactly as prescribed Keep your appointments with the doctor Follow your doctors advice about exercise Make certain family members have their blood pressure checked regularly Live a normal life in every other way!

Summary : 

Summary What is Hypertension? Different Symptoms & Causes How to Diagnose? Different treatment Options. Role of Pharmacist