HYPERTENSION : HYPERTENSION PRESENTED BY : PRESENTED BY Suleman Atique Gondal Over View : Over View Definition
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 %
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.
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
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:
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)
Lack of exercise
Drug Induced Hypertension e.g NSAIDs,Steriods, Uncontrollable Risk Factors : Uncontrollable Risk Factors Heredity
Men between age 35 and 50
Women after menopause
1 out of every 3 African Americans
Higher incidence in non-Hispanic blacks and Mexican Americans Symptoms : Symptoms Usually NO SYMPTOMS!
“The Silent Killer”
Frequent urination at night Diagnosis : Diagnosis Home Blood Pressure Monitoring
Standard for BP monitoring
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
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
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
Stress Pharmacologic Treatment : Pharmacologic Treatment Diuretics
Angiotensin receptor blockers
Calcium channel blockers
Centrally-acting alpha-2 agonists
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
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:-
Pharmacological parameters Non-Pharmacological Counseling : Non-Pharmacological Counseling Physical Activity
Stress Physical Activity : Physical Activity Types of physical activity
Flexibility exercises Aerobic Activity : Aerobic Activity This type of movement most benefits the
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 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
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