Hypertension 高血压.pptVIP

Hypertension Aetiology of Hypertension Primary – 90-95% of cases – also termed “essential” of “idiopathic” Secondary – about 5% of cases Renal or renovascular disease Endocrine disease Phaeochomocytoma Cusings syndrome Conn’s syndrome Acromegaly and hypothyroidism Coarctation of the aorta Iatrogenic Hormonal / oral contraceptive NSAIDs H O T Hypertension Optimal Treatment Largest intervention trial in hypertension. Published in 1998 Conducted in General Practice. 18,790 patients in 26 countries Followed up for an average of 3.8 years H O T Findings Lowest incidence of major CV events occurred at a mean achieved DBP of 83 mmhg. This target (compared to mean achieved of 105 mmHg was associated with a 30% reduction in main CV events. In diabetes – Diastolic or = 80mmhg 51 % lower risk compared to 90 mmHg Hypertension and Diabetes Hypertension co-exists with type II in about 40% at age 45 rising to 60% at age 75. 70% of type II patients die from cardio-vascular disease. At least 60% of patients will require 2 or 3 antihypertensive agents to achieve tight control. Stages Identification of hypertensive patients Baseline investigations Initiating therapy Reviewing patients Stepping up therapy Motivation and compliance Investigation of the New Hypertensive History and examination Exclude secondary Hypertension Urea and electrolytes FBP and ESR ECG Lipid profile Chest x-ray no longer routinely indicated Clinical clues to renal vascular disease Hypertension under 50 Yrs of age. Generalised vascular (esp peripheral) disease. Mild – moderate renal dysfunction. Sudden onset pulmonary oedema. Ladder Approach Bendrofluazide Bendrofluazide + Atenolol or ACE Calcium Channel blocker Alpha blocker Tailored Approach Assessment of overall cardiovascular risk Recognition of co-morbidities Lipid profile Renal function Existing contra- indications Coronary Risk Calculator Launch risk calculator program Therapeutic targets Logical Combinations ACE Inhibitor Side Effects Cough (15