(精编)【高血压英文教学精品课件】 Hypertension 2011 update.pptVIP

Hypertension 2011 update Salam Ishak AL Sammak.MD,FACP Nephrology associate medical group Hypertension 2011 update Epidemiology and Back ground JNC Seven definition and classification Sub classification and types of Hypertension Treatment options Lessons learned from New Trials of hypertension Take home message Hypertension 2011 update RAAS Blockade ACEi ARB Direct Renin inhibitors Diuretics Thiazide( Chlorthalidone vs HCTZ) Loop diuretic Aldosterone blocking agents Calcium channel blockers Dihydropyridine Non dihydropyridine Hypertension 2011 update Beta Blockers Selective Non selective Combined β and α Blockers are more effective Centrally acting drugs Clonidine Direct Vasodilator Minoxidil:common side effect fluid retention and Tachycardia Hydralazine Hypertension 2011 update Resistant Hypertension Blood pressure 140/90 despite using three different drugs including a diuretic Causes Non Adherent to diet, Non Compliance with taking medication Smoking Heavy Alcohol drinking Obesity and Obstructive sleep Apnea Use of drugs like NSAID Contraceptive drugs Hypertension 2011 update Secondary causes of Hypertension Renal artery stenosis Hyperaldosternism Pheochromocytoma Cushing syndrome PrimaryHyperparathyroidism Hypertension2011update When to suspect Renal artery stenosis Sudden rise in creatinine level specially after starting ACE or ARB Sudden elevation in a previously well controlled hypertension Flash pulmonary edema Different in size more than 1.5 cm between two kidneys Presence of Abdominal bruit Older Age ,more prominent in white than African American with other Cardiovascular diseases Hypertension 2011 update Hyperaldosterniosm Higher percentage in Resistant hypertension 10-15% Hypokalemia with metabolic Alkalosis present in only 50% of cases Screening test: Plasma Aldosterone level /Plasma Renin Activity Ratio 20, Aldosterone level 15 Morning specimen with supine position CT scan is more sensitive than MRI Stop Aldostero