Hypertension, Hyperlipidemia and how to help your patients stop ...课件.ppt

Hypertension, Hyperlipidemia: Are our children safe? Patrick R Hints and exam tips HTN is a hot topic for exams – particularly, what is really malignant HTN and who needs urgent treatment. Also be sure that you know how to recognize the secondary causes of HTN Lipids are less beloved by examiners though they do like to ask about niacin and flushing Cardiovascular risk in your clinic patients Do not approach HTN, Hyperlipidemia as individual problems. Look upon them as part of your patients cardiovascular risk profile – once your patients understand that they are changing their lifestyle and taking meds to lower their risks of stroke, heart attack, kidney disease and peripheral vascular disease they will be more likely to follow your advice Consider does your pt have the “metabolic syndrome” Any 3 of obesity, high TG, low HDL, HTN, impaired glucose tolerance Who are my at risk patients – who should I be screening? (basically everyone!) Obesity Dyslipidemia – all pts need fasting lipid profile DM Smoking Lack of exercise Age 55 for men, 65 for women FHx of premature cardiovascular disease Microalbuminuria in diabetics Hypertension Management should be based on the “JNC-7” guidelines Treatment should be instituted at 140/90 in most pts or 130/80 in pts with DM or chronic kidney disease Stage II HTN is 160/100 and only important to distinguish because these patients usually need 2 drugs to control. Making 1st diagnosis needs 2 readings at least 5 mins apart and in both arms. Many doctors will actually get two readings a week or two apart in a previously undiagnosed patient, and many patients will be resistant to start therapy without more than one reading Ambulatory BP monitoring can be used to evaluate for white coat HTN, and also helpful in assessing response to therapy, or persuading a pt that he needs treatment New diagnosis of HTN Assess other cardiovascular risk factors Look for reversible causes of HTN Look for evidence of end organ damage Renal Retina