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HYPERTENSION

Posted by SAMUEL ISABIRYE on February 5, 2013 at 4:55 PM

Persistently high resting blood pressure (>140/90mm Hg

at least two measurements five minutes apart with

patient seated).

 

Classification of Blood pressure (BP)*

 

Category SBP mmHg DBP mmHg

Normal <120 and <80

Prehypertension 120-139 or 80-89

Hypertension,

stage 1

140-159 or 90-99

Hypertension,

stage 2

=160 or =100

 

key: SBP=systolic blood pressure DBP=diastolic

blood pressure

 

Causes

 

z

In the majority of cases the cause is not known

(essential hypertension)

 

Secondary hypertension is associated with:

 

z

Kidney diseases

z

Endocrine diseases

z

Eclampsia

z

Medicines (steroids and decongestants containing

 

caffeine and pseudoephedrine)

z

Others

 

Clinical features

 

z

The majority of cases are symptomless and are

only discovered on routine examination

 

May present as a complication affecting:

 

z

Brain (stroke)

z

Eyes (impairment of vision)

z

Heart (heart failure)

z

Kidney (renal failure)

 

UCG 2010

200

 

 

 

9. Cardiovascular diseases

General symptoms include:

 

z

Headache

z

Palpitations, dizziness

z

Shortness of breath

 

Differential diagnosis

 

z

Pre-eclampsic toxaemia (PET)

z

Eclampsia

z

Other causes of stroke

 

Investigations

 

¾

Urine analysis

¾

Blood sugar

¾

Plasma urea and electrolytes

¾

Chest X-ray

¾

ECG

 

Management: Treat to maintain optimal

blood pressure

 

Mild hypertension (stage 1)

 

f

Do not add extra salt to cooked food

f

Increase physical activity / exercise

f

Reduce body weight

f

Stop smoking

f

Decrease alcohol intake

 

If all the above fail (within 3 months) initiate

medicine therapy:

 

 

f

Give bendrofluazide 2.5mg-5mg each morning

 

- avoid in pregnancy and breastfeeding

Moderate and Severe hypertension (stage 2)

 

f

bendrofluazide 2.5-5mg each morning

 

f

plus ACE inhibitor (e.g. Captopril, Lisinopril or

enalapril) or CCB (e.g. Nifedipine or amlodipine)

or ARB (e.g.Lorsatan or Candesartan) or Beta

blockers (e.g. Atenolol or propranolol)

 

see table on the next page for dosages.

 

UCG 2010 201

 

 

 

9. Cardiovascular diseases

Hypertensive emergencies

 

f

Treatment depends on whether there is acute

target organ damage e.g. encephalopathy,

unstable angina, myocardial infarction,

pulmonary oedema or stroke.

 

f

If acute end target organ damage present admit

and give parenteral medicnes. Give IV

furosemide 40-80 mg stat.

 

f

Plus IV Hydralazine 20mg slowly over 20

minutes. Check blood pressure regularly at least

3 hourly.

 

f

If without acute target organ damage treat with

combination oral antihypertensive therapy as

above for severe hypertension.

 

f

Special Considerations.(Compelling

indications)

Patients with hypertension and other

comorbidities require special attention and

medicine therapy may differ from that above.

The table below indicates the suitable medicines

for such patients.

 

 

UCG 2010 202

 

 

 

9. Cardiovascular diseases

Caution

 

U

Propranolol, atenolol: do not use in heart failure

 

or asthma

U

Diuretics: do not use in pregnancy or

breastfeeding except in case of pulmonary

oedema or pre-eclampsia

Note:

 

.

Bendrofluazide: potassium supplements are

seldom required - only use in susceptible patients

.

Methyldopa: use in hypertension with renal

failure and in pregnancy and breastfeeding

 

Prevention

 

z

Regular physical exercise

z

Reduce salt intake

Categories: None

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