| Disease |
SYSTEMIC HYPERTENSIONSYSTEMIC HYPERTENSIONSYSTEMIC HYPERTENSION |
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| Quotation |
“High blood pressure….. is a sign, not a disease |
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| Definition |
Sustained elevation of blood pressure-systolic of 140mms Hg or greater, and or diastolic pressure of 90mms Hg or greater. |
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| Prognosis |
In essential hypertension is good with adequate control. If untreated, prognosis worsens with both raised systolic or diastolic pressure and in those over 50 the systolic pressure is a better predictor of complications |
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| Treatment |
WHEN BP IS > 200MM SYSTOLIC Acute rise of blood pressure is potentially very dangerous, and can lead to hemiplegia. Due to cerebral hemorrhage Immediate and complete Bed Rest. Cap DEPIN 0mg – punctured and squeezed sublingually – (Nifedipine=6AC-2)- May be repeated after 15mins. Or Inj. Reserpine 1 amp IM stat & SOS (6A-1)Inj. CALMPOSE 2 cc IM stat (Diazepam = 4D-3=Tranquiliser)Simultaneously, start anti-hypertensive treatment. Eg. Tab ATEN -50mg 1 bd (ATENolol = 6AC-2 = Betablocker) or Tab Encas 2.5 mg 1 bd (Enalapril=6AV-1 = ACE inhibitor) Subsequently: i. Adjust the doses of anti-hypertensive drugs. ii. Salt free diet. iii. Instruct the patient to be regular n treatment and check up.
Inj. Reserpine Tab Encas ATEN DEPIN CALMPOSE |
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| General Measures |
Life style modification measures are of great importanceWeight reduction for obese patientsReduction of salt intake (5-6 gms daily even in uncomplicated cases), and greater reductions down to 3 gms daily in renal impairment.Smoking cessation is a very important step to reduce overall cardiovascular risk. Regular exercises graded and gradually increased, as clearly instructed in writing. (provide pamphlets on graded exercise, if possible) Relaxation techniques, yoga, Savasana, Biofeed back etc. Control of concomitant diabetes, hyperllipidemia. Alcohol consumption to be reduced to less than an ounce a day. |
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| Advice to Patient |
Emphasizing on the asymptomatic nature of the disease in many patients and the need for lifetime management and supervision to avoid serious complications. When on therapy stand up form bed slowly to avoid orthostatifc hypotension. Do not stop any drug, especially beta blockers suddenly. It is best to give explanatory pamphlets. Patient not to judge level of his blood pressure by a ‘subjective feeling’ |
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| Follow Up |
Once stable, to be reviewed periodically, monthly or bimonthly. To supervise for complications, quality of life, adherence to life style modification advice, and dietary modes. At least annual evaluation by urinalysis, ECG, serum potassium lipids, chest film etc. |
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| Inadequate Response |
Always consider possibility of patient’s failure in taking drugs. Rule out the patient consuming medications like oral contraceptives, corticosteroids, or NSAIDS, or over the counter medications like ‘cold tablets’If not, consider possibility of secondary hypertension. (Renal artery stenosis is the most common) |
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| Prevention |
Nil specific |
