1. Lifestyle changes for prehypertension
2. Step 9
2.1. Review session 2
2.1.1. Atenalol 100 mg/day
2.1.2. Carvizide 1/day
2.1.3. Amlopedine 10mg/day
2.2. mechanism flow chart
2.2.1. 15 years ago diagnosed as essential hypertension, got depressed years later because of many factor including job change, which lead him gaining weight, which can induce OSA. Also, OSA increase the complications of hypertension, making it more resistant.
2.3. 20 minutes
3. Step 10
3.1. Management
3.1.1. Goals of therapy
3.1.1.1. Treat underlying cause
3.1.1.2. lifestyle modification
3.1.1.3. control the symptoms
3.1.1.4. control BP
3.1.1.4.1. normal 140/90 or less
3.1.1.4.2. chronic disease: 130/80 or less
3.1.1.4.3. Our patient: 120/80 or less
3.1.1.5. Prevent complications
3.1.1.6. assess for end-organ damage
3.1.1.7. Psychiatry counsling
3.1.1.8. Occupational counsling
3.1.2. Pharmacological
3.1.2.1. ACE inhibtors
3.1.2.1.1. inhibits ACE
3.1.2.1.2. Sideeffects
3.1.2.1.3. Contraindicated
3.1.2.1.4. Indicated
3.1.2.2. ARB
3.1.2.2.1. Sideeffects
3.1.2.2.2. Contraindicated
3.1.2.3. Alpha blockers
3.1.2.3.1. Blocks alpha receptors, periphrel vessles, cause vasodialation
3.1.2.3.2. Good for hyperlipidemia
3.1.2.4. Central acting agents
3.1.2.4.1. Emergency cases
3.1.2.5. Beta blockers
3.1.2.5.1. Bisoprolol
3.1.2.5.2. Blocks beta receptors
3.1.2.5.3. decrease CO,rate,contractility
3.1.2.5.4. vasodialation in the periphrel arteries
3.1.2.5.5. Sideeffects
3.1.2.5.6. Contraindicated
3.1.2.6. Diuritics
3.1.2.6.1. Increase urination
3.1.2.6.2. Inhibit Na uptake
3.1.2.6.3. Loop diuritics
3.1.2.6.4. K sparing
3.1.2.6.5. K wasting
3.1.2.6.6. Distal tubules
3.1.2.6.7. Sideeffects
3.1.2.7. Calium channel blockers
3.1.2.7.1. Dihydro
3.1.2.7.2. Mechanism
3.1.2.7.3. Sideffects
3.1.2.7.4. Amlopedine
3.1.2.7.5. Verapamil
3.1.2.7.6. indicated for LVH
3.1.3. Non-pharmacological
3.1.3.1. Weight reduction
3.1.3.1.1. to the limit of optimal BMI
3.1.3.1.2. Enhanced by
3.1.3.2. Smoking cessation
3.1.3.2.1. Virocodene
3.1.3.2.2. Nicotine replacement therapy
3.1.3.2.3. Referred to clinics
3.1.3.3. Alcohol cessation
3.1.3.4. Stop medications like
3.1.3.4.1. NSAIDS
3.1.3.5. CPAP for OSA
3.1.3.5.1. Need to do sleep test before
3.1.3.5.2. Problem in compliance
3.1.3.5.3. Compliance: 30%
3.1.3.5.4. Sideffects
3.1.3.5.5. Ask patients to tie a ball
3.1.3.5.6. Srugery to correct crowding
3.1.3.6. Meditiation
3.1.3.7. Psychiatric therapy
3.1.3.8. .
3.2. Prevention
3.2.1. Decrease risk factors such as weight, smoking, salt intake, lipid profile
3.2.2. Excercise regularly
3.2.3. Brochures
3.2.3.1. BP measurement at home, or 2 hrs
3.2.4. Aplasia for renal artery stenosis