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Hypertension in Family Practice
Dr T McD KluytsMB ChB, MPraxMed, DTO
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PRE TEST
1. What is the range of diastolic pressure in “moderate
hypertension?”
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Choose a range90 – 99
100 – 109105 – 11490 – 104100 – 114
(100 – 109)
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2.Which of the following drugs are not recognised EDL drugs
for hypertension in PHC?a. Hydrochlorothiazide 25b. Propranolol 40mgc. Perindopril 4mgd. Spironolactone 25mge. Reserpine 5mg
B, D, E
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3.Which of the following conditions in a Hypertensive
patient would indicate referral to a higher level of
care? a. Diastolic pressure
>114mmHgb. Depressionc. Macroscopic haematuriad. Poliuriae. Visual accuity disturbance
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Wat is die rol van ABP monitor in die diagnose en hantering
van hipertensie? APB speel tans nie ‘n rol in die diagnose van hipertensie nie en diagnostiese kriteria is nie hiervoor vasgelê nie. APB is primêr ‘n navorsingsinstrument en word aangewend om die graad van bloeddruk kontrole wat deur medikasie gehandhaaf word, aan te dui. Dit mag nuttig gebruik word om psigososiale invloede op bloeddruk aan te toon.
FOLLOW UP TREATMENT FOR HYPERTENSION IN
CLINICAL PRACTICE
How to plan your consultation
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FREQUENCY
The frequency of follow up will be dictated by several factors:
ClinicalPsychosocialDemographic
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CLINICAL FACTORSSeverity of the diseaseComplications
Disease relatedConcomitant conditions
Duration of treatmentDegree of control
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PSYCHOSOCIAL
Dependency of patientAgeCompliability
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DEMOGRAPHICTransport Geographical locationCommunication facilities available
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PRESENTING PROBLEM
HELP SEEKINGBEHAVIOUR
ASSOCIATED CONDITIONS
HEALTH EDUCATION
STOTT’S MODEL
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MAIN PROBLEMHYPERTENSION
CONTROLLEDUNCONTROLLED
FLUCTUATINGCRITICAL
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HELPSEEKING BEHAVIOUR
IS THIS CONSULTATION SCHEDULED?IF NOT, WHAT IS THE REASON?IF YES, IS THERE ANY ADDITIONAL ISSUES?
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ASSOCIATED CONDITIONSCARDIOVASCULAR
ANGINACHRONIC ULCERATIONSCOLD EXTREMITIES
RENALPROTEINURIAHEMATURIAUREMIAPOLI / OLIGURIA
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ASSOCIATED CONDITIONSVISUAL
AccuityPeripheral visionFundoscopy
PERIPHERAL CIRCULATIONCappillary filling Aortic bruitsPeripheral pulsesOedema
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ASSOCIATED CONDITIONS
HEARTCardiomegaly Additional heart soundsBasal crepitationsAltered pulse rateAngina ECG-changes
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ASSOCIATED CONDITIONS
CEREBRALChange of ConsciousnessMemory lossVertigo
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ASSOCIATED CONDITIONS
VITAL SIGNSRESPIRATORY RATETEMPERATUREPULSE RATE
GENERAL SYSTEMIC EXAMINATION
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ASSOCIATED CONDITIONS
LIFESTYLE MODIFICATIONEXERCISE RECORDDIET RECORDADDICTION ISSSUES IF ANY
DRUG SIDE EFFECTSALLERGIES
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HEALTH EDUCATIONIntroduce a Q+A session where the patient gets the opportunity to ask any questions that has been bothering him/her.Use this to clear up any misconceptions that might be held by the patient.Review and re-affirm the treatment plan with the patient.
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REFERENCES
1. Susic D, Frohlich ED. Nephroprotective effect o antihypertensive drugs in essential hypertension. Hypertension 8(3) 2000:14-27
2. Standard treatment guidelines and essential drug list. Pretoria, National Department of Health. 1998.