1. HypertensionThe basics

2. A bit of note Technique : mercury sphygmomanometer BP should be measured in both arms -higher reading is taken as the systemic BP. BP should be taken both lying + standing todetect any postural drop, especially in DMand HTN the elderly. ?postural hypotension : Rising Lying BP>20mmhg 3. Non pharmacological RX1. BMI:- [Weight (kg)/Height 2(m)]- Normal range :18.5 to 23.5kg/m2 .2. Salt intake :- teaspoonfuls of salt or 3 teaspoonfuls ofmonosodium glutamate3. alcohol : Standard advice is to restrict intake to nomore than 21 units for men and 14 units for womenper week (1 unit equivalent to 1/2 a pint of beer or100ml of wine or 20ml of proof whisky 4. 4. exercise :- milder exercise, such as brisk walking for 30 60 minutes at least 3times a week5. diet :-fruits, vegetables and dairy products- reduced saturated and total fat6. smoking cessation 5. When to start RX? Individual -patients global CVD risk. In diabetes mellitus or chronic kidneydisease, medical treatment is required if BPis above 130/80 mmHg High risk subjects ( previous CVA or CAD)the threshold for commencing hypertensiontreatment should be lowered 6. Severe HTN1. Hypertensive urgencies :- Initial treatment should aim for about 25% reductionin BP over 24 hours but not lower than 160/90 mmHg2. Hypertensive emergencies :- The BP needs to be reduced rapidly.- 25% depending on clinical scenario over 3 to 12hours but not lower than 160/90 mmHg** why we cannot lower BP fast ?Avoid renal / cerebral / coronary ischemia 7. HTN urgencies- grade III or IV retinal changes , but no overtorgan failure.DRUG DOSE ONSET ofaction( hr)DURATION (hr)FREQUENCY (hr)CAPTOPRIL 25mg 0.5 6 1-2NIFIDEPINE 10-20mg 0.5 3-5 1-2LABETOLOL 200-400mg 2hr 6 4 8. HTN emergencies Present complications eg ac heart failure,ACS, coronary aneurysm, HTNenchepalopathy, RF, SAH1. IV Labetolol 50mg bolus / 1 minute , repeat every5 minutes interval ( max : 200mg) to continue IVI2mg/min 2. IV Hydralazine 5-10mg/ min repeat evry 20-30minutes. Initial IVI 200-300mcg/ min , maintain50-150mcg/ min 3. pregnancy : IV Labetolol 200mg in 50ml NS, infusion4ml/hr 9. Acute hypertensive crisis @pregnancy1. IV hydrallazine (2.5-5 mg bolus, orinfusion)2. IV labetalol (10-20 mg slow bolus over 5minutes, or infusion)3. oral nifedipine (10 mg stat dose), may beused to lower the BP.185-186 (Level I)Sublingual nifedipine is no longerrecommended.184 (Level III)Diuretics are, in general, contraindicated asthey reduce plasma 10. HTN and DM1) Start Rx early in DM >130 mmHg and/or >80 mmHg.Target to