Ebook Cardiology in family practice - A practical guide: Part 2
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Ebook Cardiology in family practice - A practical guide: Part 2
Chapter 4HypertensionEtiology and PathophysiologyHypertension is highly prevalent in the United States and worldwide, and it is a major risk factor fo Ebook Cardiology in family practice - A practical guide: Part 2or coronary artery disease, stroke, heart failure, renal disease, and cardiovascular events [1]. The prevalence of hypertension increases with age. The Framingham Heart Study reported a 90% lifetime risk for developing hypertension in patients who arc normotensive at the age of 50 [2]. The risk of c Ebook Cardiology in family practice - A practical guide: Part 2ardiovascular disease doubles with each increment of 20/10 mmHg above 115/75 [3]. Systolic hypertension is now considered a more important risk factorEbook Cardiology in family practice - A practical guide: Part 2
than diastolic pressure [4,5].An estimated 50 million Americans have high blood pressure, but awareness, treatment, and control is still poor, especiChapter 4HypertensionEtiology and PathophysiologyHypertension is highly prevalent in the United States and worldwide, and it is a major risk factor fo Ebook Cardiology in family practice - A practical guide: Part 2nsion has increased from 20 to 27% over the past decade [6]. The 1999-2000 survey found that one third of hypertensive patients were not aware of their disease, less than two-thirds adopted lifestyle modification or took medication to lower their blood pressure, and only 31% were at their blood pres Ebook Cardiology in family practice - A practical guide: Part 2sure goal [6], It is little consolation that international blood pressure control rates were no better. Between 2004 and 2008. there was a (29.4%) redEbook Cardiology in family practice - A practical guide: Part 2
uction in the rate of uncontrolled hypertension, indicating that progress has been made toward the American Heart Association's (AHA) Impact 2010 goalChapter 4HypertensionEtiology and PathophysiologyHypertension is highly prevalent in the United States and worldwide, and it is a major risk factor fo Ebook Cardiology in family practice - A practical guide: Part 2r major risk factor for vascular disease (goal untreated BP <120/80 mmHg).Although hypertension is initiated by pathophysiologic factors that increase peripheral resistance or cardiac output, long-standing hypertension, results in stiffening of conduit arteries, and this stiffening may be a more imp Ebook Cardiology in family practice - A practical guide: Part 2ortant determinant of cardiovascular risk than the etiology of hypertension in itself [9]. Increased stiffness of large arteries leads to early wave rEbook Cardiology in family practice - A practical guide: Part 2
eflection that impacts the heart during systole rather than diastole, increasing peak systolic pressure and myocardials. Hollenberg and s. Heitner. CaChapter 4HypertensionEtiology and PathophysiologyHypertension is highly prevalent in the United States and worldwide, and it is a major risk factor fo Ebook Cardiology in family practice - A practical guide: Part 2easing diastolic pressure and myocardial blood supply [10]. Early wave reflection increases pulse pressure, and a widened pulse pressure has also been shown to be independently associated with subsequent myocardial infarction and other cardiovascular events [II].About 90% of hypertension is characte Ebook Cardiology in family practice - A practical guide: Part 2rized as essential, or idiopathic. Important secondary causes of hypertension include renal artery stenosis, hyperaldosteronism, renal parenchymal disEbook Cardiology in family practice - A practical guide: Part 2
ease, pheochromocytoma, coarctation of the aorta, and illicit drugs. Hypertension is a heterogeneous disorder in which the different predisposing factChapter 4HypertensionEtiology and PathophysiologyHypertension is highly prevalent in the United States and worldwide, and it is a major risk factor fo Ebook Cardiology in family practice - A practical guide: Part 2ssure and a variety of environmental factors including diet, alcohol intake, age. socioeconomic status, lifestyle, and stress.DiagnosisThe classification of hypertension has recently been simplified to improve recognition of hypertension by both patients and health care providers. The classification Ebook Cardiology in family practice - A practical guide: Part 2s have been tied to treatment algorithms in the recommendations of the 7th Joint National Committee (JNC 7) [12].The classification of blood pressureEbook Cardiology in family practice - A practical guide: Part 2
(outlined in Table 4.1) is based on the average of two or more properly measured blood pressure readings on two separate occasions. The category of prChapter 4HypertensionEtiology and PathophysiologyHypertension is highly prevalent in the United States and worldwide, and it is a major risk factor fo Ebook Cardiology in family practice - A practical guide: Part 2hose individuals for preventive efforts [12].Table 4.1 Classification of blood pressure for adults (Adapted from Chobanian el al. 112|)BP classificationSystolic blood pressure (mmHg)Diastolic blood pressure (mmHg)Normal<120and <80Prehypertension120-139or 80-89Stage 1 hypertension140-159or 90-99Stage Ebook Cardiology in family practice - A practical guide: Part 2 2 hypertension>160or >100Once a patient is determined to be either prehypertensive or hypertensive, a thorough assessment of risk factors, possible sEbook Cardiology in family practice - A practical guide: Part 2
econdary causes, and therapeutic targets should be initiated [12]. The physician should inquire about cigarette smoking. obesity, family history of caChapter 4HypertensionEtiology and PathophysiologyHypertension is highly prevalent in the United States and worldwide, and it is a major risk factor fo Ebook Cardiology in family practice - A practical guide: Part 2hat may point to secondary causes of hypertension, particularly, use of prescription or nonprescription drugs, merit scrutiny.A complete physical exam and diagnostic tests should be performed to evaluate for signs of end organ damage and secondary causes of hypertension. Blood pressure should be obt Ebook Cardiology in family practice - A practical guide: Part 2ained in both arms. A funduscopic exam should be performed to evaluate for papilledema, retinal hemorrhage or exudates, arterio-venous nicking orTheraEbook Cardiology in family practice - A practical guide: Part 2
py83arteriolar narrowing. The cardiolhoracic exam should inelude evaluation of jugular venous pressure, heart size, and auscultation for murmurs, gallChapter 4HypertensionEtiology and PathophysiologyHypertension is highly prevalent in the United States and worldwide, and it is a major risk factor fo Ebook Cardiology in family practice - A practical guide: Part 2l masses or aortic or renal artery bruits, the extremities examined for edema, and peripheral pulses palpated. The diagnostic workup should include an electrocardiogram, complete blood count, chemistry panel with attention to electrolytes. BUN. creatinine, glucose, and calcium, urinalysis, and a fas Ebook Cardiology in family practice - A practical guide: Part 2ting lipid profile. Echocardiography is more sensitive for left ventricular hypertrophy than EKG. and is important at prognostication [13].TherapyLifeEbook Cardiology in family practice - A practical guide: Part 2
style modifications alone have been shown to reduce blood pressure and cardiovascular disease complications. Lifestyle modifications include weight reChapter 4HypertensionEtiology and PathophysiologyHypertension is highly prevalent in the United States and worldwide, and it is a major risk factor fo Ebook Cardiology in family practice - A practical guide: Part 2ting sodium to <2.4 g/day, regular exercise and moderation of alcohol intake. The DASH trial showed that adherence to the DASH diet lowered systolic blood pressure by 5.5 mmHg and diastolic blood pressure by 3.0 mmHg [14]. This trial also showed a reduction in blood pressure of normotensive subjects Ebook Cardiology in family practice - A practical guide: Part 2 participating in the study. The DASH-Sodium trial added low salt intake (3 g/day compared to the average intake of 9 g in developed countries) to theEbook Cardiology in family practice - A practical guide: Part 2
DASH diet, resulted in a reduction in systolic BP by 7.1 mmHg [15]. Based on these results, therapeutic lifestyle modification forms an important corChapter 4HypertensionEtiology and PathophysiologyHypertension is highly prevalent in the United States and worldwide, and it is a major risk factor fo Ebook Cardiology in family practice - A practical guide: Part 2ries.The approach recommended in the Joint National Committee on Prevention. Detection. Evaluation, and Treatment of High Blood Pressure (JNC 7) bases therapeutic recommendations on both the degree of hypertension and the underlying risk of cardiovascular disease. Patients are divided into those wit Ebook Cardiology in family practice - A practical guide: Part 2h uncomplicated hypertension and those with high-risk conditions, which are termed "compelling indications" for the use of other antihypertensive dingEbook Cardiology in family practice - A practical guide: Part 2
classes (see Table 4.2).For hypertensive patients without compelling indications, thiazide diuretics or beta blockers should be the first choice [12]Chapter 4HypertensionEtiology and PathophysiologyHypertension is highly prevalent in the United States and worldwide, and it is a major risk factor fo Ebook Cardiology in family practice - A practical guide: Part 2ich randomized. 33.357 participants over 55 with hypertension and at least one other coronary risk factor to chlorthalidone. amlodipine, or lisinopril (an arm with doxazosin was terminated prematurely due to adverse outcomes). After a mean follow-up of 4.9 years, there was no difference in either th Ebook Cardiology in family practice - A practical guide: Part 2e primary outcome or all-cause mortality among treatments [16]. Compared directly, diuretics were equivalent to amlodipine, but superior to lisinoprilEbook Cardiology in family practice - A practical guide: Part 2
. although this may have been due to improved blood pressure control with chlorthalidone ACE inhibitors, angiotension II blockers, calcium channel bloChapter 4HypertensionEtiology and PathophysiologyHypertension is highly prevalent in the United States and worldwide, and it is a major risk factor fo Ebook Cardiology in family practice - A practical guide: Part 2 goal of <140/90 mmHg forEbook Cardiology in family practice - A practical guide: Part 2
rindications. OtherStage 2 Hypertension>160>100Yesmost. May consider ACEI, ARB. BB. CCB. or combination Two-drug combination for most (usually thiazidGọi ngay
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