1. Therapeutics of Hypertension By Prof. Mohammad Saleh Hassan

2.  How Can You Diagnose Hypertension?

3.  1- Accurate Sphygmomanometer  2- Relaxed Patient  3- Measure at sitting and Standing Position  4- Appropriate Cuff Size  5- Arm Supported at the Level of the Heart  6- No Isometric Contraction of the Arm Muscles  7- Using Korotkove Sounds  8- Deflate the Cuff at 2 mmHg per second  9- Repeated Measurements (for several weeks)  10- Consider White Coat Hypertension

4.  How Can You Assess a Hypertensive Patient?

5. How Can You Assess a Hypertensive Patient?  1- Consider Possible Secondary Causes  2- Think in Contributing Factors  3- Examine for End Organ Damage

7.  If <135/<85 mmHg ------------------  Assess in 5 years  If 135-139/85-89 mmHg ----------  Assess yearly  If 140-159/90-99 mmHg ----------  Repeat (in weeks)& Start Non-drug Therapy  if Remains High or Organ Damage ---------------  Treat  If 160-199/100-109 mmHg--------  Same as above  If >200/>110 mmHg-------------------  Repeat (same visit) -----  if Remains High----------  Treat  If Malignant ---------------------------------  Admit & Treat

9.  Clinic BP:  No Diabetes  <140/85 mmHg  Diabetes Type I  <130/80 mmHg  Diabetes Type II  < 140/80 mmHg  Home/Ambulatory BP:  No Diabetes  <130/80 mmHg  Diabetes  < 130/75 mmHg

10.  Diuretics-------------  Especially for HF and elderly  β Blockers ---------  Especially for patients with ischemic heart disease  Ca ++ Antagonists-Dihydropyridin ----------  Especially for patients with ischemic heart disease or DM  Ca ++ Ischemic Antagonists Rate limiting  -----------  For Cardiac Patients Unable to Tolerate β Blockers

11.  ACE Inhibitors ------  For patients with HF or DM or Resistant Hypertension  α Blockers -----------  Second Line  AC-II Antagonists  Patients not Tolerating ACEI  Central Vasodilators  Severe HPT, in Pregnancy, and as Third Line  Direct Vasodilators  In Severe HPT

12.  Ind. Contra-Ind.  DiureticsElderly Gout  β BlockersMyocardial Infarct. COPD Angina H Block  Ca ++ Antagonists- Dihydropyridin Elderly isolated Systolic HPT

13. Ind. Contra-Ind.  Ca ++ Ischemic Antagonists Rate- limiting Angina Combination with β Blockers  ACEIHF, Pregnancy LV Dysfunction Renovasc. Dis. Type I D Neph.

14. Ind. Contra-Ind. α Blockers Prostatism Urinary incontinence AC-II Antag. Cough Pregnancy (with ACEI) Renovasc. Dis. Cent. Vasodil. Pregnancy Resistant HPT Direct Vasodil. Resistant HPT