1. HYPERTENSION IN SPECIAL OCCASIONS Prof. YOUSEF Abdullah AL TURKI Professor and Consultant FAMILY MEDICINE Professor and Consultant FAMILY MEDICINE Family and community medicine department COLLEGE OF MEDICINE KING SAUD UNIVERSITY

2. CONTENTS  HYPERTENSION DURING FASTING IN RAMADAN  HYPERTENSION DURING HAJJ PERIOD  HYPERTENSION DURING TRAVEL  CONCLUSION  FURTHER READINGS

3. CASE SCENARIO  Ahmed 52 years, recently diagnosed to have hypertension, he is on diet and life style modification. Started on Atenolol 50 mg once daily two month ago, his BP 140/95. Ahmed ask you if he can fast during Ramadan safely? Ahmed ask you if he can fast during Ramadan safely?

5. HYPERTENSION AND FASTING  STUDY: The effect of the fast of Ramadan on ambulatory blood pressure in treated hypertensives. Perk G, etal. J Hum Hypertens. 2001 Oct;15(10): 723-5  Conclusion: Treated Hypertensive patients may be assured that with continuation of previous medications, fasting during the month of Ramadan can be safely undertaken.

6. HYPERTENSION AND FASTING  STUDY: Variation of blood pressure during the month of Ramadan. Habbal R, etal. Arch malcoeu vaiss1998 Aug;91(8):995-8  Conclusion: We can confirm that in patients with essential hypertension without complications, the fast is well supported. The variations of BP are minimal and are related to the variations of sleep,activity and eating pattern.

7. HEART DISEASES AND FASTING  STUDY: The effect of fasting in Ramadan on patients with heart disease. Hassan Chamsi- pasha, Waqar H. Ahmed. Saudi Med J 2004;25(1):47-51  Conclusion: The effects of fasting during Ramadan on stable patients with cardiac disease are minimal. The majority of patients with stable cardiac disease can fast during Ramadan without significant detrimental effects.

8. HEART DISEASES AND FASTING  STUDY: Does hospitalization for congestive heart failure occur more frequently in Ramadan: A population based study(1991- 2001). Al Suwaidi J, etal.Int J Cardiol 2004;96(2):217-21.  Conclusion: This population- based study demonstrates that no significant difference was found in number of hospitalization for CHF which fasting in Ramadan when compared to the non-fasting months.

9. MEDICATIONS DURING RAMADAN  Frequency and doses of medications  Antihypertensive drugs Examples: -Thiazides Examples: -Thiazides - Beta blocker - Beta blocker - ACE inhibitor - ACE inhibitor - Angiotensin ii antagonist - Angiotensin ii antagonist - calcium channel blockers - calcium channel blockers

11. PATIENT EDUCATION AND FASTING  Life style modifications: diet advise dietary sodium reduction dietary sodium reduction weight reduction weight reduction physical activity physical activity psychosocial aspect psychosocial aspect قال تعالى: ( يا أيها الذين آمنوا كتب عليكم الصيام كما كتب على الذين من قبلكم لعلكم تتقون). سورة البقرة، الآية 183 قال تعالى: ( يا أيها الذين آمنوا كتب عليكم الصيام كما كتب على الذين من قبلكم لعلكم تتقون). سورة البقرة، الآية 183

12. CASE SCENARIO  Ibrahim 65 years old, known Hypertensive patient for the last 10 years on treatments.His BP 150/90. He want to perform Hajj this year. He want to perform Hajj this year. He ask you for health advise regarding his hypertension before performing Hajj? He ask you for health advise regarding his hypertension before performing Hajj?

13. HYPERTENSION AND HAJJ  Medical reports  Medications: drugs availability Compliance Compliance  Avoid physical exhaustion  Proper utilization of health services  Elderly patients قال تعالى: ( يريد الله بكم اليسر ولا يريد بكم العسر) سورة البقرة، الآية 185 قال تعالى: ( وما جعل عليكم في الدين من حرج) سورة الحج، الآية 78

14. HYPERTENSION AND HAJJ  STUDY: Pattern of admission to hospitals during muslim pilgrimages (Hajj). AL Ghamdi SM, etal. Saudi Med J 2003; 24(10):1073-6.  Conclusion: Hospital admission during Hajj is related to old age and occurs in patients with associated co-morbid conditions.

17. HYPERTENSION AND TRAVEL  Medical report  Medications: Compliance  Travel advise  Control BP  Pre travel stable status  Control hypertensive patients can travel safely

18. HYPERTENSION AND TRAVEL  STUDY: Toleration of high altitude by patients with heart and pulmonary diseases.Fischer, MMW fortschr Med 2003 Feb 20;145(8):36-8.  Conclusion: It is, however, still possible for patients with coronary heart disease, high blood pressure or bronchial asthma to tolerate high altitudes without having to experience health problem.  Prerequistes, optimal medications and pre travel stable status.

19. CONCLUSION  HYPERTENSIVE PATIENTS CAN FAST SAFELY DURING RAMADAN.  HYPERTENSIVE PATIENTS CAN TRAVEL AND PERFORM HAJJ WITHOUT HAVING TO EXPERIENCE HEALTH PRBLEMS.  PRE- TRAVEL STABLE STATUS IS IMPORTANT.  HEALTHY LIFE STYLES AND GOOD COMPLIANCE TO ANTI HYPERTENSIVE DRUGS WILL HELP TO MAINTAIN CONTROLL BLOOD PRESSURE DURING RAMADAN, HAJJ AND TRAVEL.

20. FURTHER READING  THE JOINT National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure ( seventh report) http://www.nhlbi.nih.gov/guidelines/hypertension http://www.nhlbi.nih.gov/guidelines/hypertension  Clinical Evidence www.clinicalevidence.org www.clinicalevidence.orgwww.clinicalevidence.org  The Cochrane Collaboration http://www.cochrane.org/ http://www.cochrane.org/http://www.cochrane.org/

21. THANK YOU