1. Internal Medicine Workshop Series Laos September /October 2009
Hypertension
Internal Medicine Workshop Series Laos
September /October 2009

2. Case number 1
A 65 year old woman who lives in Sekong comes to the district health center because of pneumonia. You treat her pneumonia but notice that her blood pressure is 150/100
Will you treat her?
What will you council her?
When will you see her again?

3. Case number 2
A 50 year old farmer from Sekong comes to hospital with a headache. His blood pressure is 180/110
Will you treat him?
What medication will you use first?
What medication will you use second?
What is the target blood pressure?

4. Diagnosis of Hypertension
BP > 160/100 on first visit
BP > 140/90 on more than one visit
Any patient with hypertensive crisis

5. Target Blood Pressure <140/90 Diabetes <130/80
Chronic renal disease <130/80

6. Cardiovascular Risk Factors Can’t change
Aging
Male
Family history

7. Cardiovascular Risk Factors Can change
Inactive
Bad eating habits
Obesity
Smoking
Diabetes
Dyslipidemia
Stress

8. Organ Damage Cerebrovascular disease (stroke, TIA)
Cardiac disease (myocardial infarction, heart failure)
Chronic renal disease
Peripheral artery disease

9. Treatment: Lifestyle Stop smoking Loose weight Decrease salt in food
Physical activity
Decrease alcohol
Manage stress

10. Treatment: Medications
Thiazide diuretic
Calcium channel blocker (long acting)
ACE inhibitor (angiotensin converting enzyme)
ARB (angiotensin receptor blocker)
Beta blocker (less than age 60)

11. Low dose of several drugs better than high dose of 1or 2 drugs
Beta Blockers, ACE and ARB not additive
Best to combine them with a diuretic or calcium channel blocker

12. If medication is not working think about…
Non compliance
Secondary Hypertension
Lifestyle

13. Remember
2/3 patients need 2 drugs
1/3 patients need 3 drugs

14. Case number 1
A 65 year old woman who lives in Sekong comes to the district health center because of pneumonia. You treat her pneumonia but notice that her blood pressure is 150/100
Will you treat her?
What will you council her?
When will you see her again?

15. Case number 2
A 50 year old farmer from Sekong comes to hospital with a headache. His blood pressure is 180/110
Will you treat him?
What medication will you use first?
What medication will you use second?
What is the target blood pressure?

16. Hypertension in pregnancy
Do not use ACE and ARB in pregnancy

17. Medication we can use in pregnancy
Methyldopa
Labetolol
Nifedipine (short or long acting)
Hydralazine

18. Medications safe with breastfeeding
Labetolol
Nifedipine XL
Methyldopa
Captopril
Enalapril