Take-home message:
✅Stage 1 hypertension treatment depends on ASCVD risk (low = lifestyle modification, high = pills)
✅If we prescribe lifestyle modification, we wait 3 to 6 months to get results
✅Symptoms are not important for starting hypertension (we can and should treat asymptomatic hypertension) but side effects are important for decreasing dose/stopping antihypertensive drugs
✅Hyperthyroidism and hypothyroidism may cause hypertension
✅Before we start ARB/ACEi we NEED to check if the patient of childbearing age is pregnant. Explaining teratogenicity is also needed.
✅We should start with low dose and go up every week or two
✅Hypertensive urgency is not urgent. It is misleading. What we need to do is improve chronic treatment of hypertension.
✅Hypertensive emergency (high blood pressure + confusion/severe headache/hypertensive rethinopathy/vision loss/chest pain/lung edema (dyspnea)/oliguria) requires IV treatment. IV treatment allows proper control of blood pressure and rapid increase or decrease of dose depending on the patient's BP

The initial evaluation of hypertension is directed to identify complications of hypertension or comorbid conditions that might influence management. Baseline assessment should include:
✔️Serum chemistry panel (including electrolytes and creatinine) and hemoglobin/hematocrit.
✔️Urinalysis to exclude hematuria and evaluate for proteinuria.
✔️ECG to screen for left ventricular hypertrophy or prior myocardial infarct.
Some experts advise measuring serum TSH because thyroid disorders are common and increase the risk for hypertension.
In addition, patients with hypertension are at increased risk for ischemic heart disease and should be screened for other major atherosclerotic risk factors. A lipid panel is recommended, and patients should be screened for diabetes mellitus with either fasting blood glucose, which may be obtained as part of a standard serum chemistry panel, or hemoglobin A1c.

A 43-year-old woman comes to the office for evaluation of high blood pressure. She exercises regularly and has followed a low-salt diet over the last 2 months. At the patient's previous 2 visits, blood pressure was 154/88 and 150/92 mm Hg. She has no headaches or other symptoms. Medical history is notable for asthma, for which the patient uses a fluticasone inhaler and, very occasionally, as-needed albuterol. She does not smoke or use alcohol and has no known drug allergies. Family history is significant for myocardial infarction in her father at age 65. During this visit, blood pressure is 146/89 mm Hg and pulse is 69/min. BMI is 27 kg/m2. Heart and lung examinations are unremarkable. No vascular bruits are heard, and peripheral pulses are 2+ and symmetrical. ECG shows normal sinus rhythm. Complete blood count and chemistry panel are normal.

Презентація, яку ми сьогодні розглядали на початку сьогоднішнього заняття по обмеженню солі та рідини в пацієнтів з серцевою недостатністю

#hypertension #heartfailure