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12. Other conditions
Hypertension
– Adult essential hypertension is d e fine d a s a s ys tolic p r e s s u r e gr e a te r tha n or
equ al
to 1 6 0 m m H g a nd / or a d ia s tolic p r e s s u r e gr e a te r tha n or e q u a l to 9 0
m m H g.
T h e e le v a t ion m u s t be c on s t a n t : blood p r e s s u r e m u s t be m e a s u r e d
tw ic e a t r e s t
d u r ing th r e e c ons e c u tiv e c ons u lta tions ov e r a p e r iod of thr e e m onths .
H yp e r t e n s ion is a r is k fa c t or for s tr oke ( c e r e br ov a s c u la r a c c id e n t or
C V A ), hea rt
fa ilu r e , r e na l fa ilu r e a nd a the r os c le r os is .
– Hypertension in pregnancy is d e fine d a s a s ys tolic p r e s s u r e gr e a te r tha n or
e q u a l to
1 4 0 m m H g or a d ia s tolic p r e s s u r e gr e a te r tha n or e q u a l to 9 0 m m H g
(w ith the p a tie nt
s e a te d a n d a t r e s t). It m a y be is ola te d or a s s oc ia te d w ith p r ote inu r ia or
oe d e m a in the
c a s e of p r e -e c la m p s ia .
H yp e r te n s ion in p r e gna nc y is a r is k fa c tor for e c la m p s ia , p la c e nta l
a br u p tion a n d
p r e m a tu r e d e liv e r y.
Treatment of adult essential hypertension
– In p a tie nts w ith m e d ic a tion-ind u c e d hyp e r te ns ion (or a l c ontr a c e p tiv e s ,
–t–hhyTOMdiahrtzhoeAiedc troOehwr rtiesiinseohenibce, istl,aotrassrs,t Ne sSoAf aIDn t ie- htcy.p),esrttoepnosr ivc heasnuges tehed tar es aintmit iae lntt.h e r a p y a r e t
w ith d ie t a nd e xe r c is e m od ific a tion: r e d u c e s a lt inta ke ,
los e a ny e xc e s s
w e ight, a nd inc r e a s e the le v e l of p hys ic a l a c tiv ity.
– I f d e s p it e t h e s e m e a s u r e s t h e blood p r e s s u r e r e m a in s c on s is t e n t ly
a bov e
1 6 0 / 1 0 0 m m H g (or 1 4 0 / 8 0 m m H g for a d ia be tic p a tie nt or follow ing a
C V A ), a n a nti-
hyp e r te ns iv e m e d ic a tion m a y be a d d e d .
– Sta r t w ith m onothe r a p y. T he op tim a l d os e d e p e nd s on the p a tie nt; r e d u c e by
ha lf the
initia l d os e for e ld e r ly p a tie nts .
1
d iu r e tic s , the be ta -bloc ke r s a nd the a ngiote ns in c onv e r ting e nzym e (A C E )
inhibitor s .
F or infor m a tion:
Indications Initial treatment
U nc om plic a te d hype r te ns ion thia zid e d iu r e tic or be ta -bloc ke r
P a tie nt ov e r 6 5 ye a r s thia zid e d iu r e tic
D ia be tic pa tie nt A C E inhibitor or be ta -bloc ke r
C om plic a te d hype r te ns ion: thia zid e d iu r e tic
F ollow ing a C V A be ta -bloc ke r
F ollow ing a m yoc a r d ia l infa r c tion A C E inhibitor
H e a r t fa ilu r e A C E inhibitor
R e na l fa ilu r e
Hypertension
– Adult essential hypertension is d e fine d a s a s ys tolic p r e s s u r e gr e a te r tha n or
equ al
to 1 6 0 m m H g a nd / or a d ia s tolic p r e s s u r e gr e a te r tha n or e q u a l to 9 0
m m H g.
T h e e le v a t ion m u s t be c on s t a n t : blood p r e s s u r e m u s t be m e a s u r e d
tw ic e a t r e s t
d u r ing th r e e c ons e c u tiv e c ons u lta tions ov e r a p e r iod of thr e e m onths .
H yp e r t e n s ion is a r is k fa c t or for s tr oke ( c e r e br ov a s c u la r a c c id e n t or
C V A ), hea rt
fa ilu r e , r e na l fa ilu r e a nd a the r os c le r os is .
– Hypertension in pregnancy is d e fine d a s a s ys tolic p r e s s u r e gr e a te r tha n or
e q u a l to
1 4 0 m m H g or a d ia s tolic p r e s s u r e gr e a te r tha n or e q u a l to 9 0 m m H g
(w ith the p a tie nt
s e a te d a n d a t r e s t). It m a y be is ola te d or a s s oc ia te d w ith p r ote inu r ia or
oe d e m a in the
c a s e of p r e -e c la m p s ia .
H yp e r te n s ion in p r e gna nc y is a r is k fa c tor for e c la m p s ia , p la c e nta l
a br u p tion a n d
p r e m a tu r e d e liv e r y.
Treatment of adult essential hypertension
– In p a tie nts w ith m e d ic a tion-ind u c e d hyp e r te ns ion (or a l c ontr a c e p tiv e s ,
–t–hhyTOMdiahrtzhoeAiedc troOehwr rtiesiinseohenibce, istl,aotrassrs,t Ne sSoAf aIDn t ie- htcy.p),esrttoepnosr ivc heasnuges tehed tar es aintmit iae lntt.h e r a p y a r e t
w ith d ie t a nd e xe r c is e m od ific a tion: r e d u c e s a lt inta ke ,
los e a ny e xc e s s
w e ight, a nd inc r e a s e the le v e l of p hys ic a l a c tiv ity.
– I f d e s p it e t h e s e m e a s u r e s t h e blood p r e s s u r e r e m a in s c on s is t e n t ly
a bov e
1 6 0 / 1 0 0 m m H g (or 1 4 0 / 8 0 m m H g for a d ia be tic p a tie nt or follow ing a
C V A ), a n a nti-
hyp e r te ns iv e m e d ic a tion m a y be a d d e d .
– Sta r t w ith m onothe r a p y. T he op tim a l d os e d e p e nd s on the p a tie nt; r e d u c e by
ha lf the
initia l d os e for e ld e r ly p a tie nts .
1
d iu r e tic s , the be ta -bloc ke r s a nd the a ngiote ns in c onv e r ting e nzym e (A C E )
inhibitor s .
F or infor m a tion:
Indications Initial treatment
U nc om plic a te d hype r te ns ion thia zid e d iu r e tic or be ta -bloc ke r
P a tie nt ov e r 6 5 ye a r s thia zid e d iu r e tic
D ia be tic pa tie nt A C E inhibitor or be ta -bloc ke r
C om plic a te d hype r te ns ion: thia zid e d iu r e tic
F ollow ing a C V A be ta -bloc ke r
F ollow ing a m yoc a r d ia l infa r c tion A C E inhibitor
H e a r t fa ilu r e A C E inhibitor
R e na l fa ilu r e
