Page 359 - Learnwell EVS
P. 359
ertension
T he obje c tiv e is to r e d u c e the blood p r e s s u r e to be low 1 6 0 / 9 0 m m H g (or
140/ 90 m m H g
for d ia be tic p a tie nts ) w hile p r od u c ing the fe w e s t p os s ible a d v e r s e e ffe c ts .
F or u nc om p lic a te d hyp e r te ns ion:
•Sta r t w ith a thia zid e d iu r e tic : hydrochlorothiazide P O 2 5 to 5 0 m g onc e d a ily.
•If the p a tie nt is not im p r ov ing a fte r 4 w e e ks , or if tr e a tm e nt is not tole r a te d :
c he c k
c om p lia nc e , a nd the n if the r e a r e no c ontr a -ind ic a tions (a s thm a , u nc ontr olle d
he a r t
fa ilu r e ), c ha nge to a be ta -bloc ke r : atenolol P O 5 0 to 1 0 0 m g onc e d a ily.
•If the tr e a tm e nt is s till of little or n o be ne fit: r e c he c k c om p lia nc e , a nd the n
Nocteo:nisf eidnearla p r il is u s e d a s m onothe r a p y ( s e e ta ble of in d ic a tions ) , s ta r t w ith 5 m
c om bin e d th e r a p y ( t h ia zid e d iu r e tic + be ta - bloc ke r or th ia zid e d iu r e tic +
A CE
inhibitor ).
3
onc e d a ily, the n inc r e a s e the d os e e v e r y 1 to 2 w e e ks , a c c or d ing to blood
p r e s s u r e , u p to
1 0 to 4 0 m g on c e d a ily or in 2 d iv id e d d os e s . I n e ld e r ly p a tie n ts , p a tie nts
ta kin g a
d iu r e tic or p a tie nts w ith r e na l im p a ir m e nt: s ta r t w ith 2 .5 m g onc e d a ily a s the r e
is a r is k
of hyp ote ns ion a nd / or a c u te r e na l im p a ir m e nt.
Specfuifriocsceamsied:etPreaOtme(2nt0ofmhygpeorntecnesivdeacirlyis)ism a y, in c e r ta in c a s e s , gr a d u a lly r e d u c e the
A n oc c a s ion a l r is e in blood p r e s s u r e u s u a lly p a s s e s w it h ou t p r oble m s ,
w herea s
a g g r e s s iv e t r e a t m e n t , n ot a bly w it h s u blin g u a l n ife d ip in e , c a n h a v e
s e r iou s
c ons e q u e nc e s (s ync op e , or m yoc a r d ia l, c e r e br a l, or r e na l is c ha e m ia ).
– In patients with hypertensive crisis:
•R e a s s u r e the p a tie nt a nd p la c e him a t r e s t.
•I f d e s p ite th e s e m e a s u r e s t he blood p r e s s u r e r e m a in s e le v a te d , th e
a d d ition of
p r e s s u r e in 2 4 to 4 8 hou r s a nd p r e v e nt e v e ntu a l c om p lic a tions .
– In patients with hypertensive crisis complicated by acute pulmonary oedema:
•T he obje c tiv e is not to nor m a lis e the blood p r e s s u r e a t a ny p r ic e , bu t to tr e a t
the
p u lm ona r y oe d e m a (s e e p a ge 3 0 8 ).
•SmtaerthtyoldroapadPjuOs t:th5e0 b0atsoe7l5ine0 tmr ega/ tdmaeynint o2nctoe3thdeivcirdiseisd isd roes seoslvfoerd2. d a ys the n inc r
Treatment of HTA in pregnancy and pre-eclampsia
A s s e s s r e gu la r ly: B P , w e ight, oe d e m a , p r ote inu r ia , a nd u te r ine he ight.
– For isolated hypertension (w ithou t p r ote inu r ia )
•R e s t a nd obs e r v a tion, nor m a l s od iu m a nd c a lor ic inta ke .
•A ntihyp e r te ns iv e tr e a tm e nt if the s ys tolic B P is ≥ 1 6 0 m m H g or the d ia s tolic
B P is
≥1 1 0 m m H g:
gr a d u a lly by 2 5 0 m g in c r e m e n t s e v e r y 2 t o 3 d a ys , u p t o t h e u s u a l
d os e of
1 .5 g/ d a y. D o not e xc e e d 3 g/ d a y.
or labetalol P O : 2 0 0 m g/ d a y in 2 d iv id e d d os e s th e n inc r e a s e by 1 0 0 to
T he obje c tiv e is to r e d u c e the blood p r e s s u r e to be low 1 6 0 / 9 0 m m H g (or
140/ 90 m m H g
for d ia be tic p a tie nts ) w hile p r od u c ing the fe w e s t p os s ible a d v e r s e e ffe c ts .
F or u nc om p lic a te d hyp e r te ns ion:
•Sta r t w ith a thia zid e d iu r e tic : hydrochlorothiazide P O 2 5 to 5 0 m g onc e d a ily.
•If the p a tie nt is not im p r ov ing a fte r 4 w e e ks , or if tr e a tm e nt is not tole r a te d :
c he c k
c om p lia nc e , a nd the n if the r e a r e no c ontr a -ind ic a tions (a s thm a , u nc ontr olle d
he a r t
fa ilu r e ), c ha nge to a be ta -bloc ke r : atenolol P O 5 0 to 1 0 0 m g onc e d a ily.
•If the tr e a tm e nt is s till of little or n o be ne fit: r e c he c k c om p lia nc e , a nd the n
Nocteo:nisf eidnearla p r il is u s e d a s m onothe r a p y ( s e e ta ble of in d ic a tions ) , s ta r t w ith 5 m
c om bin e d th e r a p y ( t h ia zid e d iu r e tic + be ta - bloc ke r or th ia zid e d iu r e tic +
A CE
inhibitor ).
3
onc e d a ily, the n inc r e a s e the d os e e v e r y 1 to 2 w e e ks , a c c or d ing to blood
p r e s s u r e , u p to
1 0 to 4 0 m g on c e d a ily or in 2 d iv id e d d os e s . I n e ld e r ly p a tie n ts , p a tie nts
ta kin g a
d iu r e tic or p a tie nts w ith r e na l im p a ir m e nt: s ta r t w ith 2 .5 m g onc e d a ily a s the r e
is a r is k
of hyp ote ns ion a nd / or a c u te r e na l im p a ir m e nt.
Specfuifriocsceamsied:etPreaOtme(2nt0ofmhygpeorntecnesivdeacirlyis)ism a y, in c e r ta in c a s e s , gr a d u a lly r e d u c e the
A n oc c a s ion a l r is e in blood p r e s s u r e u s u a lly p a s s e s w it h ou t p r oble m s ,
w herea s
a g g r e s s iv e t r e a t m e n t , n ot a bly w it h s u blin g u a l n ife d ip in e , c a n h a v e
s e r iou s
c ons e q u e nc e s (s ync op e , or m yoc a r d ia l, c e r e br a l, or r e na l is c ha e m ia ).
– In patients with hypertensive crisis:
•R e a s s u r e the p a tie nt a nd p la c e him a t r e s t.
•I f d e s p ite th e s e m e a s u r e s t he blood p r e s s u r e r e m a in s e le v a te d , th e
a d d ition of
p r e s s u r e in 2 4 to 4 8 hou r s a nd p r e v e nt e v e ntu a l c om p lic a tions .
– In patients with hypertensive crisis complicated by acute pulmonary oedema:
•T he obje c tiv e is not to nor m a lis e the blood p r e s s u r e a t a ny p r ic e , bu t to tr e a t
the
p u lm ona r y oe d e m a (s e e p a ge 3 0 8 ).
•SmtaerthtyoldroapadPjuOs t:th5e0 b0atsoe7l5ine0 tmr ega/ tdmaeynint o2nctoe3thdeivcirdiseisd isd roes seoslvfoerd2. d a ys the n inc r
Treatment of HTA in pregnancy and pre-eclampsia
A s s e s s r e gu la r ly: B P , w e ight, oe d e m a , p r ote inu r ia , a nd u te r ine he ight.
– For isolated hypertension (w ithou t p r ote inu r ia )
•R e s t a nd obs e r v a tion, nor m a l s od iu m a nd c a lor ic inta ke .
•A ntihyp e r te ns iv e tr e a tm e nt if the s ys tolic B P is ≥ 1 6 0 m m H g or the d ia s tolic
B P is
≥1 1 0 m m H g:
gr a d u a lly by 2 5 0 m g in c r e m e n t s e v e r y 2 t o 3 d a ys , u p t o t h e u s u a l
d os e of
1 .5 g/ d a y. D o not e xc e e d 3 g/ d a y.
or labetalol P O : 2 0 0 m g/ d a y in 2 d iv id e d d os e s th e n inc r e a s e by 1 0 0 to
