Transcript Investigations

Investigations:
• Urine examination.
• Serum K.
• Serum creatinine.
• Blood Sugar.
• Hb.
Investigations:
• Serum uric acid.
• Lipid profile.
• ECG.
• Fundus.
• More extensive
investigations are needed
in secondary hypertension.
BP levels above which hypertension in
child should be considered:
Common causes of hypertension according
to age
Evaluation of asymptomatic hypertensive
child:
Pediatric doses of anti
hypertensive drugs:
Substances that can elevate BP
Why to treat HTN?
– 52%  in CHF
– 35-40%  in stroke morbidity and
mortality
– 35%  in LVH
– 20-25%  CAD events
– 21%  vascular mortality
Benefits of Lowering BP
• Sustaining a 12 mmHg reduction
in SBP over 10 years will prevent
one death for every 11 patients
treated with Stage I HTN
w/additional CVD risk factors
JNC-7 Management of BP for
Adults
BP classification
Lifestyle 
Normal
Encourage
No compelling
indication
Compelling indication
< 120/80
Prehypertension
Yes
No drug tx
Drugs targeted for the
compelling indications
Yes
Thiazide for most
Drugs targeted for the
compelling indications
Yes
2 drug combo
including thiazide
Drugs targeted for the
compelling indications
120-139 / 80-89
Stage I HTN
140-159 / 90-99
Stage II HTN
> 160 / > 100
Treatment Outline
• Goals of Therapy
• Lifestyle modification
• Pharmacologic treatment
• Follow-up and monitoring
Goals of Therapy
• Reduce CVD and renal
morbidity and mortality
• Treat to BP < 140/90 mmHg
or BP <130/80 mmHg in
patients with DM or less in
patients with chronic KD
Goals of Therapy
• Achieve BP goal especially in
persons > 50 years of age
• Maintain QOL
• Minimize side effects
Lifestyle Modification
Modification
Approx. SBP reduction (mmHg)
Weight reduction
5 – 10 / 10 kg
Adopt DASH diet
8 – 14
Dietary Na+ restriction
2–8
Physical activity
4–9
Moderation of alcohol
consumption
2–4
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Lifestyle Modification
• Works best in motivated individuals
• Initiate at prehypertension classification
• Obesity  risk for HTN and DM
• If > 20% over ideal body weight (IBW)
– considered obese
– Decrease intake by 500 cal/day
– Increase exercise and activity
One KG decrease in BW is
accompanied by reduction
of 1.6 and 1.3 mmHg in
systolic and diastolic BP.
Salt sensitivity is more common in:
• Elderly.
• Blacks.
• Type 1 diabetes.
• Secondary hypertension.
Guidelines for moderate salt
restriction:
Dietary potassium:
• Diet rich in fruits and vegetables is
superior to pills.
• Potassium supplements should be
avoided in: renal insufficiency, with
diuretics, ACE inhibitors or ARBs.
Food rich in potassium: