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Racial, genetic, life style influence:
Type extent of complications (renal failure and •
stroke are more common in blacks).
Response to dietary therapy (low salt reach •
fruit and vegetable diet).
Antihypertensive drugs (less control with ACE •
inhibitor and beta blockers in blacks).
Hypertensive patient can be categorized
according to their risk profile:
Group a (low risk): no TOD, no other risk •
factors and no associated cardiovascular
disease.
Group b (intermediate risk): one or more •
additional risk factors but not diabetes or
TOD.
Group c (high risk): diabetes, TOD and/or •
associated cardiovascular disease.
CV risk factors:
TOD:
How to measure blood
pressure?
Cuff size:
12 X 26cm bladder in most adults. •
12 X 40cm bladder in obese (arm •
circumference > 33cm).
10 X 18cm bladder in thin adults or •
children (arm circumference < 26cm).
Before taking blood pressure the patient
should:
Avoid smoking , eating and coffee for at least two hours •
prior to measurement.
Urine should be voided if necessary. •
Talking should be avoided five minutes before and •
during blood pressure measurement.
Blood pressure should be measured in quiet room with •
comfortable temperature.
Right arm (if volume of pulse is equal in both arms). •
Supine or sitting (standing in special conditions). •
Arm should be supported. •
Cuff is directly to skin. •
Bladder is centered on brachial artery. •
Edge of the cuff is 3cm above the elbow. •
Use palpatory method first. •
Inflate to 30 mmHg above pulse oclusion pressure. •
Use the cone of stethoscope. •
Cone is firmly applied over brachial artery. •
Cone is not touching cuff. •
It isn’t essential to keep manometer at heart level
•
Repeated inflation with incomplete deflation will damp •
korotkov sounds.
Standing BP should be taking in:
First visit evaluation. •
Elderly patients above 60 years. •
Diabetic patients. •
Patients with postural symptoms. •
Patients on potent VD or large doses of diuretics. •
Standing BP should be measured 2 minutes after •
standing.
Medical history:
Previous levels of high BP and history of •
treatment.
Symptoms of TOD. •
Symptoms suggestive secondary •
hypertension.
Current drug intake (contraceptive pills, •
NSAI).
Medical history:
Co morbid conditions (diabetes, bronchial •
asthma, gout, migraine, depression).
Family history of diabetes, CAD, stroke or renal •
disease.
Life style factors: salt and fat intake, smoking, •
physical and alcohol consumption.
Clinical examination:
BP measurements. •
Weight and height. •
Peripheral, femoral pulses and neck •
bruits.
Cardiac examination: LVH, 3rd HS, loud •
2nd sound, ejection murmur over aortic
area and AR murmur.
Clinical examination:
Abdominal examination: renal •
mass, aortic aneurysm or bruits.
Chest examination: OLD. •
Neurological examination: level •
of consciousness speech, motor
power, lateralization and PN.