Search In this Thesis
   Search In this Thesis  
العنوان
Comparison of different guidelines in management of hypertension and role of family physicians /
المؤلف
Hamed, Amani Nashat.
هيئة الاعداد
باحث / امانى نشأت
مشرف / عبدالمجيد احمد
مشرف / خالد هيصم
مشرف / عبدالمجيد عبدالمجيد
الموضوع
Family Medicine. High blood pressure.
تاريخ النشر
2012.
عدد الصفحات
148 P. :
اللغة
الإنجليزية
الدرجة
ماجستير
التخصص
ممارسة طب الأسرة
تاريخ الإجازة
1/1/2012
مكان الإجازة
جامعة قناة السويس - كلية الطب - الاسره
الفهرس
Only 14 pages are availabe for public view

from 148

from 148

Abstract

Hypertension is one of the most important public health problems worldwide, accounting for 7.6 million premature deaths, 92 million disability-adjusted life years, 54% of stroke, and 47% of ischemic heart disease in 2001.
Better hypertension management leads to improved healthoutcomes. A large systematic review of 147 trial reports on themanagement of hypertension has shown that a reduction of 10 mm Hg in systolic blood pressure and 5 mm Hg in diastolic was associated with a 20% reduction of coronary heart disease and 32% reduction in stroke in one year.
Hypertension is the most important preventable risk factor for premature death worldwide. It increases the risk of ischemic heart diseasestrokes, peripheral vascular disease, and other cardiovascular diseases, including heart failure, aortic aneurysms, diffuse atherosclerosis, and pulmonary embolism. Hypertension is also a risk factor for cognitive impairment and dementia, and chronic kidney disease. Other complications include hypertensive retinopathy and hypertensive nephropathy.
Diagnosis is based on the finding of elevated blood pressure on three separate occasions. Accordingly, a systolic blood pressure of 140 mm Hg or greater and /or a diastolic blood pressure of 90 mm Hg or greater, taken on two separate occasions
Laboratory screen, including 12-lead electrocardiogram, urinalysis, fasting blood glucose or A1c, hematocrit, serum sodium, potassium, creatinine (estimated or measured glomerular filtration rate), calcium, and lipid profile (total cholesterol, high-density lipoprotein [HDL] cholesterol, low-density lipoprotein [LDL] cholesterol, and triglycerides)
Risk assessment and treatment based on blood pressure level, presence or absence of target organ damage, and other risk factors, such as smoking, dyslipidemia, diabetes.
Secondary hypertension is a type of hypertension with an underlying, potentially correctable cause. A secondary etiology may be suggested by symptoms (e.g., flushing and sweating suggestive of pheochromocytoma), examination findings (e.g., a renal bruit suggestive of renal artery stenosis), or laboratory abnormalities (e.g., hypokalemia suggestive of aldosteronism). Secondary hypertension also should be considered in patients with resistant hypertension, and early or late onset of hypertension.
The management of hypertension is cost-effective; treatment with medication results in improved health outcomes (higher quality-adjusted life-years). However, awareness of hypertension, its treatment and control are far from adequate worldwide.
Management of Hypertension include Prompt diagnosis,Assessment of the risk,Achieve target levels of BP by Lifestyle,mono or Combination therapy,Promote adherence.
Lifestyle modifications, including weight reduction and maintenance, the Dietary Approaches to Stop Hypertension (DASH) diet, reduction of dietary sodium, moderation of alcohol intake, physical activity, tobacco avoidance, increase in dietary potassium intake, relaxation and stress management .
Drug therapy, including thiazide diuretics, beta-blockers, angiotensin-converting enzyme inhibitors, calcium channel blockers, angiotensin receptor blockers, and combinations of these drugs
Patient education and shared management plane are cornerstones in achieving BPgoals.
Referral for consultation for resistant hypertension and for further work up is the choice when BP goals can not be reached.
Follow-up and continuing care is provided either in primary care or to be shared with specialests.
Major Outcomes to be Considered are either adequate control of blood pressure (<140 mm Hg systolic and <90 mm Hg diastolic) or Risk of non-fatal and fatal cardiovascular disease ,Morbidity and mortality from cardiovascular disease.
In this study I found that screening and early detection of hypertension help in control and reduce its complication and I found that managing prehypertension stage by life style modification is still the gold standard of preventing or postponing a transition to frank hypertension. Hypertension is to be managed in consideration of assessd risk and comorbid conditions ,choice of medication depend on level of BP ,risk factors and comorbidities .Patient motivation is a cornerstone in adherence and controle of hypertension ,awareness and self monitoring need to be focused on and workup to be done to achieve better information sharing between health systems and community. Prevention programs are also needed to emphasize the importance of these features.acssesability of care of hypertensive patients need to be assured by every mean ,home visits may be the best solution for those who find it diffecult to follow up in primary care.shared care with specialist is advisable in case of suspected secondary hypertension ,resistant hypertension and in all cases of failure to reach BP goals.