SPPS249 Hypertension042511-printerfriendly

SPPS249 Hypertension042511-printerfriendly - Hypertension...

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Unformatted text preview: Hypertension I: Causes, consequences, diagnostic evaluation. Sophomore medical curriculum UCSD SOM-208, Spring 2009 D.T. OConnor, MD WHY IS HYPERTENSION IMPORTANT? High prevalence ~ 25% (~50% in some populations!). Risk: CV morbidity and mortality. Prevention of risk, with treatment. WHAT IS BLOOD PRESSURE? Flow = pressure/resistance CO = MAP/SVR MAP = (CO)(SVR) CO = cardiac output MAP = mean arterial blood pressure SVR = systemic vascular resistance So . . . BP is hydrostatic uid pressure (in cm blood or mmHg). BP must result from either CO, or SVR (or both). Drugs that BP must either CO, or SVR (or both). Indirect (non-invasive) BP measurement: Auscultation of Korotkoff sounds over brachial artery. Sphygmomanometer. Now you hear it . . . Now you dont . . . Adverse consequences of hypertension: Target (end) organ damage in heart, brain, kidneys, arteries. Hypertension II: Treatment of patients with hypertension. Antihypertensive treatment is working (preventing complications) . . . Antihypertensive treatment reduces hypertension target organ damage virtually across the board . Antihypertensive treatment: Dramatic results in severe hypertension. Antihypertensive treatment: Signi cant results even in f mild hypertension. HDFP trial (NHLBI) HOT trial (Hypertension Optimal Treatment; Lancet, 1997) Antihypertensive treatment: how far to go? Goal BPs? SBP <135 mmHg, DBP <85 mmHg. Beyond that: no additional bene t (risk reduction). f Antihypertensive treatment: Can we begin with measures short of drugs? (And thus avoid medication side effects?) Non-pharmacological treatment. Antihypertensive treatment: Can we begin with measures short of drugs? Avoid (if possible) NSAIDs (PGSIs) or vasoconstrictors (decongestants). Antihypertensive treatment: Can we begin with measures short of drugs?...
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SPPS249 Hypertension042511-printerfriendly - Hypertension...

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