Hypertension
RAASD PC +7
NSAIDS?
In an exam question, if asked about management then must tell the whole story. About the approach, stages and life style modifations, medications, follow up etc.
This NICE guidelines is actually old and outdated and you dont need to now devide by age and start ACD. Can start with any drug. However 1. Must consider other comorbid factors when choosing a drug 2. American blacks no use ACE because they dont have the receptors
For very high, its better to start with a combination of two drugs. But some brands have already combined 2 in 1. So use that instead.
Pharmacology of starting this drugs? Start before sleeping and after diziness dsappears use in day time?? Attach pharmcology of all of these drugs involv.ed.
Need to know classifciations like centrally actting vs peripheraly acting=
Beta blockers avoided in acute heart failure.
Betablockers + calcium channel (verapamil/diltiazem) shouldnt be used in combination because can cause bradycardia. Others all can be used. Only this combination is problematic.
UKUse single dosing per day (long release) and combination better,
Special situations
Anlodiidine better but nefedipine effect can be cancelled by porponolol.
Diltiazemam and verapimil not used.
Stable anginer ⇒ first choice A
Need to know contradindications and special indications. Others dont that much need,
Above can be asked in emergency viva and essay!!
Start thrombolysing only after stabalising blood pressure.
Dont bring down too fast to preserve pushing ability to save penumbra.
Usualy nifedipine. And methyldopa and labetolol is added.
Isolated systolic BP is more common inelderly
Incentives given to doctors and nurses to control BP is more cost effective to the government!
Diuretics (HCT) should be preferably avoided in DM!
Use to be called malignant hypertension!
If asked complications, tell from all systems. One mark for all systems, not four from one!
These values you better now because emergencies can be asked for viva and everywhere!
In exams better to answer using these guidelines and definitions, but if using orevious guidlines then must also use previous defintions. Becasue stage 1 and tsage 2 definitions is differetn in NICE and american guidelines. So if using NICE management (55 and ACD) guidelines then must use NICE defintions!!
CASE
Other case book
Young hypertension guide to long cases
