Okay welcome everyone to the discussion of hypertension hypertension we’re going to divide it in a simple way if it’s in the outpatient setting or if it’s in the inpatient setting or if it is urgency if it’s emergency it’s gonna be interesting let’s see in the outpatient setting what do we have we have good calcium channel blocker and we have ace inhibitors
Slash arbs and what else what else do we have what do you think we have arterial garages arterial dilators and we have venus dilators vino dilators okay excellent what else we have diuretics the thyroid excellent what else you have aldosterone antagonist excellent although so i’m talking about is that aldosterone and then what else yeah beta blockers better
Blockers perfect fantastic so the thing that have high efficacy calcium channel blocker and ace inhibitor the one that have moderate efficacy arterial diets or vinod dilators variable efficacy like in certain people thiazide mainly african-american aldosterone antagonist usually different if there’s depending on the cause that’s what that’s not like if it’s
Caused by adrenal disease then you start aldosterone antagonist okay so these are the things beta blocker have low efficacy in managing high blood pressure now we’re gonna talk about the side effects and the benefits for each one of them okay so the calcium channel blocker what do you want to talk about first benefits or side effects i’m gonna start with the
Side effects okay side effects okay side effects could cause peripheral edema but don’t forget a tell anti-angina that’s a benefit it’s anti-anginal that’s the benefit for it okay example i’m ice inhibitor herbs what are the side effects it can cause acute renal failure if given to renal artery stenosis okay cough could cause too angioedema whatever increased
Potassium increase chloride creatine sorry okay what are the benefits when do we use it or i mean someone with congestive heart failure right coronary artery disease and patient with diabetes mellitus excellent perfect i love it thank you for adding this this is this is very important one diabetes the latest for example lisinopral and valsartan are dilators why
What are the side effects hypertension reflex tachycardia that’s the main thing due to hypertension yeah yeah because affect the power substances uh benefits we don’t use it that much so so usually i think emergency we can use it and short acting so it’s not good we know dilators however what are the side effects for the headache due to vasodilation headache and
Has benefit of what what are the side effects hypokalemia and what are the benefits salt sensitive to someone so decrease the salt aldosterone works the opposite of thiazide so at the same antagonist like spironolactone works the opposite of of s thyroid that blocks the thiazide channel so what what would you expect the side effect to type hyperkalemia perfect
And when do we use it in heart failure okay and hyper hyper aldosterone is in hyper aldosterone is what we call i think remember corn syndrome right that’s easy beta blockers what are the side effects for it bradycardia productive dysfunction and depression affect your mood what are the benefits for this though to be used in chf coronary artery disease chronic
Chf yeah like me okay these are the things that we use them the calcium channel blocker like the verapamil delta zam usually given for rate control for atrial fibrillation that’s not given for hypertension another thing alpha antagonist like terazosin you will be given for benign prostate cancer let’s let’s let’s name them in others just so that we don’t confuse
Them others like calcium channel blocker heart selective so dihydropyridine you mean to say these are used for rate control okay another one alpha antagonist like terazosin it’s good if somebody has benign procedure hyperplasia plus hypertension we can do that and loop diuretic what else loop theoretics okay affect the volume there’s a risk of hypotension okay
The other thing with beta blockers too better blockers that are non-selective libitolo like cardioselective yeah there’s one that cardio selected metoprolol and there’s there’s one so there’s different with beta blockers this this there’s difference some of them have no alpha some of them have some alpha some of them have most alpha most alpha can be given like la
Bitelol given an end-stage renal disease some alpha like carvedilol and no alpha like it metaphor affect the alpha channels okay so this everything and the other thing never clonidine why there’s never hypertension rebound hypertension okay you’re never afraid of everything no patient setting unless now what you’re going to talk about now in the inpatient what
Do we start with what do we give in the inpatient setting how do we treat hypertension in the inpatient study what are the options we have clonidine okay and what else do we have globutarlor the beta excellent what else hydra laziness hydrolyzing perfect okay clonadine you can start with 0.5 one milligram to 0.3 milligram diabetic below 10 milligrams 10 milligram
Q four hours prn and the hydrolyzing you can do 10 milligram q4 hours too same thing okay systolic blood pressure usually when the soil blood pressure less than 180 and heart rate more than 90 or distilled blood pressure more than 100 okay that’s when you consider these things like if it’s very high now what is the difference between hypertensive urgency versus
Emergency in emergency we don’t have any ongoing end-organ damage excellent so this is basically the the difference is that and organ damage so there’s emergency the only difference is that if you put it on and again yeah i’m going and organ damage okay emergency there’s no hand over damage so how do we manage and the blood pressure usually in emergency what is
It what is it the value of blood pressure usually generally the systolic is greater than 180 and the diastolic is greater than 1 10 or 120. so emergency either more either more organ damage or 220 more than 220 over 110 okay so that’s the emergency what do we do how do you man manage we first uh we first send the patient to er admitted okay yeah we do that and
After that we calculate the mean arterial pressure it’s an important and then second thing we start we can do nicardipine if it is related to raised intracranial pressure exactly there’s an increase in taking pressure now the second thing we we try to decrease mean arterial pressure to 25 percent low and one to six hours of the baseline okay with the baseline
We would decrease that and the fourth thing what do we do we give oral medications okay medication so we said oh let me just send that we said the high end emergency is more than 220 over 110 how about the urgency it should be more than what 180. excellence it’s been more than 180 over 100 and usually there’s this is when you have like a good emergency medicine
Physician they will take care of it so they you can do a nitroglycerin patch if there’s an intraglycerin patch you just gotta remove the patch that’s the most important thing before you put the admit orders that’s the first thing after that you can do clonidine po oral okay and then you give what iv medications okay so that’s basically with urgency first you give
Oral medication second temporize and thirds observation three things okay another medication temporarily iv medications you can do heavy medications like label today some of these calcium channel occur pinot go pan this substance so in a summary if there’s an outpatient management we can do calcium channel blocker beta blocker they all have anti-anginal benefits
The ic inhibitor for chf of coronary artery disease arterial dilator not so much we use it on those antagonists also for chf beta blocker also for chf so these are the benefits that with controlling hypertension can be used for other medical problems the nutrition and patient we give clonidine labato or hydralazine okay we try to drop it slowly to avoid ischemia
Tissues and in emergency we calculate the mineral tera pressure we’re doing the car of the peen try to degrade the mineral the patient 25 percent in one to six hours and then we give our medications in emergency we do planet in and iv medications okay and uh after we remove the patch and intraclassical patch they have one and basically that’s the summary blood pressure peace out
Transcribed from video
COMMON MEDICAL PROBLEMS 3 HYPERTENSION By Ali Kaizen
