Hypertension : Treatment Concepts

Dr Jitendra Ingole, MD Medicine

Associate Professor

Health & Happiness is inherent desire of every living being.

Technological advances have increased

dramatically.

But Are We Really Healthy ?

Preliminary Findings

• Hypertension Prevalence 12%

• 13 Undergraduate Students

Courtesy : Dept. Of Preventive & Social Medicine , SKNMC , Pune

Pressing Need of The Hour to Identify and Treat Hypertension

Concepts

What is relevant today, may not be relevant tomorrow.

Don't let the guidelines confuse you...

Sublingual Nifedipine

Dual Benefit Drug

Dual Benefit

HTn and Migraine Beta Blocker

HTn and Diabetes ACE / ARB

Beta Blockers : A Word of Caution

Do NOT STOP Beta blockers abruptly.

Paradoxical Use Of Anti-HTn drug

Be ready for Surprise !

Prazosin

Antihypertensive drug : When used in Scorpion sting, it (paradoxically) causes deloading by which BP rises.

The indication is specific to SCORPION STING.

BP 148/98 mmHg

?

Dose & Timing of The Drug

The Salt Debate

Vadapav : Salt Per serving 400mg

Chips : Salt Per serving 500mg

Papad : Per serving 200mg

Per plate Pavbhaji : 670mg

Coke : 50mg

Average of 10 gram of Salt in a day !

Sodium and Common Salt aren’t necessarily the same thing

Frassetto LA, et al. Dietary sodium chloride as predictor for degree of hyperchloremic metabolic acidosis in healthy humans. Am J Physiol Renal Physiol. 2007 Aug;293(2):F521-5

Na+ Cl-

Hypertension due to Sodium Bicarbonate Vs Sodium Chloride

Luft FC,Zemel MB, Sowers JA, Sodium bicarbonate and sodium chloride: effects on blood pressure and electrolyte homeostasis in normal and hypertensive man. J Hypertens 8:663–670

Bone Loss

Barzel US (1995) The skeleton as an ion exchange system: implications for the role of acid-base imbalance in the genesis of osteoporosis. J Bone Miner Res 10:1431–1436

Muscle (Protein) Loss

Mitch WE, Medina R, Grieber S, et al. Metabolic acidosis stimulates muscle protein degradation by activating the ATP dependent pathway involving ubiquitin and proteasomes. J Clin Invest. 1994; 93:2127–2133.

Salt Sensitive and Salt Insensitive

The bottom line is: We never evolved to eat a high salt diet

What to use for Taste then ?

Salt is Not your Enemy

Many Grey areasMany Grey areas

Many Grey areas

Many Grey areas

Many Grey areas

Diuretic drugs

Check Electrolyte levels Periodically

Prolonged Diuretic Therapy

Patients may suffer seriously due to severe Unrecognised Hyponatremia

Stress and Hypertension

Can You swim as good as me in water ?

Home Monitoring Of Blood Pressure

Sleep

Sleep & Hypertension

Sleep deprivation has been linked to increases in incidence and prevalence of hypertension.

Likewise, sleep disruption also increases the likelihood of having hypertension.

Vitamin D & Hypertension

Vitamin D and Hypertension

Data from cross-sectional studies report that low 25-hydroxy vitamin D is associated with higher systolic blood pressure and higher incidence of hypertension.

Tamez H, Thadhani RI. ; Vitamin D and hypertension: an update and review : Curr Opin Nephrol Hypertens. 2012 Sep;21(5):492-9.

Treatment

Exercise

Drug Compliance

Prescription Writing

Checklist

• Starting Proper drug • In Proper dose • At Proper Interval• Sleep• Stress• Drug Compliance • Home BP monitoring• Creative Reminders• Periodic Evaluation• Diet

• Exercise• Obese patients : Reduce

body weight • Salt restriction • Electrolytes evaluation • Vitamin • Check for side effects • Modifying drug dosage if

required

Patient Story

Thanks

To

All Of You

T H A N K S

Dr Jitendra Ingole, MD

Associate Professor, Medicine