I / Definition
+ HTA is consensually defined as BP ≥ 140/90 mmHg.
+ Measured in the office and at least two measurements per consultation, during three consecutive consultations over a period of 3 to 6 months.
★★★ Pre-hypertension: SBP> 120 and <139 mmHg, DBP> 80 and <89 mmHg
II / Etiology
+ 90% primary hypertension: essential, idiopathic
+ 10% secondary hypertension (REV-SGC)
- Renal: renal artery stenosis, polycystic kidney disease, GNC, .....
- Endocrine: pheochromocytoma, Cushing's syndrome,
Conn's syndrome, acromegaly, hyperparathyroidism.
- Vasculorénale
- Aortic coarctation
- Pregnancy
- Toxic medication: corticosteroids, NSAIDs, .....III / Risk Factor
+ Age (> 50 years in men,> 60 years for women)
+ Heredity
+ Food (↑ salt)
+ Smoking
+ The weight (obesity)
+ Stress
+ Physical exertion and physical inactivity
+ Diabetes (treated or untreated)
+ Dyslipidemia:
- LDL cholesterol ≥ 1.60 g / L (4.1 mmol / L)
- HDL cholesterol ≤ 0.40 g / L (1 mmol / L) regardless of sex
+ Familaux history of hypertension
+ Familaux history early cardiovascular event:
- Myocardial infarction
- Early stroke (<45 years)
IV / Hypertention Measurement Method
+ Tensionmètre
+ At rest for 10 minutes → heart abnormal low
+ Good condition quiet, alcohol tobacco distenceV / Diagnstic
1-Clinical Examination
+ No symptoms and the systematic review
+ Symptomatology quend to raised BP
- Headache.
- Tinnitus / phosphenes.
- Dizziness
- Palpitations.
- Chest pain.
- Asthenia
- Dyspnea
- Epistaxis.
- Hematuria
- Nocturia
2-Additional Examination
+ ECG LVH (Left Ventricular Hypertrophy) electric,
ischemia, rythne disorder
+ BU (Urinary Bandelatte): hematuria, proteinuria
+ Serum potassium without withers: Research serum potassium <3.9 mmol / L
+ Creatinine with eGFR (GFR): Research kidney failure
+ Blood Glucose young and exploration lipid abnormality
(TC, HDL, LDL, TG): assessment CVRF
+ Haemoglobin, hematocrit, serum uric acid microalbuminuria
VI / Classification
+ HTA stage I (mild): NO: 140-159 mmHg,
PAD: 100-109 mmHg
+ HTA stage II (moderate): NO: 160-179mmHg,
PAD: 100-109mmHg
+ HTA stage III (severe): SBP ≥ 180 mmHg,
DBP ≥ 110 mmHg
VII / Complication
+ Heart Complication: -HVG (Left Ventricular Hypertrophy), IC
-Insufficient Coronary, artery disease
+ Neurological Complication: stroke, convulsion crisis, retinopathy
+ Renal Complication: IR
+ Other: -éclampsie
- aneurysm
- Aortic dissection
- Malignant hypertension
VIII / Treatement
1- Purpose
↓ + mobility / cardiovascular mortality
+ Maintain SBP <140 mmHg and DBP <90 mmHg
+ PES FdR cardiovascular
2- dietary habit Rules "WRSTA"
+ Weight: BMI <25 kg / m²
+ Regular physical activity
+ Salt decrease <6 g / d
+ Tobacco stop
+ Alcohol to decrease <30 g / day
3- treatements médicamentaux
A- Diuretic
+ Effect: - natriuretic and vaso-relaxing
→ transient decrease in blood volume and
↓ prolonged resistance dice péripliérique
+ Type: thiazide -diurétique: Esidrex 12.5-25 mg / J
-diurétique cove: Lasix 20-40mg
-diurétique sparing of postassium:
. Spironolactone 12.5-25 mg / J
. Amiliride 10-20 mg / J
B-Beta Blockers:
+ Effect: chronotope Action (CP) - negative inotropic
(Contraction) and TA DC → ↓
+ Type: -selective: not vasodilator:
Atenolol (Ténomine 50-100mg / J)
-not selective: vasodilator:
labetalol (Trandate 400mg x 2 / J)
+ Contraindications: - Asthma.
- Non controlled heart failure
- Pregnancy.
- Unbalanced Diabetes
- PUD.
- Raynaud's Syndrome
- Bradycardia.
- Cardiogenic shock
- Symptomatic hypotension
C-Calcium inhibitor (IC)
+ Effect: inhibits the entry of Ca + in smooth muscle cells of arterial vasodilation paroire →
+ Type: -Dihydropyridine: (Not bradycardia).
. Nicadipine: 20mg or 50mg Loxene
. Nifedipine: Adalat 20mg (2 x 1CP / J)
.Amlodipine: Amlor 10-20mg / J
.Nitrendipine 20mg / J
-Bradycardisant. Virapamil (Isoptine 120-240mg / J)
. Diltiazem (Tildiem 200-300mg / J)
. Bepridil (unicordium)
+ Side effect: - IMO rougeus, headache
-hTA orthostatic
-constipation
-Allongement QT
-BSA And BAV
+ Note: - angina, hypertension, arrhythmia
- Other: obstrectif heart disease, PAH
+ Contraindications: - Pregnancy, Allergy
- Uncompensated heart failure
- Sinus dysfunction, high BAVdegree
D-converting enzyme inhibitor (ACE)
+ Effect: Blocking → converting enzyme reduced angiotensin II
formation and increases the rate of vasodilator bradykinin
by inhibiting its degradation
+ Type: - perindopril (Coversyl 4-8mg)
- Enalapril (20mg Renilex / J)
- Captopril (Lopril 50-100mg / J)
- Lisinopril (Zetril 5-10mg / J)
+ Note: IVG + HTA
+ Side effect: -hTA
- RFID (efferent glomerular arteriole vasodilatation
→ ↓ renal perfusion)
- Hyperkalaemia
- Neutropenia
- Proteinuria
E-Antagonist angiotensin II receptor
+ Effect - selectively inhibits the AT II receptor
- AT II neutralizes circulating and tissue
+ Type: - Losartan (Cozaar 50-100 mg / J)
- Irbesartan (Aprovel 150-300 mg / J)
- Valsartan (Nisis 80-100 mg / J)
+ Note: - essential hypertension
- IC
- Nephropathy diabètiquediabètique
No comments:
Post a Comment