SA Pharmaceutical Journal - Volume 74, Issue 3, 2007
Volume 74, Issue 3, 2007
Author L.H. MabuzaSource: SA Pharmaceutical Journal 74, pp 8 –49 (2007)More Less
It must be remembered that not only are there risk factors predisposing a patient towards hypertension, but that hypertension itself is a risk factor for developing CVD.
Hypertension, cigarette smoking, hypercholesterolaemia and diabetes are the principal risk factors for CVD.
The hypertensive patient's likelihood of developing CVD depends more on the sum of his / her risk factors than on the BP alone.
The risk of CVD in smokers is proportional to the number of cigarettes smoked and how deeply the smoker inhales. Total serum cholesterol values above 6.5 mmol/l are associated with a high risk of CAD.
There is strong evidence that, in patients with insulin resistance, vascular abnormalities such as hypertension and atherosclerosis precede the onset of type 2 diabetes mellitus.
Obesity is strongly associated with the metabolic syndrome (a condition including obesity, high triglyceride levels, low HDL levels, high BP and high fasting plasma glucose levels).
A health care professional should help the patient translate medical targets into realistic personal goals.
Selection of an antihypertensive agent must be informed by the patient's individual risk profile, the likelihood of drug interaction and the accessibility of the medication to the patient.
The Framingham Risk Scale (FRS) is a useful tool to calculate the 5-year absolute risk of a cardiovascular event (new angina, myocardial infarction, coronary heart disease, sudden death, stroke or transient ischaemic attack).
Author S.W.P. MhlongoSource: SA Pharmaceutical Journal 74, pp 18 –62 (2007)More Less
In a nutshell, the following are the key points in family medicine and primary health care with regard to hypertension:
Blood pressure should be recorded accurately.
Most patients with hypertension have neither signs nor symptoms.
Approximately 20% of patients who by all other criteria have essential hypertension have suppressed plasma rennin activity.
Investigations include: urinalysis - protein, glucose and blood, urea and electrolytes, creatinine, random blood glucose, electrocardiogram: there may be changes consistent with left ventricular hypertrophy secondary to hypertension. In the ECG SV1 + RV5 or RV6 (whichever is tallest) > 35 mm (sokolow lyon criterion), random total cholesterol level.
There are 3 important antihypertensive agents for the management of persons without compelling indications: diuretics (thiazide-like and thiazide), angiotensin-converting enzyme inhibitors (ACE-I) and calcium-channel blockers (CCBs). For a full discussion of antihypertensive treatment see the recent South African Hypertension Society Guideline 2006.
Author Andrew McKuneSource: SA Pharmaceutical Journal 74, pp 33 –35 (2007)More Less
Author Gerald JacobsSource: SA Pharmaceutical Journal 74, pp 38 –40 (2007)More Less
Author H.R. SchneiderSource: SA Pharmaceutical Journal 74, pp 42 –48 (2007)More Less