1 1

Ayan Adhikary Mahammad Samim Mondal

Kushal Talukdar

Burdwan Medical College amp Hospital

A Case Report On

HYPERTENSION

2 2

HypertensionDefinition-The lateral pressure exerted by a flowing blood column on a blood vessel is called Blood Pressure The chronic elevation of this blood pressure is known as Hypertension [acc to (JNC7) Systolic BP- ge140mmHg Diastolic BP- ge 90 mmHg]

Hypertension

Primary Essential(A disorder of unknown

origin affecting the normal regulating

mechanism seen in 80-90 pts)

Secondary(Due to an underlying

disease process)

Classification[JNC7]

Systolic pressure (mmHg)

Diastolic pressure (mmHg)

Normal 90-119 60-79

Prehypertension 120-139 80-89

Stage 1 140-159 90-99

Stage 2 ge160 ge100

Isolated Systolic Hypertension

ge140 lt90

3 3

Drugs In My Hand

4 4

HISTORY amp CLINICAL FEATURES

Suffering from subacute transient headache with pain in the limbs easy fatigability and dizziness

She has no loss of appetite amp no sleep bladder or bowel disorder

Menopause attained 7 yrs ago no OCP usage

She has no history suggestive of any major illness or relating to this condition

No history of drug addictionabuse amp no drug allergy

On physical examination the patient is alert and cooperative

On systemic examination nothing of significance was found

5 5

The patient is suffering from Primary Hypertension

Inscrip

tion

(Initial)

(Subscription amp Signature)

Criticism Superscription Salt restricted diet Brand Names Tazloc-trio+Amlodipine Time of intake not

specified OD PTML 500 Secondary hypertension is

not excluded

WHO

6 6

Angiotensinogen

Angiotensin I

Angiotensin II

AT1 receptor AT2

receptor

Other ATreceptors

Bradykinin

Inactive

peptides

VasodilationAttenuate growth anddisease progression

ACEinhibitors

AIIRAs

PL-C

PhospholipidIP3 DAG

[Ca Activation Of MLCK

ReninAliskiren

Vasoconstriction BP

Adrenaline Release BP

Other BP Lowering Mechanisms1Central amp peripheral sympathetic stimulation2Release of aldosterone amp adrenaline from adrenals3Renal actions promoting salt amp water reabsorption4Vasopressin release amp Cardiac growth promotion

Pharmacokinetics Administered orally with bioavailibility-

33Telmisartan has no active metabolite peak action within 3hrs amp lasts 24hrs (20-80mg OD)

Advantage over ACE inhibitors -No cough angioedema dysgeusia amp complete inhibition of AT2 with AT1 sparing effect

KINETICSDYNAMICS

Angiotensin Receptor Blockers

7 7

Thiazides are the drug of choice in uncomplicated hypertension available for parenteral administration

Chlorothiazide(05-2gm in two divided doses)Indapamide(25gm single daily dose) etc

PharmacokineticsAdministered orally with Bioavailability=9-56 (dose dependent)t 12 (chlorothiazide)= 15 hrs

ContraindicationsDyslipidemiaGoutHypokalemiaErectile Dysfunction

Diuretics

8 8

Calcium Channel Blockers

Contraindications Unstable angina Breastfeeding Aortic stenosis

DOC for low renin hypertension amp isolated systolic hypertensionPharmacokineticsOral bioavailability 65-90(half life-30-50hrs) (Dosage-tab 5-10mg OD)

Patient of severe CAD CCB can increase anginal frequency amp severity

Excessive lowering of BP in patients taking other BP medication

9 9

severe hypertension ( SPge180mmHg DPge120mmHg) acute impairment of one or more organ

systems like CVS CNS amp renal may be irreversible organ

damage

Hypertensive

Emergency

bull Sodium Nitroprusside iv 20-300 μgmin

bull Glycerol Trinitrate iv 5-20 μgminbull Esmolol amp Phentolamine

Mean BP should be lowered by no more than 25 within minutes to few hours amp then gradually to not lower than 160100 mmHg

10 10

Hypertension with other

complication

Bishnu Saha (48M)

Pulse-82min BP- 14080mmHg Δ HTN ċ UTI)

Reshmi Mondal(25FHindu)BP-15090

Pulse-84min PregnantΔ Hypertensive Disorder

Gopal Das(60M)

BP-190100Δ HTN ċ COPD ċ LVF

Narayan Saha(66M)

BP-180100Pulse-90min

Δ Duodenal Ulcer ċ HTN

Lalmohan Pramanik(62M)

Pulse-80min BP- 16094 PP-190 Urine sugar-++Chest clear

CVS- S1 available)Δ DM-type-II ċ HTN

Tab A

mlodipine 15mg 1 ta

b once

dailyco

nt

Tab L

efodoxamine(250mg)1tab

BD5days

Tab Parace

tamol(500mg)

Tab Hydralazine (5

-10 mg iv every 15-20 min )

Folic acid supplement

Fluid

salt

rest

ricte

d die

t

Tab A

mlo

dipin

e 15m

g 1 ta

b once

dailyc

ont

Tab T

elest

a 1 ta

b once

daily

cont

Tab P

arindo 1

tab B

Dcont

Telm

isarta

n(80)1

0D(1hr)

Carvedilo

l(31

25)10D(1

hr)

Nitroglyce

rin(6

4) 1

BD (1hr)

Aspiri

n(75)1

0D

Atrovast

atin(1

0) OD

Tiotro

pium

Br

Form

etero

l

Tab G

lyco

met G

P (1 ta

b At b

reakfa

st)

Tab M

etform

in(5

00mg) 1

tab O

D

Tab T

enalapril

(25

mg) B

D

Tab S

tato

r(10m

g) OD

Comparative Study

11 11

CVS (3530)Respiratory(118)GI(206)

ADRs(Adverse Drug Reactions) are among the leading cause of mortality amp morbidity Regular monitoring of ADR is important specially in a chronic asymptomatic disorder like HypertensionThe following study was conducted in med OPD of Majeeida Hospital New Delhi CCBs are the most prescribed drugs (317) amp β blockers are associated with highest no of ADR (75)

PHARMACOVIGILANCE amp ADR

Hypokalaemia

Carbohydrate

intolerance

OedemaTachycardia

Dysgeusia Nausea

Cough

Angioedem

ia

Approved Combinations (JNC7)

Combinations better avoided

ACEInhibitorARB+ Diuretics

Adr blocker + Clonidine

HydralazineDHP+ Beta-blocker

Nifedipine+ Diuretic

VasodilatorSympatholytics+ Diuretic

Hydralazine+DHP

12 12

Rational Drug Therapy

Drug Interaction

Lithium Thiazide(Pharmacokinetic intr)Increased toxicity of lithium

Verapamil Propranolol (Pharmacodynamic intr)Heart Failure PrecipitationAV block amp sever bradycardiaEnalapril Spironolactone(Pharmacodynamic intr)HyperkalaemiaCardiac arrythmias

13 13

Amlodipine Tablet 5 mg (as maleate mesylate or besylate)

Bisoprolol Tablet 125 mg 5 mg 1048710 includes metoprolol and carvedilol as alternatives

Enalapril Tablet 25 mg 5 mg (as hydrogen maleate)

Hydralazine Powder for injection 20 mg (hydrochloride) in ampouleTablet 25 mg 50 mg (hydrochloride)

Hydrochlorothiazide Oral liquid 50 mg5 mlSolid oral dosage form 125 mg 25 mg

Methyldopa Tablet 250 mg

sodium nitroprusside

Powder for infusion 50 mg in ampoule

WHOrsquos current European policy

Priority interventions of the action plan for noncommunicable diseases 2012-2016 include

Promotion of a healthy diet through marketing and fiscal measuresElimination of trans fats amp Salt reductionCardio-metabolic risk reduction assessment and managementPromotion of physical activity and mobility

AmlodipineAtenolol ChlorthalidoneClonidine Hydrochloride Enalapril MaleateLosartanpotassiumMethyldopaNifedipine PropranololSodiumNitroprusside Terazosin

WHO Essential Drugs

Indiarsquos Essential Drugs

14 14

War against Hypertension

H-BP v

s W

HO Risk factorsA diet high in saturated fatExcessive salt consumptionOverweight and obesityA sedentary lifestyle and lack of exerciseExcessive alcohol consumptionSmokingUn-managed stressA family history of high blood pressureBeing over 65 years of ageCo-morbidities such as diabetes

WHOHigh B

P

Manage high blood pressure byeating a healthy diet reducing salt intake exercising regularly stopping smoking reducing alcohol consumptionmanaging stress having regular blood pressure checksCommunity-based efforts to reduce blood pressure and stroke in Japan

15 15

• Slide 1
• Slide 2
• Slide 3
• Slide 4
• Slide 5
• Slide 6
• Slide 7
• Slide 8
• Slide 9
• Slide 10
• Slide 11
• Slide 12
• Slide 13
• Slide 14
• Slide 15

2 2

HypertensionDefinition-The lateral pressure exerted by a flowing blood column on a blood vessel is called Blood Pressure The chronic elevation of this blood pressure is known as Hypertension [acc to (JNC7) Systolic BP- ge140mmHg Diastolic BP- ge 90 mmHg]

Hypertension

Primary Essential(A disorder of unknown

origin affecting the normal regulating

mechanism seen in 80-90 pts)

Secondary(Due to an underlying

disease process)

Classification[JNC7]

Systolic pressure (mmHg)

Diastolic pressure (mmHg)

Normal 90-119 60-79

Prehypertension 120-139 80-89

Stage 1 140-159 90-99

Stage 2 ge160 ge100

Isolated Systolic Hypertension

ge140 lt90

3 3

Drugs In My Hand

4 4

HISTORY amp CLINICAL FEATURES

Suffering from subacute transient headache with pain in the limbs easy fatigability and dizziness

She has no loss of appetite amp no sleep bladder or bowel disorder

Menopause attained 7 yrs ago no OCP usage

She has no history suggestive of any major illness or relating to this condition

No history of drug addictionabuse amp no drug allergy

On physical examination the patient is alert and cooperative

On systemic examination nothing of significance was found

5 5

The patient is suffering from Primary Hypertension

Inscrip

tion

(Initial)

(Subscription amp Signature)

Criticism Superscription Salt restricted diet Brand Names Tazloc-trio+Amlodipine Time of intake not

specified OD PTML 500 Secondary hypertension is

not excluded

WHO

6 6

Angiotensinogen

Angiotensin I

Angiotensin II

AT1 receptor AT2

receptor

Other ATreceptors

Bradykinin

Inactive

peptides

VasodilationAttenuate growth anddisease progression

ACEinhibitors

AIIRAs

PL-C

PhospholipidIP3 DAG

[Ca Activation Of MLCK

ReninAliskiren

Vasoconstriction BP

Adrenaline Release BP

Other BP Lowering Mechanisms1Central amp peripheral sympathetic stimulation2Release of aldosterone amp adrenaline from adrenals3Renal actions promoting salt amp water reabsorption4Vasopressin release amp Cardiac growth promotion

Pharmacokinetics Administered orally with bioavailibility-

33Telmisartan has no active metabolite peak action within 3hrs amp lasts 24hrs (20-80mg OD)

Advantage over ACE inhibitors -No cough angioedema dysgeusia amp complete inhibition of AT2 with AT1 sparing effect

KINETICSDYNAMICS

Angiotensin Receptor Blockers

7 7

Thiazides are the drug of choice in uncomplicated hypertension available for parenteral administration

Chlorothiazide(05-2gm in two divided doses)Indapamide(25gm single daily dose) etc

PharmacokineticsAdministered orally with Bioavailability=9-56 (dose dependent)t 12 (chlorothiazide)= 15 hrs

ContraindicationsDyslipidemiaGoutHypokalemiaErectile Dysfunction

Diuretics

8 8

Calcium Channel Blockers

Contraindications Unstable angina Breastfeeding Aortic stenosis

DOC for low renin hypertension amp isolated systolic hypertensionPharmacokineticsOral bioavailability 65-90(half life-30-50hrs) (Dosage-tab 5-10mg OD)

Patient of severe CAD CCB can increase anginal frequency amp severity

Excessive lowering of BP in patients taking other BP medication

9 9

severe hypertension ( SPge180mmHg DPge120mmHg) acute impairment of one or more organ

systems like CVS CNS amp renal may be irreversible organ

damage

Hypertensive

Emergency

bull Sodium Nitroprusside iv 20-300 μgmin

bull Glycerol Trinitrate iv 5-20 μgminbull Esmolol amp Phentolamine

Mean BP should be lowered by no more than 25 within minutes to few hours amp then gradually to not lower than 160100 mmHg

10 10

Hypertension with other

complication

Bishnu Saha (48M)

Pulse-82min BP- 14080mmHg Δ HTN ċ UTI)

Reshmi Mondal(25FHindu)BP-15090

Pulse-84min PregnantΔ Hypertensive Disorder

Gopal Das(60M)

BP-190100Δ HTN ċ COPD ċ LVF

Narayan Saha(66M)

BP-180100Pulse-90min

Δ Duodenal Ulcer ċ HTN

Lalmohan Pramanik(62M)

Pulse-80min BP- 16094 PP-190 Urine sugar-++Chest clear

CVS- S1 available)Δ DM-type-II ċ HTN

Tab A

mlodipine 15mg 1 ta

b once

dailyco

nt

Tab L

efodoxamine(250mg)1tab

BD5days

Tab Parace

tamol(500mg)

Tab Hydralazine (5

-10 mg iv every 15-20 min )

Folic acid supplement

Fluid

salt

rest

ricte

d die

t

Tab A

mlo

dipin

e 15m

g 1 ta

b once

dailyc

ont

Tab T

elest

a 1 ta

b once

daily

cont

Tab P

arindo 1

tab B

Dcont

Telm

isarta

n(80)1

0D(1hr)

Carvedilo

l(31

25)10D(1

hr)

Nitroglyce

rin(6

4) 1

BD (1hr)

Aspiri

n(75)1

0D

Atrovast

atin(1

0) OD

Tiotro

pium

Br

Form

etero

l

Tab G

lyco

met G

P (1 ta

b At b

reakfa

st)

Tab M

etform

in(5

00mg) 1

tab O

D

Tab T

enalapril

(25

mg) B

D

Tab S

tato

r(10m

g) OD

Comparative Study

11 11

CVS (3530)Respiratory(118)GI(206)

ADRs(Adverse Drug Reactions) are among the leading cause of mortality amp morbidity Regular monitoring of ADR is important specially in a chronic asymptomatic disorder like HypertensionThe following study was conducted in med OPD of Majeeida Hospital New Delhi CCBs are the most prescribed drugs (317) amp β blockers are associated with highest no of ADR (75)

PHARMACOVIGILANCE amp ADR

Hypokalaemia

Carbohydrate

intolerance

OedemaTachycardia

Dysgeusia Nausea

Cough

Angioedem

ia

Approved Combinations (JNC7)

Combinations better avoided

ACEInhibitorARB+ Diuretics

Adr blocker + Clonidine

HydralazineDHP+ Beta-blocker

Nifedipine+ Diuretic

VasodilatorSympatholytics+ Diuretic

Hydralazine+DHP

12 12

Rational Drug Therapy

Drug Interaction

Lithium Thiazide(Pharmacokinetic intr)Increased toxicity of lithium

Verapamil Propranolol (Pharmacodynamic intr)Heart Failure PrecipitationAV block amp sever bradycardiaEnalapril Spironolactone(Pharmacodynamic intr)HyperkalaemiaCardiac arrythmias

13 13

Amlodipine Tablet 5 mg (as maleate mesylate or besylate)

Bisoprolol Tablet 125 mg 5 mg 1048710 includes metoprolol and carvedilol as alternatives

Enalapril Tablet 25 mg 5 mg (as hydrogen maleate)

Hydralazine Powder for injection 20 mg (hydrochloride) in ampouleTablet 25 mg 50 mg (hydrochloride)

Hydrochlorothiazide Oral liquid 50 mg5 mlSolid oral dosage form 125 mg 25 mg

Methyldopa Tablet 250 mg

sodium nitroprusside

Powder for infusion 50 mg in ampoule

WHOrsquos current European policy

Priority interventions of the action plan for noncommunicable diseases 2012-2016 include

Promotion of a healthy diet through marketing and fiscal measuresElimination of trans fats amp Salt reductionCardio-metabolic risk reduction assessment and managementPromotion of physical activity and mobility

AmlodipineAtenolol ChlorthalidoneClonidine Hydrochloride Enalapril MaleateLosartanpotassiumMethyldopaNifedipine PropranololSodiumNitroprusside Terazosin

WHO Essential Drugs

Indiarsquos Essential Drugs

14 14

War against Hypertension

H-BP v

s W

HO Risk factorsA diet high in saturated fatExcessive salt consumptionOverweight and obesityA sedentary lifestyle and lack of exerciseExcessive alcohol consumptionSmokingUn-managed stressA family history of high blood pressureBeing over 65 years of ageCo-morbidities such as diabetes

WHOHigh B

P

Manage high blood pressure byeating a healthy diet reducing salt intake exercising regularly stopping smoking reducing alcohol consumptionmanaging stress having regular blood pressure checksCommunity-based efforts to reduce blood pressure and stroke in Japan

15 15

• Slide 1
• Slide 2
• Slide 3
• Slide 4
• Slide 5
• Slide 6
• Slide 7
• Slide 8
• Slide 9
• Slide 10
• Slide 11
• Slide 12
• Slide 13
• Slide 14
• Slide 15

3 3

Drugs In My Hand

4 4

HISTORY amp CLINICAL FEATURES

Suffering from subacute transient headache with pain in the limbs easy fatigability and dizziness

She has no loss of appetite amp no sleep bladder or bowel disorder

Menopause attained 7 yrs ago no OCP usage

She has no history suggestive of any major illness or relating to this condition

No history of drug addictionabuse amp no drug allergy

On physical examination the patient is alert and cooperative

On systemic examination nothing of significance was found

5 5

The patient is suffering from Primary Hypertension

Inscrip

tion

(Initial)

(Subscription amp Signature)

Criticism Superscription Salt restricted diet Brand Names Tazloc-trio+Amlodipine Time of intake not

specified OD PTML 500 Secondary hypertension is

not excluded

WHO

6 6

Angiotensinogen

Angiotensin I

Angiotensin II

AT1 receptor AT2

receptor

Other ATreceptors

Bradykinin

Inactive

peptides

VasodilationAttenuate growth anddisease progression

ACEinhibitors

AIIRAs

PL-C

PhospholipidIP3 DAG

[Ca Activation Of MLCK

ReninAliskiren

Vasoconstriction BP

Adrenaline Release BP

Other BP Lowering Mechanisms1Central amp peripheral sympathetic stimulation2Release of aldosterone amp adrenaline from adrenals3Renal actions promoting salt amp water reabsorption4Vasopressin release amp Cardiac growth promotion

Pharmacokinetics Administered orally with bioavailibility-

33Telmisartan has no active metabolite peak action within 3hrs amp lasts 24hrs (20-80mg OD)

Advantage over ACE inhibitors -No cough angioedema dysgeusia amp complete inhibition of AT2 with AT1 sparing effect

KINETICSDYNAMICS

Angiotensin Receptor Blockers

7 7

Thiazides are the drug of choice in uncomplicated hypertension available for parenteral administration

Chlorothiazide(05-2gm in two divided doses)Indapamide(25gm single daily dose) etc

PharmacokineticsAdministered orally with Bioavailability=9-56 (dose dependent)t 12 (chlorothiazide)= 15 hrs

ContraindicationsDyslipidemiaGoutHypokalemiaErectile Dysfunction

Diuretics

8 8

Calcium Channel Blockers

Contraindications Unstable angina Breastfeeding Aortic stenosis

DOC for low renin hypertension amp isolated systolic hypertensionPharmacokineticsOral bioavailability 65-90(half life-30-50hrs) (Dosage-tab 5-10mg OD)

Patient of severe CAD CCB can increase anginal frequency amp severity

Excessive lowering of BP in patients taking other BP medication

9 9

severe hypertension ( SPge180mmHg DPge120mmHg) acute impairment of one or more organ

systems like CVS CNS amp renal may be irreversible organ

damage

Hypertensive

Emergency

bull Sodium Nitroprusside iv 20-300 μgmin

bull Glycerol Trinitrate iv 5-20 μgminbull Esmolol amp Phentolamine

Mean BP should be lowered by no more than 25 within minutes to few hours amp then gradually to not lower than 160100 mmHg

10 10

Hypertension with other

complication

Bishnu Saha (48M)

Pulse-82min BP- 14080mmHg Δ HTN ċ UTI)

Reshmi Mondal(25FHindu)BP-15090

Pulse-84min PregnantΔ Hypertensive Disorder

Gopal Das(60M)

BP-190100Δ HTN ċ COPD ċ LVF

Narayan Saha(66M)

BP-180100Pulse-90min

Δ Duodenal Ulcer ċ HTN

Lalmohan Pramanik(62M)

Pulse-80min BP- 16094 PP-190 Urine sugar-++Chest clear

CVS- S1 available)Δ DM-type-II ċ HTN

Tab A

mlodipine 15mg 1 ta

b once

dailyco

nt

Tab L

efodoxamine(250mg)1tab

BD5days

Tab Parace

tamol(500mg)

Tab Hydralazine (5

-10 mg iv every 15-20 min )

Folic acid supplement

Fluid

salt

rest

ricte

d die

t

Tab A

mlo

dipin

e 15m

g 1 ta

b once

dailyc

ont

Tab T

elest

a 1 ta

b once

daily

cont

Tab P

arindo 1

tab B

Dcont

Telm

isarta

n(80)1

0D(1hr)

Carvedilo

l(31

25)10D(1

hr)

Nitroglyce

rin(6

4) 1

BD (1hr)

Aspiri

n(75)1

0D

Atrovast

atin(1

0) OD

Tiotro

pium

Br

Form

etero

l

Tab G

lyco

met G

P (1 ta

b At b

reakfa

st)

Tab M

etform

in(5

00mg) 1

tab O

D

Tab T

enalapril

(25

mg) B

D

Tab S

tato

r(10m

g) OD

Comparative Study

11 11

CVS (3530)Respiratory(118)GI(206)

ADRs(Adverse Drug Reactions) are among the leading cause of mortality amp morbidity Regular monitoring of ADR is important specially in a chronic asymptomatic disorder like HypertensionThe following study was conducted in med OPD of Majeeida Hospital New Delhi CCBs are the most prescribed drugs (317) amp β blockers are associated with highest no of ADR (75)

PHARMACOVIGILANCE amp ADR

Hypokalaemia

Carbohydrate

intolerance

OedemaTachycardia

Dysgeusia Nausea

Cough

Angioedem

ia

Approved Combinations (JNC7)

Combinations better avoided

ACEInhibitorARB+ Diuretics

Adr blocker + Clonidine

HydralazineDHP+ Beta-blocker

Nifedipine+ Diuretic

VasodilatorSympatholytics+ Diuretic

Hydralazine+DHP

12 12

Rational Drug Therapy

Drug Interaction

Lithium Thiazide(Pharmacokinetic intr)Increased toxicity of lithium

Verapamil Propranolol (Pharmacodynamic intr)Heart Failure PrecipitationAV block amp sever bradycardiaEnalapril Spironolactone(Pharmacodynamic intr)HyperkalaemiaCardiac arrythmias

13 13

Amlodipine Tablet 5 mg (as maleate mesylate or besylate)

Bisoprolol Tablet 125 mg 5 mg 1048710 includes metoprolol and carvedilol as alternatives

Enalapril Tablet 25 mg 5 mg (as hydrogen maleate)

Hydralazine Powder for injection 20 mg (hydrochloride) in ampouleTablet 25 mg 50 mg (hydrochloride)

Hydrochlorothiazide Oral liquid 50 mg5 mlSolid oral dosage form 125 mg 25 mg

Methyldopa Tablet 250 mg

sodium nitroprusside

Powder for infusion 50 mg in ampoule

WHOrsquos current European policy

Priority interventions of the action plan for noncommunicable diseases 2012-2016 include

Promotion of a healthy diet through marketing and fiscal measuresElimination of trans fats amp Salt reductionCardio-metabolic risk reduction assessment and managementPromotion of physical activity and mobility

AmlodipineAtenolol ChlorthalidoneClonidine Hydrochloride Enalapril MaleateLosartanpotassiumMethyldopaNifedipine PropranololSodiumNitroprusside Terazosin

WHO Essential Drugs

Indiarsquos Essential Drugs

14 14

War against Hypertension

H-BP v

s W

HO Risk factorsA diet high in saturated fatExcessive salt consumptionOverweight and obesityA sedentary lifestyle and lack of exerciseExcessive alcohol consumptionSmokingUn-managed stressA family history of high blood pressureBeing over 65 years of ageCo-morbidities such as diabetes

WHOHigh B

P

Manage high blood pressure byeating a healthy diet reducing salt intake exercising regularly stopping smoking reducing alcohol consumptionmanaging stress having regular blood pressure checksCommunity-based efforts to reduce blood pressure and stroke in Japan

15 15

• Slide 1
• Slide 2
• Slide 3
• Slide 4
• Slide 5
• Slide 6
• Slide 7
• Slide 8
• Slide 9
• Slide 10
• Slide 11
• Slide 12
• Slide 13
• Slide 14
• Slide 15

4 4

HISTORY amp CLINICAL FEATURES

Suffering from subacute transient headache with pain in the limbs easy fatigability and dizziness

She has no loss of appetite amp no sleep bladder or bowel disorder

Menopause attained 7 yrs ago no OCP usage

She has no history suggestive of any major illness or relating to this condition

No history of drug addictionabuse amp no drug allergy

On physical examination the patient is alert and cooperative

On systemic examination nothing of significance was found

5 5

The patient is suffering from Primary Hypertension

Inscrip

tion

(Initial)

(Subscription amp Signature)

Criticism Superscription Salt restricted diet Brand Names Tazloc-trio+Amlodipine Time of intake not

specified OD PTML 500 Secondary hypertension is

not excluded

WHO

6 6

Angiotensinogen

Angiotensin I

Angiotensin II

AT1 receptor AT2

receptor

Other ATreceptors

Bradykinin

Inactive

peptides

VasodilationAttenuate growth anddisease progression

ACEinhibitors

AIIRAs

PL-C

PhospholipidIP3 DAG

[Ca Activation Of MLCK

ReninAliskiren

Vasoconstriction BP

Adrenaline Release BP

Other BP Lowering Mechanisms1Central amp peripheral sympathetic stimulation2Release of aldosterone amp adrenaline from adrenals3Renal actions promoting salt amp water reabsorption4Vasopressin release amp Cardiac growth promotion

Pharmacokinetics Administered orally with bioavailibility-

33Telmisartan has no active metabolite peak action within 3hrs amp lasts 24hrs (20-80mg OD)

Advantage over ACE inhibitors -No cough angioedema dysgeusia amp complete inhibition of AT2 with AT1 sparing effect

KINETICSDYNAMICS

Angiotensin Receptor Blockers

7 7

Thiazides are the drug of choice in uncomplicated hypertension available for parenteral administration

Chlorothiazide(05-2gm in two divided doses)Indapamide(25gm single daily dose) etc

PharmacokineticsAdministered orally with Bioavailability=9-56 (dose dependent)t 12 (chlorothiazide)= 15 hrs

ContraindicationsDyslipidemiaGoutHypokalemiaErectile Dysfunction

Diuretics

8 8

Calcium Channel Blockers

Contraindications Unstable angina Breastfeeding Aortic stenosis

DOC for low renin hypertension amp isolated systolic hypertensionPharmacokineticsOral bioavailability 65-90(half life-30-50hrs) (Dosage-tab 5-10mg OD)

Patient of severe CAD CCB can increase anginal frequency amp severity

Excessive lowering of BP in patients taking other BP medication

9 9

severe hypertension ( SPge180mmHg DPge120mmHg) acute impairment of one or more organ

systems like CVS CNS amp renal may be irreversible organ

damage

Hypertensive

Emergency

bull Sodium Nitroprusside iv 20-300 μgmin

bull Glycerol Trinitrate iv 5-20 μgminbull Esmolol amp Phentolamine

Mean BP should be lowered by no more than 25 within minutes to few hours amp then gradually to not lower than 160100 mmHg

10 10

Hypertension with other

complication

Bishnu Saha (48M)

Pulse-82min BP- 14080mmHg Δ HTN ċ UTI)

Reshmi Mondal(25FHindu)BP-15090

Pulse-84min PregnantΔ Hypertensive Disorder

Gopal Das(60M)

BP-190100Δ HTN ċ COPD ċ LVF

Narayan Saha(66M)

BP-180100Pulse-90min

Δ Duodenal Ulcer ċ HTN

Lalmohan Pramanik(62M)

Pulse-80min BP- 16094 PP-190 Urine sugar-++Chest clear

CVS- S1 available)Δ DM-type-II ċ HTN

Tab A

mlodipine 15mg 1 ta

b once

dailyco

nt

Tab L

efodoxamine(250mg)1tab

BD5days

Tab Parace

tamol(500mg)

Tab Hydralazine (5

-10 mg iv every 15-20 min )

Folic acid supplement

Fluid

salt

rest

ricte

d die

t

Tab A

mlo

dipin

e 15m

g 1 ta

b once

dailyc

ont

Tab T

elest

a 1 ta

b once

daily

cont

Tab P

arindo 1

tab B

Dcont

Telm

isarta

n(80)1

0D(1hr)

Carvedilo

l(31

25)10D(1

hr)

Nitroglyce

rin(6

4) 1

BD (1hr)

Aspiri

n(75)1

0D

Atrovast

atin(1

0) OD

Tiotro

pium

Br

Form

etero

l

Tab G

lyco

met G

P (1 ta

b At b

reakfa

st)

Tab M

etform

in(5

00mg) 1

tab O

D

Tab T

enalapril

(25

mg) B

D

Tab S

tato

r(10m

g) OD

Comparative Study

11 11

CVS (3530)Respiratory(118)GI(206)

ADRs(Adverse Drug Reactions) are among the leading cause of mortality amp morbidity Regular monitoring of ADR is important specially in a chronic asymptomatic disorder like HypertensionThe following study was conducted in med OPD of Majeeida Hospital New Delhi CCBs are the most prescribed drugs (317) amp β blockers are associated with highest no of ADR (75)

PHARMACOVIGILANCE amp ADR

Hypokalaemia

Carbohydrate

intolerance

OedemaTachycardia

Dysgeusia Nausea

Cough

Angioedem

ia

Approved Combinations (JNC7)

Combinations better avoided

ACEInhibitorARB+ Diuretics

Adr blocker + Clonidine

HydralazineDHP+ Beta-blocker

Nifedipine+ Diuretic

VasodilatorSympatholytics+ Diuretic

Hydralazine+DHP

12 12

Rational Drug Therapy

Drug Interaction

Lithium Thiazide(Pharmacokinetic intr)Increased toxicity of lithium

Verapamil Propranolol (Pharmacodynamic intr)Heart Failure PrecipitationAV block amp sever bradycardiaEnalapril Spironolactone(Pharmacodynamic intr)HyperkalaemiaCardiac arrythmias

13 13

Amlodipine Tablet 5 mg (as maleate mesylate or besylate)

Bisoprolol Tablet 125 mg 5 mg 1048710 includes metoprolol and carvedilol as alternatives

Enalapril Tablet 25 mg 5 mg (as hydrogen maleate)

Hydralazine Powder for injection 20 mg (hydrochloride) in ampouleTablet 25 mg 50 mg (hydrochloride)

Hydrochlorothiazide Oral liquid 50 mg5 mlSolid oral dosage form 125 mg 25 mg

Methyldopa Tablet 250 mg

sodium nitroprusside

Powder for infusion 50 mg in ampoule

WHOrsquos current European policy

Priority interventions of the action plan for noncommunicable diseases 2012-2016 include

Promotion of a healthy diet through marketing and fiscal measuresElimination of trans fats amp Salt reductionCardio-metabolic risk reduction assessment and managementPromotion of physical activity and mobility

AmlodipineAtenolol ChlorthalidoneClonidine Hydrochloride Enalapril MaleateLosartanpotassiumMethyldopaNifedipine PropranololSodiumNitroprusside Terazosin

WHO Essential Drugs

Indiarsquos Essential Drugs

14 14

War against Hypertension

H-BP v

s W

HO Risk factorsA diet high in saturated fatExcessive salt consumptionOverweight and obesityA sedentary lifestyle and lack of exerciseExcessive alcohol consumptionSmokingUn-managed stressA family history of high blood pressureBeing over 65 years of ageCo-morbidities such as diabetes

WHOHigh B

P

Manage high blood pressure byeating a healthy diet reducing salt intake exercising regularly stopping smoking reducing alcohol consumptionmanaging stress having regular blood pressure checksCommunity-based efforts to reduce blood pressure and stroke in Japan

15 15

• Slide 1
• Slide 2
• Slide 3
• Slide 4
• Slide 5
• Slide 6
• Slide 7
• Slide 8
• Slide 9
• Slide 10
• Slide 11
• Slide 12
• Slide 13
• Slide 14
• Slide 15

5 5

The patient is suffering from Primary Hypertension

Inscrip

tion

(Initial)

(Subscription amp Signature)

Criticism Superscription Salt restricted diet Brand Names Tazloc-trio+Amlodipine Time of intake not

specified OD PTML 500 Secondary hypertension is

not excluded

WHO

6 6

Angiotensinogen

Angiotensin I

Angiotensin II

AT1 receptor AT2

receptor

Other ATreceptors

Bradykinin

Inactive

peptides

VasodilationAttenuate growth anddisease progression

ACEinhibitors

AIIRAs

PL-C

PhospholipidIP3 DAG

[Ca Activation Of MLCK

ReninAliskiren

Vasoconstriction BP

Adrenaline Release BP

Other BP Lowering Mechanisms1Central amp peripheral sympathetic stimulation2Release of aldosterone amp adrenaline from adrenals3Renal actions promoting salt amp water reabsorption4Vasopressin release amp Cardiac growth promotion

Pharmacokinetics Administered orally with bioavailibility-

33Telmisartan has no active metabolite peak action within 3hrs amp lasts 24hrs (20-80mg OD)

Advantage over ACE inhibitors -No cough angioedema dysgeusia amp complete inhibition of AT2 with AT1 sparing effect

KINETICSDYNAMICS

Angiotensin Receptor Blockers

7 7

Thiazides are the drug of choice in uncomplicated hypertension available for parenteral administration

Chlorothiazide(05-2gm in two divided doses)Indapamide(25gm single daily dose) etc

PharmacokineticsAdministered orally with Bioavailability=9-56 (dose dependent)t 12 (chlorothiazide)= 15 hrs

ContraindicationsDyslipidemiaGoutHypokalemiaErectile Dysfunction

Diuretics

8 8

Calcium Channel Blockers

Contraindications Unstable angina Breastfeeding Aortic stenosis

DOC for low renin hypertension amp isolated systolic hypertensionPharmacokineticsOral bioavailability 65-90(half life-30-50hrs) (Dosage-tab 5-10mg OD)

Patient of severe CAD CCB can increase anginal frequency amp severity

Excessive lowering of BP in patients taking other BP medication

9 9

severe hypertension ( SPge180mmHg DPge120mmHg) acute impairment of one or more organ

systems like CVS CNS amp renal may be irreversible organ

damage

Hypertensive

Emergency

bull Sodium Nitroprusside iv 20-300 μgmin

bull Glycerol Trinitrate iv 5-20 μgminbull Esmolol amp Phentolamine

Mean BP should be lowered by no more than 25 within minutes to few hours amp then gradually to not lower than 160100 mmHg

10 10

Hypertension with other

complication

Bishnu Saha (48M)

Pulse-82min BP- 14080mmHg Δ HTN ċ UTI)

Reshmi Mondal(25FHindu)BP-15090

Pulse-84min PregnantΔ Hypertensive Disorder

Gopal Das(60M)

BP-190100Δ HTN ċ COPD ċ LVF

Narayan Saha(66M)

BP-180100Pulse-90min

Δ Duodenal Ulcer ċ HTN

Lalmohan Pramanik(62M)

Pulse-80min BP- 16094 PP-190 Urine sugar-++Chest clear

CVS- S1 available)Δ DM-type-II ċ HTN

Tab A

mlodipine 15mg 1 ta

b once

dailyco

nt

Tab L

efodoxamine(250mg)1tab

BD5days

Tab Parace

tamol(500mg)

Tab Hydralazine (5

-10 mg iv every 15-20 min )

Folic acid supplement

Fluid

salt

rest

ricte

d die

t

Tab A

mlo

dipin

e 15m

g 1 ta

b once

dailyc

ont

Tab T

elest

a 1 ta

b once

daily

cont

Tab P

arindo 1

tab B

Dcont

Telm

isarta

n(80)1

0D(1hr)

Carvedilo

l(31

25)10D(1

hr)

Nitroglyce

rin(6

4) 1

BD (1hr)

Aspiri

n(75)1

0D

Atrovast

atin(1

0) OD

Tiotro

pium

Br

Form

etero

l

Tab G

lyco

met G

P (1 ta

b At b

reakfa

st)

Tab M

etform

in(5

00mg) 1

tab O

D

Tab T

enalapril

(25

mg) B

D

Tab S

tato

r(10m

g) OD

Comparative Study

11 11

CVS (3530)Respiratory(118)GI(206)

ADRs(Adverse Drug Reactions) are among the leading cause of mortality amp morbidity Regular monitoring of ADR is important specially in a chronic asymptomatic disorder like HypertensionThe following study was conducted in med OPD of Majeeida Hospital New Delhi CCBs are the most prescribed drugs (317) amp β blockers are associated with highest no of ADR (75)

PHARMACOVIGILANCE amp ADR

Hypokalaemia

Carbohydrate

intolerance

OedemaTachycardia

Dysgeusia Nausea

Cough

Angioedem

ia

Approved Combinations (JNC7)

Combinations better avoided

ACEInhibitorARB+ Diuretics

Adr blocker + Clonidine

HydralazineDHP+ Beta-blocker

Nifedipine+ Diuretic

VasodilatorSympatholytics+ Diuretic

Hydralazine+DHP

12 12

Rational Drug Therapy

Drug Interaction

Lithium Thiazide(Pharmacokinetic intr)Increased toxicity of lithium

Verapamil Propranolol (Pharmacodynamic intr)Heart Failure PrecipitationAV block amp sever bradycardiaEnalapril Spironolactone(Pharmacodynamic intr)HyperkalaemiaCardiac arrythmias

13 13

Amlodipine Tablet 5 mg (as maleate mesylate or besylate)

Bisoprolol Tablet 125 mg 5 mg 1048710 includes metoprolol and carvedilol as alternatives

Enalapril Tablet 25 mg 5 mg (as hydrogen maleate)

Hydralazine Powder for injection 20 mg (hydrochloride) in ampouleTablet 25 mg 50 mg (hydrochloride)

Hydrochlorothiazide Oral liquid 50 mg5 mlSolid oral dosage form 125 mg 25 mg

Methyldopa Tablet 250 mg

sodium nitroprusside

Powder for infusion 50 mg in ampoule

WHOrsquos current European policy

Priority interventions of the action plan for noncommunicable diseases 2012-2016 include

Promotion of a healthy diet through marketing and fiscal measuresElimination of trans fats amp Salt reductionCardio-metabolic risk reduction assessment and managementPromotion of physical activity and mobility

AmlodipineAtenolol ChlorthalidoneClonidine Hydrochloride Enalapril MaleateLosartanpotassiumMethyldopaNifedipine PropranololSodiumNitroprusside Terazosin

WHO Essential Drugs

Indiarsquos Essential Drugs

14 14

War against Hypertension

H-BP v

s W

HO Risk factorsA diet high in saturated fatExcessive salt consumptionOverweight and obesityA sedentary lifestyle and lack of exerciseExcessive alcohol consumptionSmokingUn-managed stressA family history of high blood pressureBeing over 65 years of ageCo-morbidities such as diabetes

WHOHigh B

P

Manage high blood pressure byeating a healthy diet reducing salt intake exercising regularly stopping smoking reducing alcohol consumptionmanaging stress having regular blood pressure checksCommunity-based efforts to reduce blood pressure and stroke in Japan

15 15

• Slide 1
• Slide 2
• Slide 3
• Slide 4
• Slide 5
• Slide 6
• Slide 7
• Slide 8
• Slide 9
• Slide 10
• Slide 11
• Slide 12
• Slide 13
• Slide 14
• Slide 15

6 6

Angiotensinogen

Angiotensin I

Angiotensin II

AT1 receptor AT2

receptor

Other ATreceptors

Bradykinin

Inactive

peptides

VasodilationAttenuate growth anddisease progression

ACEinhibitors

AIIRAs

PL-C

PhospholipidIP3 DAG

[Ca Activation Of MLCK

ReninAliskiren

Vasoconstriction BP

Adrenaline Release BP

Other BP Lowering Mechanisms1Central amp peripheral sympathetic stimulation2Release of aldosterone amp adrenaline from adrenals3Renal actions promoting salt amp water reabsorption4Vasopressin release amp Cardiac growth promotion

Pharmacokinetics Administered orally with bioavailibility-

33Telmisartan has no active metabolite peak action within 3hrs amp lasts 24hrs (20-80mg OD)

Advantage over ACE inhibitors -No cough angioedema dysgeusia amp complete inhibition of AT2 with AT1 sparing effect

KINETICSDYNAMICS

Angiotensin Receptor Blockers

7 7

Thiazides are the drug of choice in uncomplicated hypertension available for parenteral administration

Chlorothiazide(05-2gm in two divided doses)Indapamide(25gm single daily dose) etc

PharmacokineticsAdministered orally with Bioavailability=9-56 (dose dependent)t 12 (chlorothiazide)= 15 hrs

ContraindicationsDyslipidemiaGoutHypokalemiaErectile Dysfunction

Diuretics

8 8

Calcium Channel Blockers

Contraindications Unstable angina Breastfeeding Aortic stenosis

DOC for low renin hypertension amp isolated systolic hypertensionPharmacokineticsOral bioavailability 65-90(half life-30-50hrs) (Dosage-tab 5-10mg OD)

Patient of severe CAD CCB can increase anginal frequency amp severity

Excessive lowering of BP in patients taking other BP medication

9 9

severe hypertension ( SPge180mmHg DPge120mmHg) acute impairment of one or more organ

systems like CVS CNS amp renal may be irreversible organ

damage

Hypertensive

Emergency

bull Sodium Nitroprusside iv 20-300 μgmin

bull Glycerol Trinitrate iv 5-20 μgminbull Esmolol amp Phentolamine

Mean BP should be lowered by no more than 25 within minutes to few hours amp then gradually to not lower than 160100 mmHg

10 10

Hypertension with other

complication

Bishnu Saha (48M)

Pulse-82min BP- 14080mmHg Δ HTN ċ UTI)

Reshmi Mondal(25FHindu)BP-15090

Pulse-84min PregnantΔ Hypertensive Disorder

Gopal Das(60M)

BP-190100Δ HTN ċ COPD ċ LVF

Narayan Saha(66M)

BP-180100Pulse-90min

Δ Duodenal Ulcer ċ HTN

Lalmohan Pramanik(62M)

Pulse-80min BP- 16094 PP-190 Urine sugar-++Chest clear

CVS- S1 available)Δ DM-type-II ċ HTN

Tab A

mlodipine 15mg 1 ta

b once

dailyco

nt

Tab L

efodoxamine(250mg)1tab

BD5days

Tab Parace

tamol(500mg)

Tab Hydralazine (5

-10 mg iv every 15-20 min )

Folic acid supplement

Fluid

salt

rest

ricte

d die

t

Tab A

mlo

dipin

e 15m

g 1 ta

b once

dailyc

ont

Tab T

elest

a 1 ta

b once

daily

cont

Tab P

arindo 1

tab B

Dcont

Telm

isarta

n(80)1

0D(1hr)

Carvedilo

l(31

25)10D(1

hr)

Nitroglyce

rin(6

4) 1

BD (1hr)

Aspiri

n(75)1

0D

Atrovast

atin(1

0) OD

Tiotro

pium

Br

Form

etero

l

Tab G

lyco

met G

P (1 ta

b At b

reakfa

st)

Tab M

etform

in(5

00mg) 1

tab O

D

Tab T

enalapril

(25

mg) B

D

Tab S

tato

r(10m

g) OD

Comparative Study

11 11

CVS (3530)Respiratory(118)GI(206)

ADRs(Adverse Drug Reactions) are among the leading cause of mortality amp morbidity Regular monitoring of ADR is important specially in a chronic asymptomatic disorder like HypertensionThe following study was conducted in med OPD of Majeeida Hospital New Delhi CCBs are the most prescribed drugs (317) amp β blockers are associated with highest no of ADR (75)

PHARMACOVIGILANCE amp ADR

Hypokalaemia

Carbohydrate

intolerance

OedemaTachycardia

Dysgeusia Nausea

Cough

Angioedem

ia

Approved Combinations (JNC7)

Combinations better avoided

ACEInhibitorARB+ Diuretics

Adr blocker + Clonidine

HydralazineDHP+ Beta-blocker

Nifedipine+ Diuretic

VasodilatorSympatholytics+ Diuretic

Hydralazine+DHP

12 12

Rational Drug Therapy

Drug Interaction

Lithium Thiazide(Pharmacokinetic intr)Increased toxicity of lithium

Verapamil Propranolol (Pharmacodynamic intr)Heart Failure PrecipitationAV block amp sever bradycardiaEnalapril Spironolactone(Pharmacodynamic intr)HyperkalaemiaCardiac arrythmias

13 13

Amlodipine Tablet 5 mg (as maleate mesylate or besylate)

Bisoprolol Tablet 125 mg 5 mg 1048710 includes metoprolol and carvedilol as alternatives

Enalapril Tablet 25 mg 5 mg (as hydrogen maleate)

Hydralazine Powder for injection 20 mg (hydrochloride) in ampouleTablet 25 mg 50 mg (hydrochloride)

Hydrochlorothiazide Oral liquid 50 mg5 mlSolid oral dosage form 125 mg 25 mg

Methyldopa Tablet 250 mg

sodium nitroprusside

Powder for infusion 50 mg in ampoule

WHOrsquos current European policy

Priority interventions of the action plan for noncommunicable diseases 2012-2016 include

Promotion of a healthy diet through marketing and fiscal measuresElimination of trans fats amp Salt reductionCardio-metabolic risk reduction assessment and managementPromotion of physical activity and mobility

AmlodipineAtenolol ChlorthalidoneClonidine Hydrochloride Enalapril MaleateLosartanpotassiumMethyldopaNifedipine PropranololSodiumNitroprusside Terazosin

WHO Essential Drugs

Indiarsquos Essential Drugs

14 14

War against Hypertension

H-BP v

s W

HO Risk factorsA diet high in saturated fatExcessive salt consumptionOverweight and obesityA sedentary lifestyle and lack of exerciseExcessive alcohol consumptionSmokingUn-managed stressA family history of high blood pressureBeing over 65 years of ageCo-morbidities such as diabetes

WHOHigh B

P

Manage high blood pressure byeating a healthy diet reducing salt intake exercising regularly stopping smoking reducing alcohol consumptionmanaging stress having regular blood pressure checksCommunity-based efforts to reduce blood pressure and stroke in Japan

15 15

• Slide 1
• Slide 2
• Slide 3
• Slide 4
• Slide 5
• Slide 6
• Slide 7
• Slide 8
• Slide 9
• Slide 10
• Slide 11
• Slide 12
• Slide 13
• Slide 14
• Slide 15

7 7

Thiazides are the drug of choice in uncomplicated hypertension available for parenteral administration

Chlorothiazide(05-2gm in two divided doses)Indapamide(25gm single daily dose) etc

PharmacokineticsAdministered orally with Bioavailability=9-56 (dose dependent)t 12 (chlorothiazide)= 15 hrs

ContraindicationsDyslipidemiaGoutHypokalemiaErectile Dysfunction

Diuretics

8 8

Calcium Channel Blockers

Contraindications Unstable angina Breastfeeding Aortic stenosis

DOC for low renin hypertension amp isolated systolic hypertensionPharmacokineticsOral bioavailability 65-90(half life-30-50hrs) (Dosage-tab 5-10mg OD)

Patient of severe CAD CCB can increase anginal frequency amp severity

Excessive lowering of BP in patients taking other BP medication

9 9

severe hypertension ( SPge180mmHg DPge120mmHg) acute impairment of one or more organ

systems like CVS CNS amp renal may be irreversible organ

damage

Hypertensive

Emergency

bull Sodium Nitroprusside iv 20-300 μgmin

bull Glycerol Trinitrate iv 5-20 μgminbull Esmolol amp Phentolamine

Mean BP should be lowered by no more than 25 within minutes to few hours amp then gradually to not lower than 160100 mmHg

10 10

Hypertension with other

complication

Bishnu Saha (48M)

Pulse-82min BP- 14080mmHg Δ HTN ċ UTI)

Reshmi Mondal(25FHindu)BP-15090

Pulse-84min PregnantΔ Hypertensive Disorder

Gopal Das(60M)

BP-190100Δ HTN ċ COPD ċ LVF

Narayan Saha(66M)

BP-180100Pulse-90min

Δ Duodenal Ulcer ċ HTN

Lalmohan Pramanik(62M)

Pulse-80min BP- 16094 PP-190 Urine sugar-++Chest clear

CVS- S1 available)Δ DM-type-II ċ HTN

Tab A

mlodipine 15mg 1 ta

b once

dailyco

nt

Tab L

efodoxamine(250mg)1tab

BD5days

Tab Parace

tamol(500mg)

Tab Hydralazine (5

-10 mg iv every 15-20 min )

Folic acid supplement

Fluid

salt

rest

ricte

d die

t

Tab A

mlo

dipin

e 15m

g 1 ta

b once

dailyc

ont

Tab T

elest

a 1 ta

b once

daily

cont

Tab P

arindo 1

tab B

Dcont

Telm

isarta

n(80)1

0D(1hr)

Carvedilo

l(31

25)10D(1

hr)

Nitroglyce

rin(6

4) 1

BD (1hr)

Aspiri

n(75)1

0D

Atrovast

atin(1

0) OD

Tiotro

pium

Br

Form

etero

l

Tab G

lyco

met G

P (1 ta

b At b

reakfa

st)

Tab M

etform

in(5

00mg) 1

tab O

D

Tab T

enalapril

(25

mg) B

D

Tab S

tato

r(10m

g) OD

Comparative Study

11 11

CVS (3530)Respiratory(118)GI(206)

ADRs(Adverse Drug Reactions) are among the leading cause of mortality amp morbidity Regular monitoring of ADR is important specially in a chronic asymptomatic disorder like HypertensionThe following study was conducted in med OPD of Majeeida Hospital New Delhi CCBs are the most prescribed drugs (317) amp β blockers are associated with highest no of ADR (75)

PHARMACOVIGILANCE amp ADR

Hypokalaemia

Carbohydrate

intolerance

OedemaTachycardia

Dysgeusia Nausea

Cough

Angioedem

ia

Approved Combinations (JNC7)

Combinations better avoided

ACEInhibitorARB+ Diuretics

Adr blocker + Clonidine

HydralazineDHP+ Beta-blocker

Nifedipine+ Diuretic

VasodilatorSympatholytics+ Diuretic

Hydralazine+DHP

12 12

Rational Drug Therapy

Drug Interaction

Lithium Thiazide(Pharmacokinetic intr)Increased toxicity of lithium

Verapamil Propranolol (Pharmacodynamic intr)Heart Failure PrecipitationAV block amp sever bradycardiaEnalapril Spironolactone(Pharmacodynamic intr)HyperkalaemiaCardiac arrythmias

13 13

Amlodipine Tablet 5 mg (as maleate mesylate or besylate)

Bisoprolol Tablet 125 mg 5 mg 1048710 includes metoprolol and carvedilol as alternatives

Enalapril Tablet 25 mg 5 mg (as hydrogen maleate)

Hydralazine Powder for injection 20 mg (hydrochloride) in ampouleTablet 25 mg 50 mg (hydrochloride)

Hydrochlorothiazide Oral liquid 50 mg5 mlSolid oral dosage form 125 mg 25 mg

Methyldopa Tablet 250 mg

sodium nitroprusside

Powder for infusion 50 mg in ampoule

WHOrsquos current European policy

Priority interventions of the action plan for noncommunicable diseases 2012-2016 include

Promotion of a healthy diet through marketing and fiscal measuresElimination of trans fats amp Salt reductionCardio-metabolic risk reduction assessment and managementPromotion of physical activity and mobility

AmlodipineAtenolol ChlorthalidoneClonidine Hydrochloride Enalapril MaleateLosartanpotassiumMethyldopaNifedipine PropranololSodiumNitroprusside Terazosin

WHO Essential Drugs

Indiarsquos Essential Drugs

14 14

War against Hypertension

H-BP v

s W

HO Risk factorsA diet high in saturated fatExcessive salt consumptionOverweight and obesityA sedentary lifestyle and lack of exerciseExcessive alcohol consumptionSmokingUn-managed stressA family history of high blood pressureBeing over 65 years of ageCo-morbidities such as diabetes

WHOHigh B

P

Manage high blood pressure byeating a healthy diet reducing salt intake exercising regularly stopping smoking reducing alcohol consumptionmanaging stress having regular blood pressure checksCommunity-based efforts to reduce blood pressure and stroke in Japan

15 15

• Slide 1
• Slide 2
• Slide 3
• Slide 4
• Slide 5
• Slide 6
• Slide 7
• Slide 8
• Slide 9
• Slide 10
• Slide 11
• Slide 12
• Slide 13
• Slide 14
• Slide 15

8 8

Calcium Channel Blockers

Contraindications Unstable angina Breastfeeding Aortic stenosis

DOC for low renin hypertension amp isolated systolic hypertensionPharmacokineticsOral bioavailability 65-90(half life-30-50hrs) (Dosage-tab 5-10mg OD)

Patient of severe CAD CCB can increase anginal frequency amp severity

Excessive lowering of BP in patients taking other BP medication

9 9

severe hypertension ( SPge180mmHg DPge120mmHg) acute impairment of one or more organ

systems like CVS CNS amp renal may be irreversible organ

damage

Hypertensive

Emergency

bull Sodium Nitroprusside iv 20-300 μgmin

bull Glycerol Trinitrate iv 5-20 μgminbull Esmolol amp Phentolamine

Mean BP should be lowered by no more than 25 within minutes to few hours amp then gradually to not lower than 160100 mmHg

10 10

Hypertension with other

complication

Bishnu Saha (48M)

Pulse-82min BP- 14080mmHg Δ HTN ċ UTI)

Reshmi Mondal(25FHindu)BP-15090

Pulse-84min PregnantΔ Hypertensive Disorder

Gopal Das(60M)

BP-190100Δ HTN ċ COPD ċ LVF

Narayan Saha(66M)

BP-180100Pulse-90min

Δ Duodenal Ulcer ċ HTN

Lalmohan Pramanik(62M)

Pulse-80min BP- 16094 PP-190 Urine sugar-++Chest clear

CVS- S1 available)Δ DM-type-II ċ HTN

Tab A

mlodipine 15mg 1 ta

b once

dailyco

nt

Tab L

efodoxamine(250mg)1tab

BD5days

Tab Parace

tamol(500mg)

Tab Hydralazine (5

-10 mg iv every 15-20 min )

Folic acid supplement

Fluid

salt

rest

ricte

d die

t

Tab A

mlo

dipin

e 15m

g 1 ta

b once

dailyc

ont

Tab T

elest

a 1 ta

b once

daily

cont

Tab P

arindo 1

tab B

Dcont

Telm

isarta

n(80)1

0D(1hr)

Carvedilo

l(31

25)10D(1

hr)

Nitroglyce

rin(6

4) 1

BD (1hr)

Aspiri

n(75)1

0D

Atrovast

atin(1

0) OD

Tiotro

pium

Br

Form

etero

l

Tab G

lyco

met G

P (1 ta

b At b

reakfa

st)

Tab M

etform

in(5

00mg) 1

tab O

D

Tab T

enalapril

(25

mg) B

D

Tab S

tato

r(10m

g) OD

Comparative Study

11 11

CVS (3530)Respiratory(118)GI(206)

ADRs(Adverse Drug Reactions) are among the leading cause of mortality amp morbidity Regular monitoring of ADR is important specially in a chronic asymptomatic disorder like HypertensionThe following study was conducted in med OPD of Majeeida Hospital New Delhi CCBs are the most prescribed drugs (317) amp β blockers are associated with highest no of ADR (75)

PHARMACOVIGILANCE amp ADR

Hypokalaemia

Carbohydrate

intolerance

OedemaTachycardia

Dysgeusia Nausea

Cough

Angioedem

ia

Approved Combinations (JNC7)

Combinations better avoided

ACEInhibitorARB+ Diuretics

Adr blocker + Clonidine

HydralazineDHP+ Beta-blocker

Nifedipine+ Diuretic

VasodilatorSympatholytics+ Diuretic

Hydralazine+DHP

12 12

Rational Drug Therapy

Drug Interaction

Lithium Thiazide(Pharmacokinetic intr)Increased toxicity of lithium

Verapamil Propranolol (Pharmacodynamic intr)Heart Failure PrecipitationAV block amp sever bradycardiaEnalapril Spironolactone(Pharmacodynamic intr)HyperkalaemiaCardiac arrythmias

13 13

Amlodipine Tablet 5 mg (as maleate mesylate or besylate)

Bisoprolol Tablet 125 mg 5 mg 1048710 includes metoprolol and carvedilol as alternatives

Enalapril Tablet 25 mg 5 mg (as hydrogen maleate)

Hydralazine Powder for injection 20 mg (hydrochloride) in ampouleTablet 25 mg 50 mg (hydrochloride)

Hydrochlorothiazide Oral liquid 50 mg5 mlSolid oral dosage form 125 mg 25 mg

Methyldopa Tablet 250 mg

sodium nitroprusside

Powder for infusion 50 mg in ampoule

WHOrsquos current European policy

Priority interventions of the action plan for noncommunicable diseases 2012-2016 include

Promotion of a healthy diet through marketing and fiscal measuresElimination of trans fats amp Salt reductionCardio-metabolic risk reduction assessment and managementPromotion of physical activity and mobility

AmlodipineAtenolol ChlorthalidoneClonidine Hydrochloride Enalapril MaleateLosartanpotassiumMethyldopaNifedipine PropranololSodiumNitroprusside Terazosin

WHO Essential Drugs

Indiarsquos Essential Drugs

14 14

War against Hypertension

H-BP v

s W

HO Risk factorsA diet high in saturated fatExcessive salt consumptionOverweight and obesityA sedentary lifestyle and lack of exerciseExcessive alcohol consumptionSmokingUn-managed stressA family history of high blood pressureBeing over 65 years of ageCo-morbidities such as diabetes

WHOHigh B

P

Manage high blood pressure byeating a healthy diet reducing salt intake exercising regularly stopping smoking reducing alcohol consumptionmanaging stress having regular blood pressure checksCommunity-based efforts to reduce blood pressure and stroke in Japan

15 15

• Slide 1
• Slide 2
• Slide 3
• Slide 4
• Slide 5
• Slide 6
• Slide 7
• Slide 8
• Slide 9
• Slide 10
• Slide 11
• Slide 12
• Slide 13
• Slide 14
• Slide 15

9 9

severe hypertension ( SPge180mmHg DPge120mmHg) acute impairment of one or more organ

systems like CVS CNS amp renal may be irreversible organ

damage

Hypertensive

Emergency

bull Sodium Nitroprusside iv 20-300 μgmin

bull Glycerol Trinitrate iv 5-20 μgminbull Esmolol amp Phentolamine

Mean BP should be lowered by no more than 25 within minutes to few hours amp then gradually to not lower than 160100 mmHg

10 10

Hypertension with other

complication

Bishnu Saha (48M)

Pulse-82min BP- 14080mmHg Δ HTN ċ UTI)

Reshmi Mondal(25FHindu)BP-15090

Pulse-84min PregnantΔ Hypertensive Disorder

Gopal Das(60M)

BP-190100Δ HTN ċ COPD ċ LVF

Narayan Saha(66M)

BP-180100Pulse-90min

Δ Duodenal Ulcer ċ HTN

Lalmohan Pramanik(62M)

Pulse-80min BP- 16094 PP-190 Urine sugar-++Chest clear

CVS- S1 available)Δ DM-type-II ċ HTN

Tab A

mlodipine 15mg 1 ta

b once

dailyco

nt

Tab L

efodoxamine(250mg)1tab

BD5days

Tab Parace

tamol(500mg)

Tab Hydralazine (5

-10 mg iv every 15-20 min )

Folic acid supplement

Fluid

salt

rest

ricte

d die

t

Tab A

mlo

dipin

e 15m

g 1 ta

b once

dailyc

ont

Tab T

elest

a 1 ta

b once

daily

cont

Tab P

arindo 1

tab B

Dcont

Telm

isarta

n(80)1

0D(1hr)

Carvedilo

l(31

25)10D(1

hr)

Nitroglyce

rin(6

4) 1

BD (1hr)

Aspiri

n(75)1

0D

Atrovast

atin(1

0) OD

Tiotro

pium

Br

Form

etero

l

Tab G

lyco

met G

P (1 ta

b At b

reakfa

st)

Tab M

etform

in(5

00mg) 1

tab O

D

Tab T

enalapril

(25

mg) B

D

Tab S

tato

r(10m

g) OD

Comparative Study

11 11

CVS (3530)Respiratory(118)GI(206)

ADRs(Adverse Drug Reactions) are among the leading cause of mortality amp morbidity Regular monitoring of ADR is important specially in a chronic asymptomatic disorder like HypertensionThe following study was conducted in med OPD of Majeeida Hospital New Delhi CCBs are the most prescribed drugs (317) amp β blockers are associated with highest no of ADR (75)

PHARMACOVIGILANCE amp ADR

Hypokalaemia

Carbohydrate

intolerance

OedemaTachycardia

Dysgeusia Nausea

Cough

Angioedem

ia

Approved Combinations (JNC7)

Combinations better avoided

ACEInhibitorARB+ Diuretics

Adr blocker + Clonidine

HydralazineDHP+ Beta-blocker

Nifedipine+ Diuretic

VasodilatorSympatholytics+ Diuretic

Hydralazine+DHP

12 12

Rational Drug Therapy

Drug Interaction

Lithium Thiazide(Pharmacokinetic intr)Increased toxicity of lithium

Verapamil Propranolol (Pharmacodynamic intr)Heart Failure PrecipitationAV block amp sever bradycardiaEnalapril Spironolactone(Pharmacodynamic intr)HyperkalaemiaCardiac arrythmias

13 13

Amlodipine Tablet 5 mg (as maleate mesylate or besylate)

Bisoprolol Tablet 125 mg 5 mg 1048710 includes metoprolol and carvedilol as alternatives

Enalapril Tablet 25 mg 5 mg (as hydrogen maleate)

Hydralazine Powder for injection 20 mg (hydrochloride) in ampouleTablet 25 mg 50 mg (hydrochloride)

Hydrochlorothiazide Oral liquid 50 mg5 mlSolid oral dosage form 125 mg 25 mg

Methyldopa Tablet 250 mg

sodium nitroprusside

Powder for infusion 50 mg in ampoule

WHOrsquos current European policy

Priority interventions of the action plan for noncommunicable diseases 2012-2016 include

Promotion of a healthy diet through marketing and fiscal measuresElimination of trans fats amp Salt reductionCardio-metabolic risk reduction assessment and managementPromotion of physical activity and mobility

AmlodipineAtenolol ChlorthalidoneClonidine Hydrochloride Enalapril MaleateLosartanpotassiumMethyldopaNifedipine PropranololSodiumNitroprusside Terazosin

WHO Essential Drugs

Indiarsquos Essential Drugs

14 14

War against Hypertension

H-BP v

s W

HO Risk factorsA diet high in saturated fatExcessive salt consumptionOverweight and obesityA sedentary lifestyle and lack of exerciseExcessive alcohol consumptionSmokingUn-managed stressA family history of high blood pressureBeing over 65 years of ageCo-morbidities such as diabetes

WHOHigh B

P

Manage high blood pressure byeating a healthy diet reducing salt intake exercising regularly stopping smoking reducing alcohol consumptionmanaging stress having regular blood pressure checksCommunity-based efforts to reduce blood pressure and stroke in Japan

15 15

• Slide 1
• Slide 2
• Slide 3
• Slide 4
• Slide 5
• Slide 6
• Slide 7
• Slide 8
• Slide 9
• Slide 10
• Slide 11
• Slide 12
• Slide 13
• Slide 14
• Slide 15

10 10

Hypertension with other

complication

Bishnu Saha (48M)

Pulse-82min BP- 14080mmHg Δ HTN ċ UTI)

Reshmi Mondal(25FHindu)BP-15090

Pulse-84min PregnantΔ Hypertensive Disorder

Gopal Das(60M)

BP-190100Δ HTN ċ COPD ċ LVF

Narayan Saha(66M)

BP-180100Pulse-90min

Δ Duodenal Ulcer ċ HTN

Lalmohan Pramanik(62M)

Pulse-80min BP- 16094 PP-190 Urine sugar-++Chest clear

CVS- S1 available)Δ DM-type-II ċ HTN

Tab A

mlodipine 15mg 1 ta

b once

dailyco

nt

Tab L

efodoxamine(250mg)1tab

BD5days

Tab Parace

tamol(500mg)

Tab Hydralazine (5

-10 mg iv every 15-20 min )

Folic acid supplement

Fluid

salt

rest

ricte

d die

t

Tab A

mlo

dipin

e 15m

g 1 ta

b once

dailyc

ont

Tab T

elest

a 1 ta

b once

daily

cont

Tab P

arindo 1

tab B

Dcont

Telm

isarta

n(80)1

0D(1hr)

Carvedilo

l(31

25)10D(1

hr)

Nitroglyce

rin(6

4) 1

BD (1hr)

Aspiri

n(75)1

0D

Atrovast

atin(1

0) OD

Tiotro

pium

Br

Form

etero

l

Tab G

lyco

met G

P (1 ta

b At b

reakfa

st)

Tab M

etform

in(5

00mg) 1

tab O

D

Tab T

enalapril

(25

mg) B

D

Tab S

tato

r(10m

g) OD

Comparative Study

11 11

CVS (3530)Respiratory(118)GI(206)

ADRs(Adverse Drug Reactions) are among the leading cause of mortality amp morbidity Regular monitoring of ADR is important specially in a chronic asymptomatic disorder like HypertensionThe following study was conducted in med OPD of Majeeida Hospital New Delhi CCBs are the most prescribed drugs (317) amp β blockers are associated with highest no of ADR (75)

PHARMACOVIGILANCE amp ADR

Hypokalaemia

Carbohydrate

intolerance

OedemaTachycardia

Dysgeusia Nausea

Cough

Angioedem

ia

Approved Combinations (JNC7)

Combinations better avoided

ACEInhibitorARB+ Diuretics

Adr blocker + Clonidine

HydralazineDHP+ Beta-blocker

Nifedipine+ Diuretic

VasodilatorSympatholytics+ Diuretic

Hydralazine+DHP

12 12

Rational Drug Therapy

Drug Interaction

Lithium Thiazide(Pharmacokinetic intr)Increased toxicity of lithium

Verapamil Propranolol (Pharmacodynamic intr)Heart Failure PrecipitationAV block amp sever bradycardiaEnalapril Spironolactone(Pharmacodynamic intr)HyperkalaemiaCardiac arrythmias

13 13

Amlodipine Tablet 5 mg (as maleate mesylate or besylate)

Bisoprolol Tablet 125 mg 5 mg 1048710 includes metoprolol and carvedilol as alternatives

Enalapril Tablet 25 mg 5 mg (as hydrogen maleate)

Hydralazine Powder for injection 20 mg (hydrochloride) in ampouleTablet 25 mg 50 mg (hydrochloride)

Hydrochlorothiazide Oral liquid 50 mg5 mlSolid oral dosage form 125 mg 25 mg

Methyldopa Tablet 250 mg

sodium nitroprusside

Powder for infusion 50 mg in ampoule

WHOrsquos current European policy

Priority interventions of the action plan for noncommunicable diseases 2012-2016 include

Promotion of a healthy diet through marketing and fiscal measuresElimination of trans fats amp Salt reductionCardio-metabolic risk reduction assessment and managementPromotion of physical activity and mobility

AmlodipineAtenolol ChlorthalidoneClonidine Hydrochloride Enalapril MaleateLosartanpotassiumMethyldopaNifedipine PropranololSodiumNitroprusside Terazosin

WHO Essential Drugs

Indiarsquos Essential Drugs

14 14

War against Hypertension

H-BP v

s W

HO Risk factorsA diet high in saturated fatExcessive salt consumptionOverweight and obesityA sedentary lifestyle and lack of exerciseExcessive alcohol consumptionSmokingUn-managed stressA family history of high blood pressureBeing over 65 years of ageCo-morbidities such as diabetes

WHOHigh B

P

Manage high blood pressure byeating a healthy diet reducing salt intake exercising regularly stopping smoking reducing alcohol consumptionmanaging stress having regular blood pressure checksCommunity-based efforts to reduce blood pressure and stroke in Japan

15 15

• Slide 1
• Slide 2
• Slide 3
• Slide 4
• Slide 5
• Slide 6
• Slide 7
• Slide 8
• Slide 9
• Slide 10
• Slide 11
• Slide 12
• Slide 13
• Slide 14
• Slide 15

11 11

CVS (3530)Respiratory(118)GI(206)

ADRs(Adverse Drug Reactions) are among the leading cause of mortality amp morbidity Regular monitoring of ADR is important specially in a chronic asymptomatic disorder like HypertensionThe following study was conducted in med OPD of Majeeida Hospital New Delhi CCBs are the most prescribed drugs (317) amp β blockers are associated with highest no of ADR (75)

PHARMACOVIGILANCE amp ADR

Hypokalaemia

Carbohydrate

intolerance

OedemaTachycardia

Dysgeusia Nausea

Cough

Angioedem

ia

Approved Combinations (JNC7)

Combinations better avoided

ACEInhibitorARB+ Diuretics

Adr blocker + Clonidine

HydralazineDHP+ Beta-blocker

Nifedipine+ Diuretic

VasodilatorSympatholytics+ Diuretic

Hydralazine+DHP

12 12

Rational Drug Therapy

Drug Interaction

Lithium Thiazide(Pharmacokinetic intr)Increased toxicity of lithium

Verapamil Propranolol (Pharmacodynamic intr)Heart Failure PrecipitationAV block amp sever bradycardiaEnalapril Spironolactone(Pharmacodynamic intr)HyperkalaemiaCardiac arrythmias

13 13

Amlodipine Tablet 5 mg (as maleate mesylate or besylate)

Bisoprolol Tablet 125 mg 5 mg 1048710 includes metoprolol and carvedilol as alternatives

Enalapril Tablet 25 mg 5 mg (as hydrogen maleate)

Hydralazine Powder for injection 20 mg (hydrochloride) in ampouleTablet 25 mg 50 mg (hydrochloride)

Hydrochlorothiazide Oral liquid 50 mg5 mlSolid oral dosage form 125 mg 25 mg

Methyldopa Tablet 250 mg

sodium nitroprusside

Powder for infusion 50 mg in ampoule

WHOrsquos current European policy

Priority interventions of the action plan for noncommunicable diseases 2012-2016 include

Promotion of a healthy diet through marketing and fiscal measuresElimination of trans fats amp Salt reductionCardio-metabolic risk reduction assessment and managementPromotion of physical activity and mobility

AmlodipineAtenolol ChlorthalidoneClonidine Hydrochloride Enalapril MaleateLosartanpotassiumMethyldopaNifedipine PropranololSodiumNitroprusside Terazosin

WHO Essential Drugs

Indiarsquos Essential Drugs

14 14

War against Hypertension

H-BP v

s W

HO Risk factorsA diet high in saturated fatExcessive salt consumptionOverweight and obesityA sedentary lifestyle and lack of exerciseExcessive alcohol consumptionSmokingUn-managed stressA family history of high blood pressureBeing over 65 years of ageCo-morbidities such as diabetes

WHOHigh B

P

Manage high blood pressure byeating a healthy diet reducing salt intake exercising regularly stopping smoking reducing alcohol consumptionmanaging stress having regular blood pressure checksCommunity-based efforts to reduce blood pressure and stroke in Japan

15 15

• Slide 1
• Slide 2
• Slide 3
• Slide 4
• Slide 5
• Slide 6
• Slide 7
• Slide 8
• Slide 9
• Slide 10
• Slide 11
• Slide 12
• Slide 13
• Slide 14
• Slide 15

12 12

Rational Drug Therapy

Drug Interaction

Lithium Thiazide(Pharmacokinetic intr)Increased toxicity of lithium

Verapamil Propranolol (Pharmacodynamic intr)Heart Failure PrecipitationAV block amp sever bradycardiaEnalapril Spironolactone(Pharmacodynamic intr)HyperkalaemiaCardiac arrythmias

13 13

Amlodipine Tablet 5 mg (as maleate mesylate or besylate)

Bisoprolol Tablet 125 mg 5 mg 1048710 includes metoprolol and carvedilol as alternatives

Enalapril Tablet 25 mg 5 mg (as hydrogen maleate)

Hydralazine Powder for injection 20 mg (hydrochloride) in ampouleTablet 25 mg 50 mg (hydrochloride)

Hydrochlorothiazide Oral liquid 50 mg5 mlSolid oral dosage form 125 mg 25 mg

Methyldopa Tablet 250 mg

sodium nitroprusside

Powder for infusion 50 mg in ampoule

WHOrsquos current European policy

Priority interventions of the action plan for noncommunicable diseases 2012-2016 include

Promotion of a healthy diet through marketing and fiscal measuresElimination of trans fats amp Salt reductionCardio-metabolic risk reduction assessment and managementPromotion of physical activity and mobility

AmlodipineAtenolol ChlorthalidoneClonidine Hydrochloride Enalapril MaleateLosartanpotassiumMethyldopaNifedipine PropranololSodiumNitroprusside Terazosin

WHO Essential Drugs

Indiarsquos Essential Drugs

14 14

War against Hypertension

H-BP v

s W

HO Risk factorsA diet high in saturated fatExcessive salt consumptionOverweight and obesityA sedentary lifestyle and lack of exerciseExcessive alcohol consumptionSmokingUn-managed stressA family history of high blood pressureBeing over 65 years of ageCo-morbidities such as diabetes

WHOHigh B

P

Manage high blood pressure byeating a healthy diet reducing salt intake exercising regularly stopping smoking reducing alcohol consumptionmanaging stress having regular blood pressure checksCommunity-based efforts to reduce blood pressure and stroke in Japan

15 15

• Slide 1
• Slide 2
• Slide 3
• Slide 4
• Slide 5
• Slide 6
• Slide 7
• Slide 8
• Slide 9
• Slide 10
• Slide 11
• Slide 12
• Slide 13
• Slide 14
• Slide 15

13 13

Amlodipine Tablet 5 mg (as maleate mesylate or besylate)

Bisoprolol Tablet 125 mg 5 mg 1048710 includes metoprolol and carvedilol as alternatives

Enalapril Tablet 25 mg 5 mg (as hydrogen maleate)

Hydralazine Powder for injection 20 mg (hydrochloride) in ampouleTablet 25 mg 50 mg (hydrochloride)

Hydrochlorothiazide Oral liquid 50 mg5 mlSolid oral dosage form 125 mg 25 mg

Methyldopa Tablet 250 mg

sodium nitroprusside

Powder for infusion 50 mg in ampoule

WHOrsquos current European policy

Priority interventions of the action plan for noncommunicable diseases 2012-2016 include

Promotion of a healthy diet through marketing and fiscal measuresElimination of trans fats amp Salt reductionCardio-metabolic risk reduction assessment and managementPromotion of physical activity and mobility

AmlodipineAtenolol ChlorthalidoneClonidine Hydrochloride Enalapril MaleateLosartanpotassiumMethyldopaNifedipine PropranololSodiumNitroprusside Terazosin

WHO Essential Drugs

Indiarsquos Essential Drugs

14 14

War against Hypertension

H-BP v

s W

HO Risk factorsA diet high in saturated fatExcessive salt consumptionOverweight and obesityA sedentary lifestyle and lack of exerciseExcessive alcohol consumptionSmokingUn-managed stressA family history of high blood pressureBeing over 65 years of ageCo-morbidities such as diabetes

WHOHigh B

P

Manage high blood pressure byeating a healthy diet reducing salt intake exercising regularly stopping smoking reducing alcohol consumptionmanaging stress having regular blood pressure checksCommunity-based efforts to reduce blood pressure and stroke in Japan

15 15

• Slide 1
• Slide 2
• Slide 3
• Slide 4
• Slide 5
• Slide 6
• Slide 7
• Slide 8
• Slide 9
• Slide 10
• Slide 11
• Slide 12
• Slide 13
• Slide 14
• Slide 15

14 14

War against Hypertension

H-BP v

s W

HO Risk factorsA diet high in saturated fatExcessive salt consumptionOverweight and obesityA sedentary lifestyle and lack of exerciseExcessive alcohol consumptionSmokingUn-managed stressA family history of high blood pressureBeing over 65 years of ageCo-morbidities such as diabetes

WHOHigh B

P

Manage high blood pressure byeating a healthy diet reducing salt intake exercising regularly stopping smoking reducing alcohol consumptionmanaging stress having regular blood pressure checksCommunity-based efforts to reduce blood pressure and stroke in Japan

15 15

• Slide 1
• Slide 2
• Slide 3
• Slide 4
• Slide 5
• Slide 6
• Slide 7
• Slide 8
• Slide 9
• Slide 10
• Slide 11
• Slide 12
• Slide 13
• Slide 14
• Slide 15

15 15

• Slide 1
• Slide 2
• Slide 3
• Slide 4
• Slide 5
• Slide 6
• Slide 7
• Slide 8
• Slide 9
• Slide 10
• Slide 11
• Slide 12
• Slide 13
• Slide 14
• Slide 15