2013 N U J EDISI AS

ASIR M PKD P

ISU BULAN INI:

HYPERTENSION

SIDANG EDITORIAL
PENASIHAT : NOR AFIFAH RAHIMI

ISI KANDUNGAN
TOPIC PAGE
2 2 3 4 5-7 8 9 9 10 11 WHAT IS HYPERTENSION? CHRONIC HYPERTENSION PRE-ECLAMPSIA ECLAMPSIA

EDITOR NURUNNUHA MOHD NAWI

PENGARANG

MEDICATIONS USED IN HYPERTENSION KUIZ NEWLY HYPERTENSION DRUG IN CLINIC PERGERAKAN KAKITANGAN DI PKD PASIR MAS SEJENAK SEKETIKA DI LUAR QUOTES

NORUL IZZA AB RAHMAN WAN HAZNI TUAN AZIZ ARINA LIANA ISMAIL MUHAINI ABD HADI FARAH HANNAN MOHD MAZELAN

High blood pressure is a common condition in which the force of the blood against your artery walls is high enough that it may eventually cause health problems, such as heart disease.

Blood pressure is determined by the amount of blood your heart pumps and the amount of resistance to blood flow in your arteries. The more blood your heart pumps and the narrower your arteries, the higher your blood pressure.

You can have high blood pressure (hypertension) for years without any symptoms. Uncontrolled high blood pressure increases your risk of serious health problems, including heart attack and stroke.

High blood pressure typically develops over many years, and it affects nearly everyone eventually. Fortunately, high blood pressure can be easily detected. And once you know you have high blood pressure, you can work with your doctor to control it. (source : mayoclinic.com)

is diagnosed when hypertension is confirmed before pregnancy or before 20 weeks gestation (blood pressure >140 mmHg systolic and/or >90 mmHg diastolic). is frequently diagnosed when high blood pressure fails to resolve post-partum. Women with chronic hypertension require careful monitoring during pregnancy as they have an increased risk of adverse events, including superimposed pre-eclampsia, placental abruption, fetal growth restriction, premature delivery and stillbirth.

is defined as:

New onset of hypertension(BP 140/90mmHG) after 20 weeks gestation. No other features to suggest pre-eclampsia (no proteinuria) Normalisation of blood pressure within three months postpartum. Gestational hypertension is associated with adverse pregnancy outcomes if it progresses to pre-eclampsia or if hypertension is severe (170/110 mmHg) Final diagnosis only made postpartum

Hypertension (140/90 mmHg) with onset after 20 weeks gestation with previously normal BP Renal manifestations - Significant proteinuria - Serum creatinine >90 micromol/L (or renal failure) - Oliguria Haematological manifestations Disseminated intravascular coagulation Thrombocytopenia Haemolysis Hepatic manifestations Raised serum transaminases Severe right upper quadrant or epigastric pain Neurological manifestations Eclamptic seizure Hyperreflexia with sustained clonus Severe headache Persistent visual disturbances Stroke Pulmonary oedema Fetal growth restriction Placental abruption

seizures in woman with pre-eclampsia. Occurs: 1/3 during pregnancy. 1/3 during labour.1/3 postpartum Risk factors: - 1st pregnancy - History of PE - Gestational Diabetes Mellitus - Chronic HPT - Underlying renal disease - Obese - Rhesus incompatibility

Characterized by :

New onset proteinuria (>300mg/24h) in pregnant woman but no proteinuria before 20 weeks gestation sudden increase proteinuria or BP Platelet count <100,000/mm3 in HPT and proteinuria woman before 20weeks gestation.

Medications Diuretics Diuretic drugs increase urine output by the kidney (i.e., promote diuresis). This is accomplished by altering how the kidney handles sodium. If the kidney excretes more sodium, water excretion will also increase. Most diuretics produce diuresis by inhibiting the reabsorption of sodium at different segments of the renal tubular system. Chlorothiazide Hydrochlorothiazide Chlorthalidone Amiloride/ hydrochlorothiazide 5 mg/50 mg Indapamide SR Indapamide Triamterene/ hydrochlorothiazide 50 mg/25 mg Acebutolol Atenolol Betaxolol Bisoprolol Metoprolol Propranolol

Starting Dose 250 mg od 25 mg od 50 mg od 1 tablet od

Maximum Daily Dose 500 mg od 200 mg od 200 mg od 4 tablet od

1.5 mg od 2.5 mg od 1 tablet bd

1.5 mg od 2.5 mg od 2 tablets bd

Beta-blockers Beta-blockers decrease arterial blood pressure by reducing cardiac output. Many forms of hypertension are associated with an increase in blood volume and cardiac output. Therefore, reducing cardiac output by beta-blockade can be an effective treatment for hypertension, especially when used in conjunction with a diuretic. ACE inhibitors ACE inhibitors are effective in the treatment of primary hypertension and hypertension caused by renal artery stenosis, which causes renin-dependent hypertension owing to the increased release of renin by the kidneys. Reducing angiotensin II formation leads to arterial and venous dilation, which reduces arterial and venous pressures. By reducing the effects of angiotensin II on the kidney, ACE inhibitors cause natriuresis and diuresis, which decreases blood volume and cardiac output, thereby lowering arterial pressure. Angiotensin receptor blockers (ARBs) ARBs are receptor antagonists that block type 1 angiotensin II (AT1) receptors on bloods vessels and other tissues such as the heart. These receptors are coupled to the Gq-protein and IP3 signal transduction pathway that stimulates vascular smooth muscle contraction.

200 mg bd 50 mg od 10 mg od 5 mg od 50 mg bd 40 mg bd

400 mg bd 100 mg od 40 mg od 10 mg od 200 mg bd 320 mg bd

Captopril Enalapril Fosinopri Lisinopril Perindopril Quinapril Ramipril Imidapril

25 mg bd 2.5 mg od 10 mg od 5 mg od 2 mg od 2.5 mg od 2.5 mg od 2.5 mg od

50 mg tds 20 mg bd 40 mg od 80 mg od 8 mg od 40 mg bd 10 mg od 10 mg od

Candesartan Irbesartan Losartan Telmisartan Valsartan Olmesartan

8 mg od 150 mg od 50 mg od 20 mg od 80 mg od 20 mg od

16 mg od 300 mg od 300 mg od 80 mg od 160 mg od 40 mg od

Medications Calcium channel blockers (CCBs) CCBs decrease systemic vascular resistance by causing vascular smooth muscle relaxation, which lowers arterial blood pressure. There are 2 major classes of CCBs. They differ in their relative selectivity toward cardiac versus vascular L-type calcium channels Dihydropyridines Because of their high vascular selectivity, these drugs are primarily used to reduce systemic vascular resistance and arterial pressure, and therefore are primarily used to treat hypertension. (ie Amlodipine, Felodipine, Isradipine, Lacidipine, Nicardipine, Nifedipine) Non-dihydropyridines Verapamil (phenylalkylamine class), is relatively selective for the myocardium, and is less effective as a systemic vasodilator drug. This drug has a very important role in treating angina (by reducing myocardial oxygen demand and reversing coronary vasospasm) and arrhythmias. Diltiazem (benzothiazepine class) is intermediate between verapamil and dihydropyridines in its selectivity for vascular calcium channels. By having both cardiac depressant and vasodilator actions, diltiazem is able to reduce arterial pressure without producing the same degree of reflex cardiac stimulation caused by dihydropyridines. -blockers Newer alpha-blockers used in treating hypertension are relatively selective 1adrenoceptor antagonists. They have favourable effects on lipid metabolism. Postural hypotension is a known side effect, especially at initiation of therapy Combined -blockers Combined -blockers offer enhanced neurohormonal blockade. * In the elderly, start with 50 mg bd Amlodipine Diltiazem Diltiazem SR Diltiazem R Felodipine Isradipine Lacidipine Lercanidipine Nicardipine Nifedipine Nifedipine SR Verapamil Verapamil CR

Starting Dose 5 mg od 30 mg tds 90 mg bd 100-200 mg od 2.5 mg od 1.5 mg bd 2 mg od 10 mg od 10 mg tds 10 mg tds 30 mg od 80 mg bd 200 mg od

Maximum Daily Dose 10 mg od 60 mg tds 90 mg bd 100-200 mg od 10 mg od 2.5 mg bd 6 mg od 20 mg od 20 mg tds 30 mg tds 120 mg od 240 mg tds 200 mg bd

Doxazosin Prazosin Terazosin

1 mg od 0.5 mg bd 1 mg od

16 mg od 10 mg bd 5 mg od

Labetalol* Carvedilol

100 mg bd 12.5 mg od

800 mg tds 50 mg od

EFFECTIVE ANTIHYPERTENSIVE COMBINATION

Effective combination Beta-blockers + diuretics Beta-blockers + CCBs CCBs + ACEIs/ARBs ACEIs + diuretics ARBs + diuretics Comments Benefits proven in the elderly, cost-effective. However, may increase the risk of new onset diabetes. Relatively cheap, appropriate for concurrent CHD Appropriate for concurrent dyslipidaemias and diabetes mellitus Appropriate for concurrent heart failure, diabetes mellitus and stroke Appropriate for concurrent heart failure and diabetes mellitus

NON-PHARMACOLOGICAL :

BMI or weight

As far as possible aim for an ideal Body Mass Index [Weight (kg)/Height2 (m)] for Asians, the normal range has been proposed to be 18.5 to 23.5 kg/m2. However a weight loss as little as 4.5 kg significantly reduces BP.

Salt intake

An intake of <100 mmol of sodium or 6g of sodium chloride a day is recommended (equivalent to <11/4 teaspoonfuls of salt or 3 teaspoonfuls of monosodium glutamate).

Alcohol

Standard advice is to restrict intake to no more than 21 units for men and 14 units for women per week (1 unit equivalent to 1/2 a pint of beer or 100ml of wine or 20ml of proof whisky).

Exercise

General advice on cardiovascular health would be for milder exercise, such as brisk walking for 30 60 minutes at least 3 times a week.

Diet

A diet rich in fruits, vegetables and dairy products with reduced saturated and total fat can substantially lower BP (11/6 mmHg in hypertensive patients and 4/2 mmHg in patients with high normal BP).

Smoking

Cessation of smoking is important in management of the patients with hypertension

the

overall

1.

Hypertension dikenali sebagai pembunuh senyap kerana Ia datang tanpa simptom yang nyata Ia adalah perkataan Greek yang bermaksud pembunuh senyap Orang dengan hipertension adalah pembunuh

2.

Ubatan hipertension boleh dihentikan apabila tekanan darah kembali normal. Betul Salah

3.

Tekanan darah kurang dari 120/80 dikira tekanan darah normal untuk orang dewasa. Betul Salah

4. Diagnosis tekanan darah tinggi selalunya dibuat selepas beberapa kali peningkatan tekanan darah direkod.

Betul Salah

UBAT BARU LIST A/KK DI KLINIK KESIHATAN UNTUK DIAGNOSIS HIPERTENSI

Telmisartan/Amlodipine terdapat dalam 2 kekuatan amlodipine: ~ Twynsta 80mg/10mg ~ Twynsta 80mg/5mg

PERGERAKAN ANGGOTA FARMASI DI PKD PASIR MAS

Jawatan/Gred
Penolong Pegawai Farmasi U29

Nama
Azira binti Ahmed

Dari
Klinik Kesihatan Dabong (PKD Kuala Krai) Klinik Kesihatan Penambang (PKD Kota Bharu)

Ke
Klinik Kesihatan Kubang Kual (PKD Pasir Mas) Klinik Kesihatan Meranti (PKD Pasir Mas)

Penolong Pegawai Farmasi U32 (KUP)

Nik Amnah binti Nik Idris

Sejenak Seketika Di Luar

P IT OL IK K N TA A H Remaja hipertensi pintar? ESI

TEKANAN darah tinggi atau hipertensi bukan sahaja dialami oleh golongan dewasa bahkan remaja.Namun, remaja yang menghidap penyakit ini didakwa lebih bijak serta pintar di sekolah berbanding rakan sebaya yang normal. Ini berdasarkan penyelidikan sekumpulan pakar perubatan di Universiti Gottingen, Jerman terhadap 7,688 remaja lelaki dan wanita yang berusia antara 11 hingga 17 tahun. Sebanyak 11 peratus responden menderita tekanan darah tinggi.

O EK IA
Asia berjaga-jaga penularan selesema H7N9

M NO

I
Harga emas jatuh

N DU

Pihak berkuasa di beberapa negara Asia mengetatkan saringan terhadap pelancong dari China dalam usaha mengekang penyebaran virus selesema burung H7N9 di negara masing-masing. Sehingga Mei, H7N9 telah menjangkiti 109 orang di China sejak virus itu mula dikesan pada Mac lalu dengan 23 orang maut. dan penyakit maut itu telah menjangkiti seorang warga Taiwan. Susulan perkembangan tersebut, pihak berkuasa Taiwan memberitahu, mereka akan melakukan ujian kesihatan ke atas pelancong di pintu masuk lapangan terbang yang menunjukkan simptom seperti panas badan atau demam. Pihak berkuasa Vietnam mula menyaring suhu badan penumpang di lapangan terbang negara itu manakala kerajaan Jepun akan membenarkan pihak berkuasa lapangan terbang dan pelabuhan memeriksa suhu badan pelawat dari China bermula bulan depan. Di Thailand, Menteri Kesihatan Pradit Sintawanarong berkata, negara itu perlu meningkatkan langkah berjaga-jaga dengan pelan menangani wabak itu akan diserahkan kepada Perdana Menteri Yingluck Shinawatra tidak lama lagi. "Berdasarkan pemerhatian kami, terdapat risiko virus H7N9 merebak ke Thailand," kata Sintawanarong. Dalam pada itu, di Singapura, institusi-institusi kesihatan di pulau tersebut kini diletakkan dalam keadaan siapsiaga berhubung penularan wabak H7N9. Langkah tersebut dilaksanakan sehari selepas seorang pakar Pertubuhan Kesihatan Sedunia menyatakan, virus H7N9 merupakan virus selesema burung yang paling berisiko membawa maut kepada manusia. Setakat ini, jangkitan virus berbahaya itu dilaporkan berpunca daripada unggas yang sakit manakala saintis-saintis semakin

PAUL WHELTON
The existing body of evidence ... favors the notion that potassium supplementation should be considered as part of recommendations for prevention and treatment of hypertension.

Walter Willett Treatment doesn't bring back the risk to that of someone without hypertension, ... High blood pressure raises the risk threefold and treatment reduces it by 25 percent.