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HEART SPECIALISTS IN GANGAMMA CIRCLE BANGALORE Assessment of patients with hypertension A patient with definite or possible newly diagnosed hypertension needs at least a basic clinical assessment to look for possible aetiology, severity and signs of complications. The history Questioning should be directed towards the following areas. 1 Past history. Has hypertension been diagnosed before? What treatment was instituted? Why was it stopped? 2 Secondary causes. Important questions relate to: • a history of renal disease in the patient or his or her family, recurrent urinary tract infec-­ tions, heavy analgesic use or conditions leading to renal disease (e.g. systemic lupus erythematosus (SLE)) • symptoms suggesting phaeochromocytoma (flushing, sweats, palpitations) • symptoms suggesting sleep apnoea • muscle weakness suggesting the hypokalaemia of hyperaldosteronism • Cushing’s syndrome (weight gain, skin changes) • family history of hypertension. 3 Aggravating factors: • high salt intake • high alcohol intake • lack of exercise • use of medications: NSAIDs, appetite suppressants, nasal decongestants, monoamine oxidase inhibitors, ergotamine, cyclosporin, oestrogen-containing contraceptive pills • other: use of cocaine, liquorice, amphetamines. 4 Target organ damage: • stroke or transient ischaemic attack (TIA) • angina, dyspnoea • fatigue, oliguria • visual disturbance • claudication. 5 Coexisting risk factors: • smoking • diabetes • lipid levels, if known • existing vascular disease • family history of ischaemic heart disease. 2• HYPERTENSION 6 Factors affecting choice of treatment: • diabetes (problems with thiazides and beta-blockers) • gout (problems with thiazides) • asthma (problems with beta-blockers) • heart failure (problems with verapamil, diltiazem, some beta-blockers, monoxidine) • severe peripheral arterial disease (problems with beta-blockers) • bradycardia or heart block (problems with beta-blockers, verapamil, diltiazem) • renovascular disease (problems with ACE inhibitors, angiotensin receptor antagonists (ARAs)) • problems with previous anti-hypertensive agents • allergies • likelihood of pregnancy (ACE inhibitors, diuretics and some calcium antagonists are contraindicated). The examination The physical examination should be undertaken with a view to establishing severity. 1 Measure the blood pressure. 2 Look for secondary causes. • Check the appearance for Cushing’s syndrome (central obesity, striae, muscle wasting), acromegaly, polycythaemia and uraemia. • Undertake abdominal palpation for renal masses (polycystic kidneys), occasionally adrenal mass, and auscultation for renal bruit (heard to the left or right of the mid-line above the umbilicus, often into the flanks). • Assess radiofemoral pulse delay and listen for mid
Popular Cardiologist in Rajanukunte, Bangalore • Coexisting disease and patient risk profile LVH: Choose ACE inhibitors, ARAs, alpha-blockers, beta-blockers, calcium antagonists. Previous acute myocardial infarction (AMI): Choose beta-blockers, ACE inhibitors in left ventricular dysfunction (LVD). Angina: Choose beta-blockers, verapamil, diltiazem. Cardiac failure or LVD: ACE inhibitors (and ARAs) and beta-blockers (carvedilol, bisoprolol and slow-release metoprolol) reduce symptoms and mortality. Monoxi-­ dine is contraindicated. Diuretics reduce symptoms, but loop diuretics (frusemide) are too short-acting to be useful for hypertension. Diabetes: ACE inhibitors and ARAs protect renal function in patients with pro-­ teinuria.16 Aortic stenosis: Vasodilators should be used with caution. Renovascular disease: ACE inhibitors and ARAs are effective but can lead to deterioration of renal function. Potassium and creatinine levels should be monitored. ACE inhibitors and ARAs are contraindicated in bilateral renal artery stenosis, or where there is a single functioning kidney. PVD: Beta-blockers are relatively contraindicated. Stroke: ARAs and low-dose thiazides are more effective for prevention than beta-blockers. Diabetes: Diuretics have an adverse effect on glucose metabolism. ACE inhibitors and ARAs are of value in reducing the development of diabetic nephropathy. Dyslipidaemia: Alpha-blockers have a mild beneficial effect on serum lipids. ACE inhibi-­ tors and calcium antagonists have a neutral effect. Gout: Diuretics inhibit uric acid excretion and are relatively contraindicated. Asthma and chronic obstructive pulmonary disease (COPD): Beta-blockers are usually contraindicated. Depression: Methyldopa, calcium antagonists and clonidine may aggravate.
Popular Cardiologist in Rajanukunte, Bangalore • Coexisting disease and patient risk profile LVH: Choose ACE inhibitors, ARAs, alpha-blockers, beta-blockers, calcium antagonists. Previous acute myocardial infarction (AMI): Choose beta-blockers, ACE inhibitors in left ventricular dysfunction (LVD). Angina: Choose beta-blockers, verapamil, diltiazem. Cardiac failure or LVD: ACE inhibitors (and ARAs) and beta-blockers (carvedilol, bisoprolol and slow-release metoprolol) reduce symptoms and mortality. Monoxi-­ dine is contraindicated. Diuretics reduce symptoms, but loop diuretics (frusemide) are too short-acting to be useful for hypertension. Diabetes: ACE inhibitors and ARAs protect renal function in patients with pro-­ teinuria.16 Aortic stenosis: Vasodilators should be used with caution. Renovascular disease: ACE inhibitors and ARAs are effective but can lead to deterioration of renal function. Potassium and creatinine levels should be monitored. ACE inhibitors and ARAs are contraindicated in bilateral renal artery stenosis, or where there is a single functioning kidney. PVD: Beta-blockers are relatively contraindicated. Stroke: ARAs and low-dose thiazides are more effective for prevention than beta-blockers. Diabetes: Diuretics have an adverse effect on glucose metabolism. ACE inhibitors and ARAs are of value in reducing the development of diabetic nephropathy. Dyslipidaemia: Alpha-blockers have a mild beneficial effect on serum lipids. ACE inhibi-­ tors and calcium antagonists have a neutral effect. Gout: Diuretics inhibit uric acid excretion and are relatively contraindicated. Asthma and chronic obstructive pulmonary disease (COPD): Beta-blockers are usually contraindicated. Depression: Methyldopa, calcium antagonists and clonidine may aggravate.
sugar clinics near me Type 1 (insulin-dependent) and type 2 (non-insulin-dependent) diabetes are aetiologically and epidemiologically distinct conditions affecting different segments of the population. Nevertheless, no major difference has been identified between the nephropathies seen in these conditions, either pathophysiologically or in terms of management. They can thus be conveniently considered together. It should be remembered, however, that patients with type 2 diabetes tend to be older and more hypertensive, and thus more likely to have concomitant hypertensive and renovascular disease.
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