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Cardiologist in Rajanukunte, Bangalore • Factors that increase triglyceride levels 1 Obesity 2 Alcohol 3 Diabetes 4 Oestrogen (including HRT in 20% of users) 5 Diuretics 6 Beta-blockers Secondary causes: • Cushing’s syndrome • acromegaly • uraemia • acute hepatitis
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
HEART SPECIALISTS IN YELAHANKA NEW TOWN BANGALORE Triglycerides The independent effect of triglyceride levels is weak, and high triglyceride levels are often associated with other risk factors (e.g. low HDLs). Secondary causes of high triglycerides are common and confuse the picture, as does the fact that serum levels can vary greatly with fasting and recent alcohol intake. The combination of high triglycerides and elevated LDL (combined dyslipidaemia) is associated with a marked increase in coronary disease risk. Isolated extremely high triglycerides (greater than 15 mmol/L) are a risk factor for pancreatitis rather than vascular disease. Modest elevations of triglycerides can usually be managed by weight control, a reduction in alcohol consumption and changes in medication. Table 1.5 Factors that affect HDL levels Factors that increase HDL levels Factors that reduce HDL levels 1 Oestrogen 2 Exercise 3 Small amounts of alcohol (10–20 g per day in men) 1 Smoking 2 Obesity 3 Inactivity 4 Hypothyroidism 5 Postmenopausal state 6 Beta-blockers Table 1.6 Factors that increase triglyceride levels 1 Obesity 2 Alcohol 3 Diabetes 4 Oestrogen (including HRT in 20% of users) 5 Diuretics 6 Beta-blockers 7 Secondary causes: • Cushing’s syndrome • acromegaly • uraemia • acute hepatitis 8 High triglycerides and low HDLs are associated with insulin resistance
HEART SPECIALISTS IN YELAHANKA NEW TOWN BANGALORE Triglycerides The independent effect of triglyceride levels is weak, and high triglyceride levels are often associated with other risk factors (e.g. low HDLs). Secondary causes of high triglycerides are common and confuse the picture, as does the fact that serum levels can vary greatly with fasting and recent alcohol intake. The combination of high triglycerides and elevated LDL (combined dyslipidaemia) is associated with a marked increase in coronary disease risk. Isolated extremely high triglycerides (greater than 15 mmol/L) are a risk factor for pancreatitis rather than vascular disease. Modest elevations of triglycerides can usually be managed by weight control, a reduction in alcohol consumption and changes in medication. Table 1.5 Factors that affect HDL levels Factors that increase HDL levels Factors that reduce HDL levels 1 Oestrogen 2 Exercise 3 Small amounts of alcohol (10–20 g per day in men) 1 Smoking 2 Obesity 3 Inactivity 4 Hypothyroidism 5 Postmenopausal state 6 Beta-blockers Table 1.6 Factors that increase triglyceride levels 1 Obesity 2 Alcohol 3 Diabetes 4 Oestrogen (including HRT in 20% of users) 5 Diuretics 6 Beta-blockers 7 Secondary causes: • Cushing’s syndrome • acromegaly • uraemia • acute hepatitis 8 High triglycerides and low HDLs are associated with insulin resistance
Diabetes clinics in Sahakara Nagar, Bangalore • Factors that increase triglyceride levels 1 Obesity 2 Alcohol 3 Diabetes 4 Oestrogen (including HRT in 20% of users) 5 Diuretics 6 Beta-blockers 7 Secondary causes: • Cushing’s syndrome • acromegaly • uraemia • acute hepatitis 8 High triglycerides and low HDLs are associated with insulin resistance.
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