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1、HypertensiveHeartDiseaseRickyM.Kirby,FNP,BCLopezInternalMedicineAssociates4250LakesideDrive,Suite204Jacksonville,FL32210(904)598-1888rickkirby@bellsouth.netReferencesJNC7FullReport,NIHPublicationNo.04-5203http://hin.nhlbi.nih.gov/nhbpep_slds/menu.htm#hbpch1JNC7Express,NIHPub.No.03-5233December2003J
2、NC7Quickreferencecard,NIHPub.No.03-5231JNC7FullReport—Comprehensivejustificationandrationale(87pages,NIHPub.No.04-5203).Express—Succinctevidence-basedrecommendations.PublishedinJAMAMay21,2003,andasaGovernmentPrintingOfficepublication(52pages,NIHPub.No.03-5233).ReferenceCard–Quickreferencecard(2page
3、s,NIHPub.No.03-5231).OverviewClassificationofBPCVDRiskBenefitsofLoweringBPBPMeasurementTechniquesIn-officeAmbulatoryBPMonitoringSelf-measurementCVDRiskFactorsCausesofHTNTargetOrganDamageLaboratory/DiagnosticTestsTreatmentGoalsofTherapyLifeStyleModificationAlgorithmforTreatmentofHypertensionManageme
4、ntofBPinAdultsMinorityPopulationsHTNintheElderlyCaseStudyFactoidsForpersonsoverage50,SBPisamoreimportantthanDBPasCVDriskfactor.Startingat115/75mmHg,CVDriskdoubleswitheachincrementof20/10mmHgthroughouttheBPrange.Personswhoarenormotensiveatage55havea90%lifetimeriskfordevelopingHTN.ThosewithSBP120–139
5、mmHgorDBP80–89mmHgshouldbeconsideredprehypertensivewhorequirehealth-promotinglifestylemodificationstopreventCVD.FactoidsThiazide-typediuretics,eitheraloneorcombination,shouldbeconsideredforinitialdrugtherapy.High-riskconditionsareacompellingreasontostartotherdrugclasses.Mostpatientswillrequiretwoor
6、moreantihypertensivedrugstoachievegoalBP.IfBPis>20/10mmHgabovegoal,initiatetherapywithtwoagents,oneusuallyshouldbeathiazide-typediuretic.FactoidsHypertensionisthemostcommonprimarydiagnosisinAmerica(35millionofficevisitsastheprimarydiagnosis).Themosteffectivetherapyprescribedbyacarefulclinicianwillc
7、ontrolHTNONLYifpatientsaremotivated.Motivationimproveswhenpatientshavepositiveexperienceswith,andtrustin,theclinicianandthemedication.Thecliniciansjudgmentremainsparamountindetermininginitialandcontinuingth
