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Diagnosis and management of sinusitis
Short Clinical Guidelines: Diagnosis and Management of Hypertension
History and Physical:
Lab tests and other diagnostic procedures
o CBC o Chem panel which includes potassium, creatinine and calcium levels o UA o Lipid panel o Urinary albumin/creatinine ratio o Electrocardiogram
Identification of risk factors (see below) Identification of co-morbidities (see below)
Cardiovascular Risk Factors:
Dyslipidemia Diabetes Mellitus Cigarette smoking Physical inactivity Family history of premature CVD (men age <55, women age <65) Microalbuminuria Estimated GFR <60mL/min Age (>55 for men, >65 for women)
Co-morbidities:
Sleep apnea Drug induced/related causes Chronic kidney disease Primary aldosteronism Renovascular disease Chronic steroid therapy and Cushing's syndrome Pheochromocytoma Coarctation of Aorta Thyroid/Parathyroid disease Adapted from the National Heart, Lung, and Blood Institute 7th JNC on Prevention, Detection, Evaluation and Treatment of High Blood Pressure by the Riverside Physician Network Medical Practice Committee
Effective date: April, 2007 Review date(s): 6/2009, 9/2011
Short Clinical Guidelines: Diagnosis and Management of Hypertension
Treatment:
Goal is blood pressure <140/90 mmHg; <130/80 mmHg for patients with Diabetes or chronic kidney disease
o Weight reduction - BMI 18.5-24.9 kg/m2 o Diet - fruits, vegetables, low fat dairy with reduced content of saturated
o Dietary sodium restriction - reduce to <100mmol per day (2.5g sodium or
o Aerobic physical activity - regularly at least 30 minutes per day, most
o Moderation of alcohol consumption - men: <2 drinks per day; women: <1
drink per day ( 1 drink: ½ oz. or 15ml alcohol = 12oz. beer, 5 oz. wine, 1.5 oz 80-proof whiskey)
o Stage 1 - Thiazide-type diuretics. May consider ACEI, ARB, BB, CCB or
o Stage 2 - 2 drug combination for most (usually Thiazide-type diuretic and
Heart failure - Thiazide diuretics, Beta blockers, ACE inhibitors,
Angiotensin receptor blockers, Aldosterone antagonist
Post myocardial infarction - Beta blockers, ACE inhibitors,
High CVD risk - Thiazide diuretics, Beta blockers, ACE
Diabetes - Thiazide diuretics, Beta blockers, ACE inhibitors,
Angiotensin receptor blockers, Calcium channel blockers
Chronic kidney disease - ACE inhibitors, Angiotensin receptor
Recurrent stroke prevention - Thiazide diuretics, ACE inhibitors
Causes of Resistant HTN:
Improper blood pressure technique Excess sodium intake Volume retention from kidney disease Inadequate diuretic therapy Medication
o Inadequate doses o Drug actions/interactions o Patient compliance
Adapted from the National Heart, Lung, and Blood Institute 7th JNC on Prevention, Detection, Evaluation and Treatment of High Blood Pressure by the Riverside Physician Network Medical Practice Committee
Effective date: April, 2007 Review date(s): 6/2009, 9/2011
Short Clinical Guidelines: Diagnosis and Management of Hypertension
o Illicit drug use o OTC/herbal supplements
Refer if goal blood pressure is not achieved despite optimal combination therapy Oral Antihypertensive Drugs: Thiazide Diuretics
Cardene SR (nicardipine sustained release)
Adapted from the National Heart, Lung, and Blood Institute 7th JNC on Prevention, Detection, Evaluation and Treatment of High Blood Pressure by the Riverside Physician Network Medical Practice Committee
Effective date: April, 2007 Review date(s): 6/2009, 9/2011
Short Clinical Guidelines: Diagnosis and Management of Hypertension
Compelling Indications for Individual Drug Classes: Recommended Drug Classes Compelling Indication
THIAZ=Thiazide diuretic; BB=Beta Blocker; ACEI=ACE Inhibitor; ARB=Angiotensin receptor blocker; CCB=Calcium channel blocker; Aldo ANT=aldosterone antagonist
Adapted from the National Heart, Lung, and Blood Institute 7th JNC on Prevention, Detection, Evaluation and Treatment of High Blood Pressure by the Riverside Physician Network Medical Practice Committee
Effective date: April, 2007 Review date(s): 6/2009, 9/2011
Short Clinical Guidelines: Diagnosis and Management of Hypertension Adapted from the National Heart, Lung, and Blood Institute 7th JNC on Prevention, Detection, Evaluation and Treatment of High Blood Pressure by the Riverside Physician Network Medical Practice Committee
Effective date: April, 2007 Review date(s): 6/2009, 9/2011
Sprawl and the Coercive Force of Zoning Law: Fear & Loathing Al Norman Although local zoning laws are written to protect the health, safety, and general welfare of community residents, these laws—and the state enabling legislation supporting them—have, in practice, severely limited public participation. Due in part to a general lack of public participation, many local ordinances pl
8 D E S E T E M B R O D E 2 0 1 2 M I A M I , F L Ó R I D A O Centro de Avaliação e Tratamento do Sul da Flórida é um edifício de concreto branco de sete andares, decorado com sempre-vivas e localizado num esquálido bairro latino a oeste da cidade de Miami. Como a maio-ria dos prédios comerciais da área, possui rolos de arame farpado ao redor do teto. Diferentemente dos outros