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

Source: http://www.rpndocs.com/rehr/documents/managementofhtn.pdf

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