Speakers discuss diagnosis and treatment of Hypertension in Diabetes, Pregnancy


 World Hypertension Day Meeting at Darul Sehat Hospital

Speakers discuss diagnosis and treatment
of Hypertension in Diabetes, Pregnancy

Exercise termed as most important part of treatment of hypertension

KARACHI: Pakistan Hypertension League in collaboration with OBS Pakistan organized World Hypertension Day meeting at Darul Sehat Hospital Karachi on May 21st 2016. Prof. Azhar M.A. Farooqui former Executive Director of NICVD and Patron of PHL was the chief guest on this occasion. The speakers included Prof. A. Rashid Khan, Prof. Azhar Farooqui, Prof.Abu Noem Farooqui, Dr.Rashid Naseem Khan, Dr. Fauzia Akhtar and Prof. Mansoor Ahmad.

Speaking about epidemiology of hypertension Dr. Rashid Khan said that it was a major risk factor for CVD, IHD, CVA, CHF and Renal Failure. Majority of the patient do not know they are suffering from hypertension; only a few take treatment and only 3-5% have achieved control of their blood pressure. He pointed out that one should never ignore mild hypertension; he also referred to hereditary and genetic risk factors, childhood predictors, obesity, and sedentary life style besides psychosocial and environmental factors. He laid emphasis on health education, medical audit, modifying known risk factors. Detect hypertension early and advocate life style management, he added.

On left Dr.Ali Farhan Vice Chairman Darul Sehat Hospital presenting a mementoe to Prof. Azhar M. A.
Farooqui who was the chief guest at the World Hypertension Day meeting organized by Pakistan
Hypertension League at DSH recently. On right Prof. Azhar Farooqui is presenting the
mementoe to 
Dr. Shahzad Alam Medical Director of DSH.

Prof. Azhar Farooqui said that hypertension was common disease of adult population the world over. It was insurance companies who detected hundred years ago that high blood pressure has important implications for health when they found out that those who had high blood pressure used to die early. It was the Veterans study in 70s that first showed that lowering blood pressure lowers mortality. We still are not sure about the cut off value of blood pressure but we do have a working definition. Nothing is certain in science and things keep on changing as new information becomes available. Normal blood pressure varies in children, adults and elderly and in special situations. Creating awareness is 50% success and the remaining 50% success depends on treatment, he added.

Prof. Abu Noem Farooqui speaking about diabetes mellitus and hypertension said that it was a lethal combination. It has shared pathophysiology known as metabolic syndrome. Almost 20-40% people with diabetes also suffer from hypertension and 7% develop End Stage Renal Failure. Focus on systolic blood pressure is a stronger predictor for risk factors.  Almost 65% of people with diabetes suffer from systolic hypertension. Desirable BP in people with diabetes is 130/80 and one has to go for more strict control of blood pressure in these patients. Poor BP control in diabetes is due to cost, inadequate patient education and side effects of drugs.  These patients may also suffer from anxiety and depression, once daily dose should be preferred as it increases compliance with therapy. He also mentioned the various anti-hypertensive drugs like diuretics, beta blockers, CCBs, ACEIs, ARBs, Alpha Blockers etc.

Dr. Rashid Naseem Khan Principal of Liaquat College of Medicine and Dentistry spoke about hypertension in pregnancy.  He pointed out that antenatal admissions due to hypertensions account for almost 25% and about 15% pregnancy gets complications. It has risk for women and the baby. Hypertension is a common medical problem in pregnancy which can lead to still birth, pre term births, and small for gestational age babies etc.  He then talked about pre eclampsia, gestational hypertension, transient hypertension, chronic hypertension while classifying hypertension in pregnancy. He also talked about risk factors for gestational hypertension like multiple pregnancy and those who have history of eclampsia. Chronic hypertension is seen in 3-5% of pregnancies. As more women were now delaying first pregnancy with advancing age there is a risk of chronic hypertension. In gestational hypertension blood pressure drops to normal after delivery or within two to six weeks after delivery. The main objective is maternal safety while treating hypertension in pregnancy. He also highlighted the importance of pre pregnancy counseling. No known antihypertensive drugs are teratogenic but ACEIs and ARBs should be avoided in pregnancy as they are Feto toxic. Low Dose Aspirin therapy is highly effective in pre eclampsia. Some of the adverse effects of drug treatment are headache, visual disabilities and abdominal pain besides pre eclampsia. HELLP syndrome is a variant of pre eclampsia. Treatment should be considered with BP of 140/90 but in case of BP of 170/110 drug treatment becomes mandatory. Methyldopa is the most preferred anti-hypertensive during pregnancy. Nifidipine and hydralazine are safest in any gestational age. Labetalol is also preferred in pregnancy. One should avoid beta blockers during first trimester of pregnancy and PIH increases the risk of CVD and IHD, he added.

Dr. Fauzia Akhtar Family Physician from AKUH referred to the JNC VIII Guidelines and pointed out that DBP of over ninety should be treated. BBs are no more recommended as the first line drugs in hypertension. Combination of ARBs and ACEIs should be avoided in the same patient and in some cases one might have to add third drug if a combination of two drugs fails to control blood pressure.

Prof. Mansoor Ahmad from KIHD described how to diagnose patient suffering from hypertension. He stated that after the age of fifty-five, there is 90% chance of developing hypertension and beyond the age of sixty, most people suffer from high blood pressure. BP control, Diabetes Control and smoking cessation besides exercise were extremely important.  Never ignore sleep apnea as a cause of hypertension. He also talked about drug induced hypertension, chronic kidney disease, renovascualr diseases and highlighted the importance of history as well as fundus examination. One should keep in mind angina, myocardial infarction, family history of hypertension, high intake of salt, COPD, Heart Failure, renal impairment and excessive use of NSAIDs. Keeping in view our environment we should advise cutting down salt intake but should not stop it. Neurological assessment was also important while quality of BP apparatus should also be kept in mind while measuring Blood Pressure and labeling a patient suffering from hypertension as it involves lifelong treatment. Electronic BP monitors are now being increasingly used but make sure about their quality. Ambulatory Blood Pressure Monitoring was most desirable before labeling a patient as suffering from hypertension. Treatment should also aim at preventing organ damage. He concluded his presentation by stating that exercise is the most important part of treatment of hypertension.