2010 Hong Kong Reference Framework for Hypertension Care for ...
2010 Hong Kong Reference Framework for Hypertension Care for ... 2010 Hong Kong Reference Framework for Hypertension Care for ...
Module 3 Secondary Hypertension 1,2FindingsWeight gain, fatigue, weakness, hirsutism,amenorrhea, moon facies, dorsal hump, purplestriae, truncal obesity, hypokalemiaUse of drug (immunosuppressive agents, NSAID,COX-2 inhibitors, estrogens / oral contraceptive,weight-loss agents, stimulants, mineralocorticoids,antiparkinsonian, monoamine oxidase inhibitors,anabolic steroids, sympathomimetics)High salt intake, excessive alcohol intake, obesityErythropoietin use in renal disease, polycythemia inchronic obstructive pulmonary disease (COPD)Paroxysmal hypertension, headaches, diaphoresis,palpitations, tachycardiaFatigue, weight gain, hair loss, diastolichypertension, muscle weaknessHeat intolerance, weight loss, palpitation, systolichypertension, exophthalmos, tremor, tachycardiaKidney stones, osteoporosis, depression, lethargy,muscle weaknessHeadaches, fatigue, visual problems, enlargement ofhands, feet, tongueDisorder suspectedCushing's syndromeSide effects of drugsUnhealthy dietErythropoietin side effectPhaeochromocytomaHypothyroidismHyperthyroidismHyperparathyroidismAcromegalyReference:1. Hebert PR, Moser M, Mayer J, Glynn RJ, Hennekens CH: Recent evidence on drug therapyof mild to moderate hypertension and decreased risk of coronary heart disease. Arch InternMed. 1993;153(5):578-81.2. Onusko E. Diagnosing Secondary Hypertension. Am Fam Physician. 2003; 67(1):67-74.HK Reference Framework for Hypertension Care for Adults in Primary Care Settings2
to assess lifestyle and identify cardiovascular risk factors that may affect prognosis and guide treatment,to reveal identifiable causes of high blood pressure, andto assess the presence Module or absence 4 Evaluation of target organ for All damage Newly and Diagnosed cardiovascular Hypertensive disease. (Box Patients 1)11 Target organ damagetorySymptoms suggestive The aims of of secondary the evaluation causes are:Symptoms (present • to or assess past history) lifestyle of and cardiovascular identify cardiovascular risk factors: risk age>55 factors for that men may and affectage>65 for women/ smokinor women under age prognosis 65) and guide treatment,Target organ damage: • to reveal retinopathy/ identifiable left ventricular causes of hypertrophy/ high blood pressure, heart failure/ andcoronary heart disease (CHD)/ proteFactors that affect • choice to assess of drug the presence treatment or like absence gout, of bronchospasm.target organ damage and cardiovascularAssessment of lifestyle: disease. exercise, (Box 1)diet, alcoholDrug historyPsychosocial factors Box 1 Target organ damage 2Family history: hypertension• Heart: Left (HT),ventricular diabetes,hypertrophy stroke, renal(ECG disease,/ Echocardiogram)myocardial infarction and other cardiovascular• Renal: Albuminuria and / or elevation of plasma creatinine (>110 µmol/L)sical examination• Vessel: USG or radiological evidence of atherosclerotic plaque (carotid,Body weight, height,iliac, Bodyfemoral Mass Indexor aorta), generalised or focal narrowing of the retinalFeatures of Cushing’sarteriessyndrome / Acromegaly (endocrine case of HT)Skin stigmata of neurofibromatosis‣ ¾ Angina or (phaeochromocytoma)prior myocardial infarctionRadial/brachial femoral delay, precordial or chest murmurs (aortic coarctation or aortic disease)‣ ¾ Prior coronary revascularisationAbdominal examination: enlarged kidney, abdominal bruit‣ ¾ Heart failureSigns of organ damage: peripheral arterial disease, fundi abnormalities, carotid bruit, neurological defects, CVS ex• Brain:‣ ¾ Stroke or transient ischaemic attacktine laboratory investigation‣ ¾ Dementia• Chronic renal disease• Peripheral arterial disease• Retinopathy: Hemorrhages or exudates, Papilloedema1 HK Reference Framework for Hypertension Care for Adults in Primary Care Settings
- Page 2: ContentPreface.....................
- Page 6 and 7: Key To Evidence Statements And Grad
- Page 8 and 9: Chapter 1.EpidemiologyHypertension
- Page 12 and 13: Chapter 6.Component 1: Prevention O
- Page 14 and 15: Chapter 7.Component 2: Early Identi
- Page 16 and 17: Chapter 8.Component 3: Clinical Car
- Page 18 and 19: Chapter 8.Component 3: Clinical Car
- Page 20 and 21: Chapter 8.Component 3: Clinical Car
- Page 22 and 23: Chapter 8.Component 3: Clinical Car
- Page 24 and 25: Chapter 8.Component 3: Clinical Car
- Page 26 and 27: Chapter 9.Component 4: Patient Empo
- Page 28 and 29: Appendix 1. Smoking Cessation Servi
- Page 30 and 31: AcknowledgmentsDr CHU Leung-wingDr
- Page 32 and 33: AcknowledgmentsDr CHAN Wai-manDr Jo
- Page 34 and 35: AcknowledgmentsDr Betty YOUNG Wan-y
- Page 36 and 37: AcknowledgmentsProfessor YU Cheuk-m
- Page 38 and 39: Reference10. Sacks FM, Svetkey LP,
- Page 40 and 41: Module 1 Framework for Population A
- Page 42 and 43: Module 1Framework for Population Ap
- Page 44 and 45: Module 2Blood Pressure Measurement2
- Page 46 and 47: Module 2Blood Pressure Measurement4
- Page 50 and 51: Module 4Evaluation for All Newly Di
- Page 52 and 53: Module 4Evaluation for All Newly Di
- Page 54 and 55: Module 5Dietary InterventionFood Gr
- Page 56 and 57: Module 5Dietary InterventionMeals a
- Page 58 and 59: Module 5Dietary InterventionReferen
- Page 60 and 61: Module 6Exercise Recommendations to
- Page 62 and 63: Module 6Exercise Recommendations to
- Page 64 and 65: Module 6Exercise Recommendations to
- Page 66 and 67: Module 7Drug Treatment for People w
- Page 68 and 69: Module 7Drug Treatment for People w
- Page 70 and 71: Module 7Drug Treatment for People w
- Page 72 and 73: Module 7Drug Treatment for People w
- Page 74 and 75: Module 8Annual AssessmentLaboratory
Module 3 Secondary <strong>Hypertension</strong> 1,2FindingsWeight gain, fatigue, weakness, hirsutism,amenorrhea, moon facies, dorsal hump, purplestriae, truncal obesity, hypokalemiaUse of drug (immunosuppressive agents, NSAID,COX-2 inhibitors, estrogens / oral contraceptive,weight-loss agents, stimulants, mineralocorticoids,antiparkinsonian, monoamine oxidase inhibitors,anabolic steroids, sympathomimetics)High salt intake, excessive alcohol intake, obesityErythropoietin use in renal disease, polycythemia inchronic obstructive pulmonary disease (COPD)Paroxysmal hypertension, headaches, diaphoresis,palpitations, tachycardiaFatigue, weight gain, hair loss, diastolichypertension, muscle weaknessHeat intolerance, weight loss, palpitation, systolichypertension, exophthalmos, tremor, tachycardiaKidney stones, osteoporosis, depression, lethargy,muscle weaknessHeadaches, fatigue, visual problems, enlargement ofhands, feet, tongueDisorder suspectedCushing's syndromeSide effects of drugsUnhealthy dietErythropoietin side effectPhaeochromocytomaHypothyroidismHyperthyroidismHyperparathyroidismAcromegaly<strong>Reference</strong>:1. Hebert PR, Moser M, Mayer J, Glynn RJ, Hennekens CH: Recent evidence on drug therapyof mild to moderate hypertension and decreased risk of coronary heart disease. Arch InternMed. 1993;153(5):578-81.2. Onusko E. Diagnosing Secondary <strong>Hypertension</strong>. Am Fam Physician. 2003; 67(1):67-74.HK <strong>Reference</strong> <strong>Framework</strong> <strong>for</strong> <strong>Hypertension</strong> <strong>Care</strong> <strong>for</strong> Adults in Primary <strong>Care</strong> Settings2
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