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‫درملنه‬ ‫فشار‬ ‫دلوړ‬
Treatment Of hypertension
Presented By:
Dr. Asmatullah Sapand
TREATMENT OF HYPERTENSION……..
‫شویدی‬ ‫برخوویشل‬ ‫لویو‬ ‫دوه‬ ‫په‬:
.1Non Pharmacologic
.2Pharmacologic
Non Pharmacologic...
NON PHARMACOLOGIC TREATMENT
‫کول‬ ‫تمرین‬ ‫منظم‬
‫کنترولول‬ ‫دوزن‬
‫کول‬ ‫ډډه‬ ‫څکولوڅخه‬ ‫دسګرټ‬
‫کارول‬ ‫میوو‬ ‫اوتا...
NON PHARMACOLOGIC TREATMENT……..
‫د‬ ‫درملنه‬ ‫نوموړي‬HTn‫ناروغانوکې‬ ‫الندې‬ ‫په‬
‫لري‬ ‫استطباب‬:
.1Prehypertensive‫نارو...
2.PHARMACOLOGIC TREATMENT
‫پ‬ ‫او‬ ‫کیږي‬ ‫ترسره‬ ‫پواسطه‬ ‫درملو‬ ‫د‬ ‫تداوي‬ ‫نوموړي‬‫ه‬
‫لري‬ ‫استطباب‬ ‫حاالتوکې‬ ‫ال...
2.PHARMACOLOGIC TREATMENT………
‫کیږي‬ ‫کارول‬ ‫منظور‬ ‫پدې‬ ‫درمل‬ ‫الندې‬ ً‫معموال‬:
.1Diuretics
.2B-blockers
.3ACE-inhibi...
DIURETICS
‫لوړفشارکموي‬ ‫میکانیزم‬ ‫الندې‬ ‫په‬ ‫درمل‬ ‫نوموړي‬:
.1‫کموي‬ ‫حجم‬ ‫وعایي‬ ‫داخل‬
.2‫کموي‬ ‫مقاومت‬ ‫محیطي‬ ...
1. THIAZIDE DIURETICS
 Tab: Hydrochlorothiazide 12.5-25mg OD up to
12.5-50mg OD.
SIDE EFFECTS:
 ↓ K+, ↓Mg2+,↑ Ca2+,
 ↓ ...
2. LOOP DIURETICS
 Tab: furosemide 20mg bid up to 40-320mg
bid/tid
SIDE EFFECTS:
 Same as thiazides, but higher risk of
...
3. ALDOSTERONE RECEPTOR BLOCKERS
 Tab: Spironolactone 12.5-25mg OD up to
12.5-100mg OD.
SIDE EFFECTS:
 Hyperkalemia,
 M...
B-BLOCKERS
‫کوي‬ ‫تاثیر‬ ‫میکانیزم‬ ‫الندې‬ ‫په‬:
‫د‬HR‫او‬CO‫سره‬ ‫کمولو‬ ‫په‬HTn‫راکموي‬.
.1‫د‬renin‫راکموي‬ ‫فعالیت‬.
DOSES OF VARIOUS BBS
 Tab: Atenolol 25mg OD up to 25-100mg OD
 Tab: Metoprolol 50mg bid up to 50-200mg
bid
 Tab: Bisopr...
ACE-INHIBITORS
‫میکانیزم‬ ‫الندې‬ ‫په‬HTn‫کموي‬:
.1‫د‬R-A-A-S‫کوي‬ ‫بالک‬.
.2Sympathetic nervous system activity‫کموي‬.
DOSES OF ACEIS
 Tab: captopril 25mg bid up to 50-450mg bid/ tid.
 Tab: ramipril 2,5 mg OD up to 2.5-20mg OD/bid
 Tab: l...
AIIRBS
 Tab: losartan 50mg OD up to 25-100mg OD/bid.
 Tab: valsartan 80 mg OD up to 80-320mg OD.
SIDE EFFECTS:
 Hyperka...
CCBS
‫په‬ ‫اوعیو‬ ‫محیطي‬ ‫د‬vasodilation‫سره‬HTn‫کموي‬.
DOSES OF CCBS (NONDIHYDROPYRIDINES)
 Tab: verapamil SR 180-240m...
CCBS
‫په‬ ‫اوعیو‬ ‫محیطي‬ ‫د‬vasodilation‫سره‬HTn‫کموي‬.
DOSES OF CCBS (DIHYDROPYRIDINES)
 Tab: Amlodipine 2.5mg OD upto...
RENIN INHIBITORS
‫او‬ ‫لري‬ ‫تاثیر‬ ‫الندې‬ ‫درمل‬ ‫نوموړي‬HTn‫راکموي‬:
 Angiotensinogen _________
Angiotensin I
 Tab: ...
AAAS
‫د‬ ‫اوعیودجدار‬ ‫د‬ ‫درمل‬ ‫نوموړي‬Alpha‫په‬ ‫آخذو‬
‫په‬ ‫مقاومت‬ ‫وعایي‬ ‫د‬ ‫کې‬ ‫پایله‬ ‫په‬ ‫او‬ ‫کولو‬ ‫نهي‬
‫...
SIDE EFFECTS OF AAAS:
 Syncope with first dose; postural
hypotension, dizziness,
 palpitations, headache,
 weakness, dr...
CENTRAL SYMPATHOLYTIC AGENTS
‫کمولوسره‬ ‫په‬ ‫مقاومت‬ ‫وعايي‬ ‫د‬ ‫هم‬ ‫درمل‬ ‫نوموړي‬
‫لري‬ ‫مثالونه‬ ‫الندې‬ ‫او‬ ‫راکم...
SIDE EFFECT OF CSAS:
 Sedation, dry mouth, sexual dysfunction,
headache,
 bradyarrhythmias; side effects may be less wit...
ARTERIOLAR DILATORS:
‫په‬ ‫مقاومت‬ ‫دمحیطي‬ ‫دشراینو‬ ‫درمل‬ ‫نوموړي‬
‫کمولوسره‬vasodilation‫او‬ ‫کوي‬ ‫رامنځته‬HTn
‫د‬ ‫...
SIDE EFFECT OF ARTERIOLAR DILATORS
 GI disturbances, tachycardia
 headache, nasal congestion
 rash
 fluid retention
 ...
PERIPHERAL SYMPATHETIC INHIBITORS
 Tab: reserpine 0.05mg OD upto 0.05-0.25mg
OD
SIDE EFFECTS:
 Depression (less likely a...
TREATMENT OF HYPERTENSIVE CRISIS
RESISTANT HYPERTENSION
‫درملو‬ ‫مناسبو‬ ‫ددرو‬ ‫چې‬ ‫فشار‬ ‫هغه‬(‫د‬diuretic
‫شمول‬ ‫په‬)‫کنټرول‬ ‫هم‬ ‫سره‬ ‫ډوزونو‬ ‫مک...
HYPERTENSIVE CRISIS
Hypertensive crisis‫عبارت‬ ‫څخه‬ ‫حالت‬ ‫بحراني‬ ‫هغه‬ ‫له‬
‫د‬ ‫چې‬ ‫کې‬ ‫کوم‬ ‫په‬ ‫دی‬HTn‫وي‬ ‫اړت...
HYPERTENSIVE URGENCY
‫کنټرول‬ ‫دڅوساعتونودننه‬ ‫فشار‬ ‫باید‬ ‫کې‬ ‫حالت‬ ‫دې‬ ‫په‬
‫شي‬.‫وي‬ ‫شدید‬ ‫فشار‬ ‫ناروغ‬ ‫د‬ ‫ک...
HYPERTENSIVE EMERGENCY
‫په‬ ‫او‬ ‫يوناڅاپه‬ ً‫معموال‬ ‫فشار‬ ‫کې‬ ‫حالت‬ ‫دې‬ ‫په‬
‫لوړیږي‬ ‫شدیدډول‬(DBP>130 mmHg.)
‫کې...
‫ادامه‬........
 Heart: Unstable angina/MI, Pulmonary
edema.
 Eyes: Hypertensive retinopathy.
 Others: Aortic dissectio...
‫د‬HYPERTENSIVE ENCEPHALOPATHY‫تداوي‬
‫چې‬ ‫څرنګه‬hypertensive emergency‫بیړنی‬ ‫یو‬
‫د‬ ‫او‬ ‫دی‬ ‫حالت‬end organ damage...
‫ادامـــــه‬........
‫له‬ ‫دي‬ ‫عبارت‬ ‫کیږي‬ ‫کارول‬ ‫منظور‬ ‫دې‬ ‫په‬ ‫چې‬ ‫درمل‬ ‫وریدي‬ ‫مهم‬ ‫هغه‬:
 Inj: Nicardipi...
‫ادامـــــه‬........
 Inj: Labetalol 20–40 mg iv every 10 minutes
to 300 mg OR 2 mg/ min infusion.
 Onset: 5–10 minutes....
‫ادامـــــه‬........
 Inj: Nitroglycerine initial 5 μg/min, then titrate by
5 μg/min at 3–5-min intervals; if no response...
‫ادامـــــه‬........
 Inj: Furosemide 10-80mg
 Onset: 15 mins minutes
 Duration: 4 hours
 SIDE EFFECTS:
 Hypotension
...
‫ادامــــــه‬......
‫ډوز‬ ‫شروع‬ ‫دوام‬ ‫تاثیرات‬ ‫جانبي‬
‫ادامــــــــه‬.......
‫ډوز‬ ‫شروع‬ ‫دوام‬ ‫تاثیرات‬ ‫جانبي‬
‫د‬HYPERTENSIVE URGENCY‫درملنه‬
‫ډوز‬ ‫شروع‬ ‫دوام‬ ‫تاثیرات‬ ‫جانبي‬
‫مـــــنــــــنـــــه‬
THANK
YOU
Treatment of hypertension-دلـــوړ فــشـــار درمـــلــــنــــه
Treatment of hypertension-دلـــوړ فــشـــار درمـــلــــنــــه
Treatment of hypertension-دلـــوړ فــشـــار درمـــلــــنــــه
Treatment of hypertension-دلـــوړ فــشـــار درمـــلــــنــــه
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Treatment of hypertension-دلـــوړ فــشـــار درمـــلــــنــــه

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Treatment of hypertension-دلـــوړ فــشـــار درمـــلــــنــــه

  1. 1. ‫درملنه‬ ‫فشار‬ ‫دلوړ‬ Treatment Of hypertension Presented By: Dr. Asmatullah Sapand
  2. 2. TREATMENT OF HYPERTENSION…….. ‫شویدی‬ ‫برخوویشل‬ ‫لویو‬ ‫دوه‬ ‫په‬: .1Non Pharmacologic .2Pharmacologic Non Pharmacologic‫پرهیز‬ ‫د‬ ‫درملنه‬(DASH- Diet)‫یا‬(life style modification)‫توصیه‬ ‫په‬ ‫نیسي‬ ‫صورت‬ ‫کولوسره‬.‫الرښوونې‬ ‫الندې‬ ‫او‬ ‫کیږي‬ ‫ته‬ ‫ناروغ‬:
  3. 3. NON PHARMACOLOGIC TREATMENT ‫کول‬ ‫تمرین‬ ‫منظم‬ ‫کنترولول‬ ‫دوزن‬ ‫کول‬ ‫ډډه‬ ‫څکولوڅخه‬ ‫دسګرټ‬ ‫کارول‬ ‫میوو‬ ‫اوتازه‬ ‫دشنوسبزیجاتو‬ ‫استعمالول‬ ‫کم‬ ‫غوړو‬ ‫او‬ ‫دغوښو‬ ‫منظم‬ ‫سم‬ ‫سره‬ ‫دډاکتردهدایت‬Visit ‫کمول‬ ‫فشارونو‬ ‫رواني‬ ‫او‬ ‫دتشویش‬
  4. 4. NON PHARMACOLOGIC TREATMENT…….. ‫د‬ ‫درملنه‬ ‫نوموړي‬HTn‫ناروغانوکې‬ ‫الندې‬ ‫په‬ ‫لري‬ ‫استطباب‬: .1Prehypertensive‫ناروغان‬(120-139/80-89) ‫کوم‬ ‫چې‬risk factor‫یا‬ ‫او‬end organ damage ‫ونلري‬. .2‫فشار‬ ‫خفیف‬ ‫چې‬ ‫ناروغان‬ ‫هغه‬(140-159/90-99) ‫کوم‬ ‫اما‬ ‫ولري‬risk factor‫اویا‬end organ damage‫ونلري‬.
  5. 5. 2.PHARMACOLOGIC TREATMENT ‫پ‬ ‫او‬ ‫کیږي‬ ‫ترسره‬ ‫پواسطه‬ ‫درملو‬ ‫د‬ ‫تداوي‬ ‫نوموړي‬‫ه‬ ‫لري‬ ‫استطباب‬ ‫حاالتوکې‬ ‫الندې‬: .1‫د‬ ‫فشاریې‬ ‫دوینې‬ ‫چې‬ ‫ناروغان‬ ‫هغه‬ ‫ټول‬ 160/100‫چې‬ ‫لدې‬ ‫بدون‬ ‫وي‬ ‫رسیدلی‬ ‫ترحده‬ ‫فکتوراویا‬ ‫خطري‬ ‫کوم‬end organ damage‫ولري‬. .2‫په‬prehypertension‫ناروغانو‬ ‫ټولو‬ ‫نورو‬ ‫او‬ ‫ناروغانو‬ ‫د‬ ‫چې‬ ‫کې‬hypertension‫هر‬ ‫په‬stage‫قرار‬ ‫کې‬ ‫کوم‬ ‫ورسره‬ ‫او‬ ‫ولري‬risk factor‫یا‬ ‫او‬end organ damage‫ولري‬ ‫هم‬.
  6. 6. 2.PHARMACOLOGIC TREATMENT……… ‫کیږي‬ ‫کارول‬ ‫منظور‬ ‫پدې‬ ‫درمل‬ ‫الندې‬ ً‫معموال‬: .1Diuretics .2B-blockers .3ACE-inhibitors .4Angiotensin receptor blockers .5Calcium Channel Blockers .6Renin inhibitors .7Alpha-Adrenoceptor Antagonists .8Central Sympatholytic Drugs .9Arteriolar Dilators .10Peripheral Sympathetic Inhibitors
  7. 7. DIURETICS ‫لوړفشارکموي‬ ‫میکانیزم‬ ‫الندې‬ ‫په‬ ‫درمل‬ ‫نوموړي‬: .1‫کموي‬ ‫حجم‬ ‫وعایي‬ ‫داخل‬ .2‫کموي‬ ‫مقاومت‬ ‫محیطي‬ ‫داوعیو‬ ‫د‬Diuretic‫د‬ ‫ګروپونه‬ ‫درې‬ ‫الندې‬HTn‫کې‬ ‫درملنه‬ ‫په‬ ‫کیږي‬ ‫کارول‬: .1Thiazide Diuretics .2Loop Diuretics .3Aldosterone inhibitors
  8. 8. 1. THIAZIDE DIURETICS  Tab: Hydrochlorothiazide 12.5-25mg OD up to 12.5-50mg OD. SIDE EFFECTS:  ↓ K+, ↓Mg2+,↑ Ca2+,  ↓ Na, ↑uric acid,  ↑glucose, ↑LDL cholesterol,  ↑triglycerides; rash,  Erectile dysfunction.
  9. 9. 2. LOOP DIURETICS  Tab: furosemide 20mg bid up to 40-320mg bid/tid SIDE EFFECTS:  Same as thiazides, but higher risk of excessive diuresis and electrolyte imbalance.  Increases calcium excretion.
  10. 10. 3. ALDOSTERONE RECEPTOR BLOCKERS  Tab: Spironolactone 12.5-25mg OD up to 12.5-100mg OD. SIDE EFFECTS:  Hyperkalemia,  Metabolic acidosis,  Gynecomastia.
  11. 11. B-BLOCKERS ‫کوي‬ ‫تاثیر‬ ‫میکانیزم‬ ‫الندې‬ ‫په‬: ‫د‬HR‫او‬CO‫سره‬ ‫کمولو‬ ‫په‬HTn‫راکموي‬. .1‫د‬renin‫راکموي‬ ‫فعالیت‬.
  12. 12. DOSES OF VARIOUS BBS  Tab: Atenolol 25mg OD up to 25-100mg OD  Tab: Metoprolol 50mg bid up to 50-200mg bid  Tab: Bisoprolol 2.5mg OD up to 2.5-10mg OD  Tab: Propranolol 20mg bid up to 40-640mg bid SIDE EFFECTS: bronchospasm, bradycardia or AV block, nasal congestion, Raynaud phenomenon, Fatigue, erectile dysfunction
  13. 13. ACE-INHIBITORS ‫میکانیزم‬ ‫الندې‬ ‫په‬HTn‫کموي‬: .1‫د‬R-A-A-S‫کوي‬ ‫بالک‬. .2Sympathetic nervous system activity‫کموي‬.
  14. 14. DOSES OF ACEIS  Tab: captopril 25mg bid up to 50-450mg bid/ tid.  Tab: ramipril 2,5 mg OD up to 2.5-20mg OD/bid  Tab: lisinopril 5-10mg OD up to 5-40mg OD SIDE EFFECTS:  Cough  Hypotension  Dizziness  Kidney dysfunction  Hyperkalemia  Angioedema  Taste alteration and rash (may be more Frequent with captopril)  Proteinuria  Blood dyscrasia.  Contraindicated In pregnancy.
  15. 15. AIIRBS  Tab: losartan 50mg OD up to 25-100mg OD/bid.  Tab: valsartan 80 mg OD up to 80-320mg OD. SIDE EFFECTS:  Hyperkalemia, kidney dysfunction.  Rare angioedema.  Combinations have additional side effects.  Contraindicated in pregnancy.
  16. 16. CCBS ‫په‬ ‫اوعیو‬ ‫محیطي‬ ‫د‬vasodilation‫سره‬HTn‫کموي‬. DOSES OF CCBS (NONDIHYDROPYRIDINES)  Tab: verapamil SR 180-240mg OD up to 180-480mg OD/bid.  Tab: diltiazem 90mg bid up to 180-360mg bid. SIDE EFFECTS:  Edema, headache,  Bradycardia, AV block  GI disturbances  Dizziness  Heart failure  Urinary frequency
  17. 17. CCBS ‫په‬ ‫اوعیو‬ ‫محیطي‬ ‫د‬vasodilation‫سره‬HTn‫کموي‬. DOSES OF CCBS (DIHYDROPYRIDINES)  Tab: Amlodipine 2.5mg OD upto 2.5-10mg OD  Tab: Nicardipine 20mg tid upto 20-40mg tid. SIDE EFFECTS: Edema, dizziness, palpitations, flushing, headache, hypotension, tachycardia, GI disturbances, urinary frequency, worsening of heart failure .
  18. 18. RENIN INHIBITORS ‫او‬ ‫لري‬ ‫تاثیر‬ ‫الندې‬ ‫درمل‬ ‫نوموړي‬HTn‫راکموي‬:  Angiotensinogen _________ Angiotensin I  Tab: aliskiren 150mg OD upto 150-300mg OD. SIDE EFFECTS: Angioedema, hypotension,  hyperkalemia
  19. 19. AAAS ‫د‬ ‫اوعیودجدار‬ ‫د‬ ‫درمل‬ ‫نوموړي‬Alpha‫په‬ ‫آخذو‬ ‫په‬ ‫مقاومت‬ ‫وعایي‬ ‫د‬ ‫کې‬ ‫پایله‬ ‫په‬ ‫او‬ ‫کولو‬ ‫نهي‬ ‫کنټرولوي‬ ‫فشار‬ ‫دوینې‬ ‫سره‬ ‫کمولو‬.‫ډول‬ ‫الندې‬‫ونه‬ ‫لري‬:  Tab: Prazosin 1mg upto 2-20mg bid/tid at bed time.  Tab: terazosin 1mg upto 1-20mg OD/bid at bedtime.
  20. 20. SIDE EFFECTS OF AAAS:  Syncope with first dose; postural hypotension, dizziness,  palpitations, headache,  weakness, drowsiness, sexual dysfunction, anticholinergic effects, urinary incontinence;  first-dose effects may be less with doxazosin.
  21. 21. CENTRAL SYMPATHOLYTIC AGENTS ‫کمولوسره‬ ‫په‬ ‫مقاومت‬ ‫وعايي‬ ‫د‬ ‫هم‬ ‫درمل‬ ‫نوموړي‬ ‫لري‬ ‫مثالونه‬ ‫الندې‬ ‫او‬ ‫راکموي‬ ‫فشار‬ ‫دوینې‬:  Clonidine 0.1mg bid upto 0.2-0.6mg bid  Methyl dopa 250mg bid upto 500-2000mg bid.  Guanafacine 1mg OD upto 1-3mg OD.  Guanabenz 4mg bid upto 8-64mg bid.
  22. 22. SIDE EFFECT OF CSAS:  Sedation, dry mouth, sexual dysfunction, headache,  bradyarrhythmias; side effects may be less with guanfacine.  Contact dermatitis with clonidine patch.  Methyldopa also causes hepatitis,  hemolytic anemia,  fever.  Rebound Hypertension following withdrawal.
  23. 23. ARTERIOLAR DILATORS: ‫په‬ ‫مقاومت‬ ‫دمحیطي‬ ‫دشراینو‬ ‫درمل‬ ‫نوموړي‬ ‫کمولوسره‬vasodilation‫او‬ ‫کوي‬ ‫رامنځته‬HTn ‫د‬ ‫یې‬ ‫ورکړه‬ ‫شکل‬ ‫یوازې‬ ‫په‬ ‫اما‬ ‫کموي‬reflex tacchycardia‫د‬ ‫امله‬ ‫همدې‬ ‫نوله‬ ‫ګرځي‬ ‫سبب‬ BBs‫او‬diuretics‫شي‬ ‫ورکړل‬ ‫باید‬ ‫یوځای‬ ‫سره‬.  Hydralazine 25 mg bid upto 50-300mg bid/qid.  Minoxidil 5mg OD upto 10-40mg OD.
  24. 24. SIDE EFFECT OF ARTERIOLAR DILATORS  GI disturbances, tachycardia  headache, nasal congestion  rash  fluid retention  hirsutism  pericardial effusion  thrombocytopenia
  25. 25. PERIPHERAL SYMPATHETIC INHIBITORS  Tab: reserpine 0.05mg OD upto 0.05-0.25mg OD SIDE EFFECTS:  Depression (less likely at low dosages, ie, < 0.25 mg),  night terrors, nasal stuffiness,  drowsiness, peptic disease,  Gastrointestinal disturbances,  bradycardia.
  26. 26. TREATMENT OF HYPERTENSIVE CRISIS
  27. 27. RESISTANT HYPERTENSION ‫درملو‬ ‫مناسبو‬ ‫ددرو‬ ‫چې‬ ‫فشار‬ ‫هغه‬(‫د‬diuretic ‫شمول‬ ‫په‬)‫کنټرول‬ ‫هم‬ ‫سره‬ ‫ډوزونو‬ ‫مکملو‬ ‫په‬ ‫مقاوم‬ ‫د‬ ‫نشي‬(resistant)‫یادیږي‬ ‫نوم‬ ‫فشارپه‬. ‫له‬ ‫دي‬ ‫عبارت‬ ‫اسباب‬ ‫معمول‬ ‫فشار‬ ‫ډول‬ ‫ددا‬: .1‫کول‬ ‫قضاء‬ ‫او‬ ‫نلرل‬ ‫علقه‬ ‫سره‬ ‫ددوا‬. .2‫خوړل‬ ‫نه‬ ‫ددوا‬ ‫ډوز‬ ‫شوي‬ ‫توصیه‬ ‫په‬. .3‫د‬combination therapy‫نه‬ ‫ډول‬ ‫ښه‬ ‫په‬ ‫کول‬ ‫مراعات‬. .4‫مساعدکوونکواو‬ ‫دنورو‬ ‫یوځای‬ ‫دفشارسره‬ ‫موجودیت‬ ‫فکتورونو‬ ‫دفشارتشدیدوونکو‬.
  28. 28. HYPERTENSIVE CRISIS Hypertensive crisis‫عبارت‬ ‫څخه‬ ‫حالت‬ ‫بحراني‬ ‫هغه‬ ‫له‬ ‫د‬ ‫چې‬ ‫کې‬ ‫کوم‬ ‫په‬ ‫دی‬HTn‫وي‬ ‫اړتیا‬ ‫ته‬ ‫کنټرول‬ ‫ژر‬ ‫او‬ ‫بیړني‬. ‫کې‬ ‫حالت‬ ‫دې‬ ‫په‬DBPً‫معموال‬>130 mmHg‫اودهمدې‬ ‫وي‬ ‫ګرځي‬ ‫سبب‬ ‫تخریب‬ ‫وعايي‬ ‫د‬ ‫کیدل‬ ‫دوامدارپاتې‬ ‫حالت‬. Hypertensive Crisis‫شوی‬ ‫ویشل‬ ‫برخو‬ ‫عمده‬ ‫دوه‬ ‫په‬: .1Hypertensive Urgency .2Hypertensive Emergency
  29. 29. HYPERTENSIVE URGENCY ‫کنټرول‬ ‫دڅوساعتونودننه‬ ‫فشار‬ ‫باید‬ ‫کې‬ ‫حالت‬ ‫دې‬ ‫په‬ ‫شي‬.‫وي‬ ‫شدید‬ ‫فشار‬ ‫ناروغ‬ ‫د‬ ‫کې‬ ‫حالت‬ ‫دې‬ ‫په‬ ً‫معموال‬ (>220/>125)‫کوم‬ ‫او‬ ‫وي‬ ‫عرضه‬ ‫بې‬ ‫اکثره‬ ‫ناروغ‬ ‫خو‬end organ damage‫کې‬ ‫حالت‬ ‫دې‬ ‫په‬ ‫چې‬ ‫وي‬ ‫نه‬ ‫موجود‬ ‫د‬ ‫تداوي‬Oral agents‫کیږي‬ ‫ترسره‬ ‫پواسطه‬. ‫ممکن‬ ‫کې‬ ‫ناروغانو‬ ‫ځینو‬ ‫په‬optic disk edema‫او‬ ‫پرمختلونکي‬end organ damage‫دې‬ ‫په‬ ‫چې‬ ‫موجودوي‬ ‫وریدي‬ ‫بیړنۍ‬ ‫باید‬ ‫صورت‬parenteral‫شي‬ ‫ترسره‬ ‫درملنه‬.
  30. 30. HYPERTENSIVE EMERGENCY ‫په‬ ‫او‬ ‫يوناڅاپه‬ ً‫معموال‬ ‫فشار‬ ‫کې‬ ‫حالت‬ ‫دې‬ ‫په‬ ‫لوړیږي‬ ‫شدیدډول‬(DBP>130 mmHg.) ‫کې‬ ‫حالت‬ ‫دې‬ ‫په‬end organ damage‫موجودوي‬ ‫شویدي‬ ‫ذکر‬ ‫الندې‬ ‫چې‬: 1. Brain: Hypertensive encephalopathy (headache, altered mental status, confusion, irritability), intracranial hemorrhage. 2. Kidney: hypertensive nephropathy (hematuria, proteinuria and progressive renal- dysfunction).
  31. 31. ‫ادامه‬........  Heart: Unstable angina/MI, Pulmonary edema.  Eyes: Hypertensive retinopathy.  Others: Aortic dissection, preeclmpsia- eclapmsia. Malignant Hypertension:‫لوړفشارچې‬ ‫هغه‬ ‫پکې‬encephalopathy‫یا‬nephropathy‫له‬ hypertensive retinopathy‫یوځای‬ ‫سره‬ ‫د‬ ‫موجودوي‬malignant hypertension‫پنوم‬ ‫یادیږي‬.
  32. 32. ‫د‬HYPERTENSIVE ENCEPHALOPATHY‫تداوي‬ ‫چې‬ ‫څرنګه‬hypertensive emergency‫بیړنی‬ ‫یو‬ ‫د‬ ‫او‬ ‫دی‬ ‫حالت‬end organ damage‫پرمختګ‬ ‫بیړنی‬ ‫کبله‬ ‫همدې‬ ‫له‬ ‫نو‬ ‫موجودوي‬parenteral ‫لري‬ ‫اړتیا‬ ‫ته‬ ‫درملنې‬. ‫د‬ ‫فشار‬ ‫باید‬ ‫کې‬ ‫حالت‬ ‫دې‬ ‫په‬1-2‫داخل‬ ‫ساعتونوپه‬ ‫د‬ ‫لومړی‬ ‫کې‬25%‫او‬ ‫شي‬ ‫کړی‬ ‫راټیټ‬ ‫اندازه‬ ‫په‬ ‫راتلونکو‬ ‫د‬ ‫وروسته‬2-6‫تر‬ ‫کې‬ ‫جریان‬ ‫ساعتونوپه‬ 160/100 mmHg‫شي‬ ‫راټیټ‬ ‫پورې‬. ‫په‬ ‫او‬ ‫کې‬ ‫وخت‬ ‫کم‬ ‫په‬ ‫څخه‬ ‫وخت‬ ‫پورته‬ ‫له‬ ‫چیرې‬ ‫که‬ ‫د‬ ‫نو‬ ‫شي‬ ‫کړی‬ ‫ټیټ‬ ‫فشار‬ ‫ډول‬ ‫سریع‬coronary, cerebral‫او‬renal‫کیږي‬ ‫سبب‬ ‫اسکیمیا‬.
  33. 33. ‫ادامـــــه‬........ ‫له‬ ‫دي‬ ‫عبارت‬ ‫کیږي‬ ‫کارول‬ ‫منظور‬ ‫دې‬ ‫په‬ ‫چې‬ ‫درمل‬ ‫وریدي‬ ‫مهم‬ ‫هغه‬:  Inj: Nicardipine 5 mg/h by iv infusion; may increase by 1–2.5 mg/h every 15 minutes to 15 mg/h  Onset: 1–5 minutes  Duration: 3–6 hours SIDE EFFECTS:  Hypotension  tachycardia  headache  May precipitate  myocardial  ischemia.
  34. 34. ‫ادامـــــه‬........  Inj: Labetalol 20–40 mg iv every 10 minutes to 300 mg OR 2 mg/ min infusion.  Onset: 5–10 minutes.  Duration: 3–6 hours SIDE EFFECTS:  GI, hypotension, bronchospasm  bradycardia  heart block.  Avoid in acute LV systolic dysfunction and asthma. Maybe continued orally.
  35. 35. ‫ادامـــــه‬........  Inj: Nitroglycerine initial 5 μg/min, then titrate by 5 μg/min at 3–5-min intervals; if no response is seen at 20 μg/min, incremental increases of 10– 20 μg/min may be used  Onset: 2–5 minutes  Duration: 3–5 minutes  SIDE EFFECTS:  Headache, nausea  hypotension  Bradycardia ‫په‬Acute MI‫تمامیږي‬ ‫موثر‬ ‫کې‬.
  36. 36. ‫ادامـــــه‬........  Inj: Furosemide 10-80mg  Onset: 15 mins minutes  Duration: 4 hours  SIDE EFFECTS:  Hypotension  Hypokalemia ‫د‬ ً‫معموال‬Vasodilator‫ورکول‬ ‫هم‬ ‫یوځای‬ ‫سره‬ ‫کیږي‬.
  37. 37. ‫ادامــــــه‬...... ‫ډوز‬ ‫شروع‬ ‫دوام‬ ‫تاثیرات‬ ‫جانبي‬
  38. 38. ‫ادامــــــــه‬....... ‫ډوز‬ ‫شروع‬ ‫دوام‬ ‫تاثیرات‬ ‫جانبي‬
  39. 39. ‫د‬HYPERTENSIVE URGENCY‫درملنه‬ ‫ډوز‬ ‫شروع‬ ‫دوام‬ ‫تاثیرات‬ ‫جانبي‬
  40. 40. ‫مـــــنــــــنـــــه‬ THANK YOU

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  • MasoomFaizani

    Feb. 4, 2021

د لوړفشار نوي او معاصره درملنه

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