高血压英文ppt精品课件positiverisk factors for

Case study n Mr. Wong is a 48-year old male, sales representative who travels often n 170cm, 84kg , BMI 29 n His brother just suffered from MI at age 40. n Concerned about his health n Want to do start exercise and lose weight Evaluation n Classify client according to Risk Stratification Criteria n ACSM/ ACP/ACCVPR/ AHA n Identify Major Coronary Artery Disease Risk Factors n Identify signs or symptoms suggestive of cardiopulmonary disease n Identify secondary risk factors n Obesity, alcohol consumption, stress levels Case Study n Recently diagnosed to have type 2 DM, put on Daonil n BP 160/90 mmHg on metoprolol 50mg bd n Half pack a day smoking habit due to stress of his job n His brother just suffered from MI at age 40. n Cholesterol level: 6.2mmol/l , HDL 0.90 mmol/l, LDL 3.8mmol/l n TG: 2.4 mmol/l n No regular exercise n No signs or symptoms of cardiopulmonary disease Positive Risk Factors for CHD ACSM (2006) Family History n Myocardial infarction, coronary revascularization (bypass surgery) or sudden death before : n the age of 55 years in father or other male first degree relative (i.e. brother or son) n the age of 65 years in mother or other female first degree relative (i.e. sister or daughter) Cigarette smoking n Current cigarette smoker or those who have quit in the last six months Hypertension n Client on Hypertensive medications n Resting SBP 140 mmHg and/ or DBP 90 mm HgFasting Glucose n Fasting blood glucose of 100mg/dL 5.6mmol/L) Dyslipidemia n Total serum cholesterol 200mg/dL (5.2 mmol/L) or n High density lipoprotein (HDL) 130mg/dL (3.4mmol/L) Obesity n Body Mass Index (BMI) 30 kg/m2 or n Waist girth = 102 cm (M); = 88 cm (F) or n Waist/hip ration = 0.95 (M); = 0.86 (F) Sedentary Lifestyle n Not participating in a regular exercise program n Accumulating less than 30 minutes moderate intensity exercise 3-5 days weekly Positive Risk Factors for CHD ACSM (2006) High level of HDL n HDL cholesterol 1.6 mmol/L (60 mg/dl) Negative Risk Factors for CHD ACSM (2006) Initial Risk Stratification n Low risk n Men40 years , +/- CVD risk factors Age 30 years and Type 1 or 2 diabetes of 10 years duration Presence of any additional risk factor for coronary artery disease Presence of microvascular disease (proliferative retinopathy or nephropathy, including microalbuminuria) Peripheral vascular disease Autonomic neuropathy * Medications n A constellation of cardiovascular risk factors related to hypertension, abdominal obesity, dyslipidemia, and insulin resistance n Certain drugs used to treat hypertension may accelerate the appearance of new-onset diabetes. In particular, both blockers and diuretics have been implicated in this effect. n ALLHAT n In high risk hypertensive patients, the diuretic, chlorthalidone, was 43% more likely than the ACEI, lisinopril, to produce diabetes, but was also 18% more likely than the calcium channel blocker, amlodipine, to produce this adverse effect. n HOPE n The development of new diabetes was reduced by 34% (p190mmHg systolic) during low-level activity may warrant adjustment in medical therapy n Stop when there is a 10 to 15mmHg fall in BP during exercise and further evaluation should be performed n Begin pharmacological treatment prior t starting exercise program if BP 160/100 Rehabilitation in Coronary Heart Disease Mainly endurance training at an intensity of 50 (-60) -75% of symptom-limited VO2max (or heart rate reserve, which is the difference between maximal and resting heart rate) for 30 minutes 3-4 times weekly (minimum), full benefit