ChesterCountyMedicineWinter2018 - 10
Hypertension: Treat or not to treat, that is the question
continued from page 9
Specific recommendations include:
o Reduce salt to less than 1500 mg per day.
o Diabetes mellitus: ACE inhibiters and ARBs especially
if they have albuminuria.
o Increase K to 3500 mg per day.
o Activity, at least 30 minutes per day 3-5 days a week.
o Limit alcohol to less than two drinks for men and one
drink for women per day.
o Decrease saturated fats and increase fruits, vegetables, grains.
According to data available dietary changes alone will reduce
BP by 11 mm Hg.
o Metabolic Syndrome: First line drugs, avoid beta blocker
unless they have CAD.
o Valvular Aortic Stenosis: Use smaller dose and avoid
o Race: African Americans are best treated with Ca blockers
First line drugs:
o Age: Same guidelines but less intense, hypertension control
is crucial for cognitive function.
o Chlorthalidone is preferred over Hydrochlorothiazide.
o Perioperative: Beta blockers may be a good choice here.
o Ca channel blockers
o CVA: A gradual decrease in the BP is important. Lower by
15% in first 24 hours. Use IV drugs for better control of
delivery. Try to bring the BP below 185 systolic and 110
diastolic in the first 24 hours.
o ACE inhibiters
o Beta blockers should only be used as first line in coronary
o Centrally acting alpha 1 agonists should be avoided and
used only as a last resort.
Call us when your driveway
needs a little love!
Hypertension is the most common chronic condition facing
adult Americans with more than 85 million suffering from this
ailment; with the new guidelines that number goes up to 46%
of the adult population. These numbers are staggering and
complications caused by hypertension have tremendous human
and economic cost.
o In summary we have tried to make a very long document
into something which is easier to understand and follow
and will hopefully give some guidance to help control this
COMMERCIAL & RESIDENTIAL
* Asphalt Seal Coating
* Driveway Repair
* Driveway Sealcoating
* Concrete & Paver Sealing
The Driveway Lady and
family owned and operated.
All Work Insured and
Pa. Lic. No. PA010998
10 CHESTER COUNT Y Medicine | WINTER 2018
This article is a collaboration
between Mian A Jan, MD, FACC,
Chairman Department of Medicine,
Penn Medicine, Chester County
Hospital, and Mian Kouresch Jan,
MD who is doing residency at
University of California, San Diego.