Risk factors for hypertension
- Heredity
- High salt diet – in predisposed individuals
- Obesity – BMI >27
- Physical inactivity
- Alcohol consumption
Ø
30g/day for 2-3 years in men
Less well
recognised risk factors
High educational status, income
– especially in Blacks
Stress
– especially in Blacks
Urbanization
Low birth weight
Genetic aspects
SECONDARY
·
Chronic glomerulonephritis
·
Chronic interstitial nephritis
·
ADPKD
·
Chronic renal failure
·
Renovascular disease
·
Obstructive uropathy
·
Cushing’s syndrome
·
Conn’s syndrome
·
Phaeochromocytoma
Other factors
influencing prognosis
·
Age >55 in men, >65 in women
·
Family history of premature CV disease
·
Smoking
·
Hyperlipidaemia
·
Microalbuminuria
·
Target organ damage
-
essentially based on lab evaluation
·
Associated clinical conditions
-
essentially clinically evident complications, diabetes mellitus
RISK
STRATIFICATION
Awareness
·
1/3
aware
·
2/3
of these on treatment
·
8%
aware of BP status
·
51.6%
Hypertensives, 3.6% normotensives aware
of BP status (p<0.0001)
Complications
·
Heart
failure
·
Stroke
·
Renal
failure
·
Malignant
hypertension
Stroke
·
4-9%
of deaths
·
6.5-41%
of neuro admissions
·
Third
or fourth commonest neurological condition in the community
·
80%
due to hypertension
·
Ischaemic
60%, haemorrhagic 20%, SAH 10%
Renal failure
·
Acute
or chronic
·
Chronic
far commoner
·
With
CGN commonest causes of ESRD
·
CRF
6-8% medical admissions
·
With
malignant hypertension(1.6% of admissions) renal failure in 77% at presentation
Treatment
·
All
classes effective to different degrees
·
Diuretics,
Ca blockers preferred
·
Fixed
dose combinations useful
·
Centrally
acting agents effective and cheap with relatively few side effects
·
Cost
considerations paramount
Additional therapy
·
Low-dose
aspirin, 75-150mg daily
·
Statin
therapy
·
Glycaemic
control
Target BP
- Gen population <140/90
- Chronic renal disease
·
-proteinuria
< 1g/24 hrs <135/85
·
-proteinuria
>1g/24 hrs <125/75
- GFR < 15mL/min <140/90
- No benefit in further reduction - AASK
·
102-107
vs <92mmHg
Mortality
·
2
year prospective
·
1344
men and women, rural setting
·
Hypertension
(140/90) 9.3%
·
3%
death each year, HT 14.9%
·
Survivors,
HT 8.4%
·
Risk
of death over 60% for 20mm Hg increase in BP
·
Population
attributable risk 7%
Community Control -
Prevention
Promotion of healthy lifestyles
- in the
media
Training of primary care workers
- to
measure BP
Encouragement of home checks
Primordial
-Intervention before potential of exposure to
risk factors
Primary
-Intervention
after potential of exposure to risk factors
Secondary
-Intervention
after development of hypertension
Tertiay
RENAL DISEASES IN NIGERIA - S. Kadiri
Worldwide
·
50
million with progressive KD
·
1
million on RRT
·
$25
Billion/year for treatment in US
·
Commonest
causes glomerulonephrotis, Hypertension , diabetes
Nigeria - General Points
- Prevalence rates not known
- CRF 6.7%, 8% of admissions 2-3 ATN/month
- Late presentation
- Diagnosis not often available
Presentation
·
AGN
·
AIN
·
ARF
·
Asymptomatic
urinary abnormalities
·
Nephrotic
Syndrome
·
Chronic
Renal Failure
·
Hypertension
Acute glomerulonephritis
·
Limited
data
·
Usual
causes
·
Hepatitis-B,
malaria, typhoid
·
Often
self-limiting
Causes of ARF
·
Acute
tubular necrosis
·
Acute
on chronic renal failure
·
Acute
/ acute on chronic obstruction
·
Malignant
hypertension
ATN-Causes
·
225
over 10 years
·
53
related to use of herbal medicines
·
Others
include septicaemia, haemolysis, obstetric conditions, gastroenteritis, acute
hepatitis, non-herbal drug toxicity
·
Rarity
of malaria, snake bites, crush injury
Asymptomatic
urinary abnormalities
·
Under
recognized
·
Under
reported
·
2
studies as examples
ATN related
to herbal medicines
·
Treatment
of febrile illness, abdominal pain infertility
·
Social
use
·
Underlying
belief in efficacy
·
Cheaper
alternative
·
Younger
age , lower SE group
·
Secrecy,
suspicion
Composition–
partial list
·
Mango
(Mangifera indica)
·
Cashew
(Anacardium occidentale)
·
Paw-paw
(Carica papaya)
·
Lemon
grass
·
Lime
leaves (Citrus aurantifolia)
·
Oruwo
( Morinda lucida)
·
Dongo-yaro
(Azadirachta indica)
Administration
·
Crushed
extracts
·
Boiled
extracts
·
Steam
baths
·
Vaginal
pessaries
Features
·
Oliguria,
anuria in over 75%
·
Onset
2-7 days in over 90%
Mean 3.5+0.7 days
·
No
oliguria in about 20-25%
·
Jaundice
Mechanism
·
I.V
Haemolysis, ( + G6PD def)
·
Hepatotoxicity
·
Direct
Nephrotoxicity
Prognosis
·
Usually
good
·
Mortality
about 10-20% (cf 40-50% in others)
·
Role
of dialysis in outcome ?
Asymptomatic urinary abnormalities
1.
Awunnor-Renner at al
- 134 Pts with glomerular disease
- 45 had asymptomatic proteinuria
- 21/45 had mesangial proliferative GN
- 1 had mesangiocapillary GN
2. Oviasu et al
·
2169
subjects - students
·
114
with AUA (5%)
·
6
of whom had nephrotic range proteinuria
Nephrotic
Syndrome
·
Commoner
than in Europe, N.America 2% cf 0.5%
·
Proliferative
GN, FSG prominent
·
Investigations
often incomplete
Common causes of NS
·
Idiopathic
glomerulonephritis
·
Hepatitis
B and C virus infection
·
Malaria
·
Diabetes
·
Sickle
cell anaemia
·
Lymphomas
·
Schistosomiasis
·
Skin
lightening creams
NS- Management
·
Diuretic
therapy
·
Diet
·
Steroid
occasionally
·
Cytotoxic
agents rarely
Chronic
Renal Failure
·
Common
·
6-8%
of admissions
·
All
age groups
·
Monthly
variations in admissions
CRF- Causes
·
Glomerulonephritis
·
Hypertension
·
Diabetes
·
Interstitial
nephritis
·
ADPKD
·
Obstructive
uropathy
Glomerulonephritis
·
Asymptomatic
urinary abnormalities
·
Nephrotic
syndrome
·
Hypertension
·
Renal
failure
CRF- Treatment
·
Largely
conservative
·
Dialysis
for < 5%
o
HD
o
Intermittent
PD
o
Chronic
PD- rare
·
Transplantation
Conservative
management
·
Control
of hypertension
·
Control
of proteinuria
·
Low
protein diet
·
Fluid
and electrolyte balance
·
Management
of intercurrent illness
Control –
Prevention
·
Ante-natal
·
Pre-school
·
Routine
urine testing
·
Improvement
in general hygiene
·
Blood
pressure control
·
early
referral
