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Hypertension
FACTS
ABOUT HIGH BLOOD PRESSURE
Hypertension is one of the commonest problems that is encountered in
the medical consultation. The following are some of the facts.
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More hypertensives are men than women.
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The older you are, the higher the chance that you
have hypertension.
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In most of the cases, no specific cause is identified.
In some cases, it may be related to renal disease, hormonal disturbances
and drugs (eg prednisolone, OC pill).
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The usual cut-off point for hypertension is 140/90
mmHg for adults, but hypertension should not be diagnosed on the basis
of a single reading. Initial elevated readings should be confirmed
on at least two follow-up visits.
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Hypertension often is asymptomatic; most of the cases
are diagnosed incidentally. Some people will experience dizziness,
headaches, nose bleeding and paraesthesia of limbs.
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Hypertension can harm the kidneys, heart and cerebrovascular
system. It accounts for 5% of ESRF in Hong Kong. Kidney disease in
turn can cause hypertension.
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Uncontrolled or poorly controlled high blood pressure
is a common cause of renal failure.
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Renal manifestation of hypertension include
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proteinuria
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renal impairment
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Primary prevention of hypertension documented efficacy:
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dietary sodium reduction
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alcohol moderation
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weight loss
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physical activity
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potassium supplementation unproven efficacy
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stress management
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calcium, magnesium, fish oil and dietary fiber
supplementation
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caffeine consumption moderation
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reduced dietary saturated-to-polyunsaturated fat
ratio
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Hypertension can be treated by lifestyle modification
(similar to the primary prevention of hypertension) and medications
Diabetic
Nephrology
FACTS
ABOUT DIABETES AND KIDNEY DISEASE
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Diabetes mellitus accounts for 21% of ESRF in Hong
Kong
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There are different types of diabetes :
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the most common are:
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Type 1, which is caused by an inability of the
pancreas to produce insulin, either autoimmune or idiopathic;
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Type 2, which range from predominantly insulin
resistance with relative insulin deficiency to a predominantly
secretory defect with or without insular resistance
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Diabetes damages blood vessels throughout the body,
affecting the kidneys, coronary arteries, cerebrovascular system and
nerves
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Common renal problems in diabetes include
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diabetic nephropathy
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renal (ischemic) disease (renal artery stenosis,
cholesterol embolism)
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urinary tract infection
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papillary necrosis
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contrast nephropathy (if diabetic patients undergo
contrast investigation)
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Symptoms and signs that a diabetic patient may be
developing kidney disease include:
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Proteinuria
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leg swelling
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hypertension
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uremic symptoms (nausea, vomiting)
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anaemia
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itching
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hypoglycaemic attack (because of reduced requirement
of insulin as kidney fails)
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Natural history of diabetic nephropathy
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Prevention of diabetic nephropathy
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controlling high blood pressure
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controlling blood sugar level
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reduction of dietary protein intake
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correct hyperlipidamia
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stop smoking
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avoid medications that damage kidneys
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Long-term renal replacement therapy for diabetics
includes peritoneal dialysis, haemodialysis kidney transplantation
and combined kidney-pancreas transplantation. The optimal mode of
treatment will be determined by the general health, medical conditions,
personal preference and the availability of resources
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