Hypertension

1. Background/Cultural Points:

   Hypertension is increasingly common in Cambodia due to: high sodium intake, low-birth weight, genetic predisposition, increasing exposure to western diet and issues of over-nutrition/obesity. Patients in Cambodia often misunderstand hypertension as an intermittent problem that may cause headaches, etc; they therefore treat themselves for high blood pressure only when they are symptomatic.

2. Diagnosis & Lab:

   1. Diagnosed by elevated BP readings on more than one visit.
   2. Consider: U/A, Creatinine, K+ advised; H/H, Glucose, and TSH if risk ff/suspected

3. Management/Education/Treatment:

   1. Review with patient: 1) HTN is a chronic condition; 2) consistent life-long treatment significantly reduces risk of heart disease and stroke; 3) good management requires the patient’s willingness to adjust his/her lifestyle and use medication as prescribed (daily, not just when symptomatic).

   2. Lifestyle Points:

      1. Reduce sodium intake. Avoid too much salty fish.
      2. Change from white-rice-only diet to minimum 20% brown rice (less machine milled) and advise portion control
      3. Weight loss if obese
      4. Exercise if sedentary
      5. Smoking cessation

   3. Medications (consider, if no contraindications, and based on comorbidities):

      1. Step 1
         1. <55y, consider ACEI (ARB if not tolerating ACEI) or CCB (Amlodipine)
         2. >55y, consider CCB (Amlodipine)
      2. Step 2: Combo ACEI/ARB + CCB
      3. Step 3: Add HCTZ
      4. Comorbidities:
         1. Diabetes: ACEI
         2. CHF: ACEI and BB (Atenolol, Metoprolol)
         3. H/O MI
      5. Aspirin (ASA) 325mg ¼ tab QD if significant cardiac risks. Warn regarding stomach irritation – consider GI protection prophylaxis or at follow-up.

4. Follow-Up:

   1. Initial follow-up at 1 month, then q3-6 mos, then annually
   2. Monitor labs appropriately, based on medication chosen (EG, Cr/K q6-12 mos if taking ACEI or Thiazide).