Hypertension, Diabetes
Mellitus & Dyslipidaemia
Group B
Topics:
B1+ B2a - Young Hypertension
B3 + B2b - Essential Hypertension
B5+ B4a - Diabetes Mellitus
B6 + B4b - Dyslipidaemia
Associated with palpitation, shortness of breath, sweating, bilateral upper and lower
limbs numbness
Denies of orthopnoea, PND, bilateral lower limbs swelling. Urination and bowel
movement normal
Went to Klinik Kesihatan Nilai. BP: 204/160mmHg and was given Captopril 25mg. She
was then referred to HTJS.
Family History:
Mother diagnosed with hypertension in 20+ years old
Father died at 56 years old due to heart attack.
Social History:
No smoking, no alcohol.
In the ED, her BP was 200-219/101-124mmHg. She was given T. amlodipine 10mg and
T. aspirin 300mg.
ECG showed ST depression in leads 1,2, V5 and V6.
Chest X-Ray showed cardiomegaly.
Troponin I: <0.04
Physical Examination:
Patient is well, obese.
Vital signs: BP 151/78mmHg, PR: 98bpm, RR: 18bpm
Cardiovascular examination:
Apex beat at left 6th intercostal space
S1 S2 heard, no murmur
No parasternal heave
No bibasal crepitaiton
1. T. Amlodipine 10mg OD
2. T. Perindopril 8mg OD
3. T. Cardiprin 100mg OD
4. T. Simvastatin 20mg ON
Amlodipine
Adverse Effect Ankle swelling, flushing, somnolence, fatigue, abdominal pain, nausea.
Rarely, confusion, rash, gingival hyperplasia, muscle cramp
Rationale Hypertension
Rationale Hypertension
Indication Dyslipidemia
CV risk reduction
Contraindication acute liver disease, transaminase, pregnancy , lactation, dose adjust in renal disease
Patient has a sudden onset of central chest pain at 7am when he was driving his car.
The pain was tightening in nature and radiated to left shoulder. It was accompanied
with minimal sweating as well.
He was subsequently sent by his lao po to the Emergency Department and pain was
relieved by sublingual GTN.
Past Medical History: He has been diagnosed with hypertension and dyslipidemia for
more than 20 years but has not been fully compliant with his medications and follow
ups. This is his 3rd admission which his first two admissions were due to acute chest
pain similarly to this episode.
Family history: Father had hypertension passed away at the age of 78. His mother lives
with his sister and is well according to patient.
Social History: He is a retired peneroka at FELDA. Does not smoke nor consume
alcohol.
Drug & Allergy History: No known drug allergy or food. Previous medications include
simvastatin, bisoprolol, amlodipine, and perindopril
Day 2 patient was stable and continued anticoagulation therapy with aspirin and
clopidogrel.
2) Hypertension
Been having Type 2 DM for 14 years since 2003. Initially presented with
persistent vomiting, abdominal pain & fatiguability. Admitted to hospital due to
Diabetic Ketoacidosis with Random Blood Sugar of 19 mmol/L.
Also has Hypertension in for 13 years, diagnosed during follow-up, and
Dyslipidaemia for 4 years
Medication History:
Both parents and younger sister have diabetes mellitus. No history of ischaemic
heart disease.
Allergies:
Diet History:
Takes home-cooked food regularly. Does not take sweet drinks. All meals are
taken on time.
Social history:
Body weight: 70 kg
BMI: 26 kg/m2
Waist circumference: 94 cm
INVESTIGATIONS
31/7/2017 1/11/2017
WEIGHT 65 KG 70 KG
BMI 26 27
SYMPTOMS HYPOGLYCEMIC
2008 2009 2010 2014 2016 2017 2017
CR 72 85 72 78 107 81
Dosage 40-80 mg OD
Max dose: 320mg /day
Rationale
Rationale Type 2 DM
Rationale Type 2 DM
Rationale Type 2 DM
Dosage Exenatide IR 5 g BD
Exenatide XR 2 mg weekly
Contraindication Hypersensitivity
Past medical hx
-gardening; no smoke/alcohol
Physical Examination Investigations
Height: 162 cm Lipid profile
- fibrates and nicotinic acid may be considered for increasing HDL and reducing TG
AFTER LDL treatment goal is achieved.
C. LDL apheresis
Indication: first line agents for familial hypercholesterolemia, primary and secondary
prevention of CVD
Prescription writing: Fenofibrate 100mg TDS daily; Gemfibrozil 600-1200mg daily doses before meal;
Bezafibrate 200 mg daily increasing (gradually over 5-7 days) to a maximum dose of 200 mg tds
(regular) or 400 mg daily (sustained release);ciprofibrate 100mgOD
PCSK 9 inhibitors (proprotein convertase subtilisin kexin type 9
inhibitors)
Drug Names Evolocumab
Drug Dosage 140mg SC every two weeks or 420mg SC every
monthly
Rationale
Adverse: GIT distress, Constipation. Reduce absorption of folic acid and fat-soluble, vitamins (A, D & K),
***Decreased absorption of certain drugs
Rationale: dyslipdenia