TREATMENT OF ACQUIRED HEMOPHILIA A WITH RECOMBINANT ACTIVATED FVII M. A. Cermelj, S. Ouviña, A. Guzmán, O. Torres, A. FerroCentro de Hematología, Trombosis y Análisis Clínicos, CEHTAC, Buenos Aires, Argentina Introduction Acquired hemophilia A ( acq He A) is a rare condition, and is due Case 1 : 7 years old girl with acq He A detected during nephrotic to the production of autoantib
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Controlling blood pressurePrevention Kit 11
MINTO PREVENTION & REHABILITATION CENTRE CENTRE DE PREVENTION ET DE READAPTATION MINTO Preventing and Managing
High Blood Pressure
About This Kit
Fortunately, high blood pressure is easily detected and treated. Since the early 1970s, death rates from heart disease and stroke have declined. This decline is due in part to
better control of high blood pressure. Still, over 5 million people have high blood pressure.
Many are not getting the treatment they need.
If you have high blood pressure, you are not alone. This kit can help you learn how to
control it. If your blood pressure is currently in the normal range, the information in this
kit will help you prevent it from getting higher. In this kit you will:
Consider the role of lifestyle in preventing and controlling high blood pressure
This kit is one of several Heart Institute Prevention and Rehabilitation Centre (HIPRC)
educational kits on Preventing and Reversing Coronary Heart Disease. Ask about other
kits in this series, including:
Understanding Coronary Heart Disease
Understanding Risk Factors for Coronary Heart Disease
Understanding Cholesterol and Triglycerides
Preventing and Managing High Cholesterol and Triglycerides
Understanding Blood Pressure
Exercising with Diabetes
Copyright 2000 INTERxVENTCANADA, Inc. All Rights Reserved. Consider the Role of Lifestyle in Preventing and
Controlling High Blood Pressure
The goal of prevention and management of high blood pressure is to reduce the risk for the
complications of high blood pressure in the safest way possible. This may be
Achieving and maintaining the systolic and diastolic blood pressure goals
recommended in your Personal HIPRC Goals Managing the other risk factors for heart disease that you can control or change If your blood pressure is normal – You may be able to prevent it from getting high by following the lifestyle habits outlined in this section. If you have high blood pressure – You may be able to bring your blood pressure down into the normal range by changing some of your lifestyle habits. This could mean you wouldn’t have to take medications. If you must take medications to control your blood pressure - You should still practice a healthy lifestyle. Your medications will work better for you when combined with healthy practices. You may be able to take less medicine or give up medicines over time. HIPRC is a comprehensive lifestyle management program. One purpose of HIPRC is to prevent and control high blood pressure. Your HIPRC Personal Action Plan and educational kits address all the major lifestyle factors important for controlling your blood pressure. To help you reduce your blood pressure or prevent it from becoming high, special focus is placed on these areas: Achieve and Maintain a Healthy Weight. If you are overweight your heart has to work harder to pump blood through your body. Losing weight and keeping it off will bring your blood pressure down. While not solely a weight management program, participants in HIPRC have been successful in losing weight and keeping it off. Follow the eating and exercise plans recommended for you. Exercise Regularly. Research has shown people who are physically active are less likely to develop high blood pressure. And, those with high blood pressure have been able to reduce their blood pressure by participating in regular exercise. Some who were on medications were even able to give up their blood pressure medicine altogether. There are many HIPRC exercise kits to help you follow your exercise plan. Copyright 2000 INTERxVENTCANADA, Inc. All Rights Reserved. Special Exercise Tips for People With High Blood Pressure
Do not exercise if your resting systolic blood pressure is above 200 mmHg and/or
diastolic blood pressure is above 115 mmHg. Be aware that certain blood pressure-lowering drugs can lower your heart rate during exercise. See “Common Medications for Lowering Blood Pressure.” Visit with your HIPRC mentor if you are taking beta-blockers. Be especially careful to warm-up and cool-down if you are taking medications to lower When performing strength training exercises use lighter weights or less resistance and perform more repetitions. Ten to 15 repetitions of each exercise are recommended. Eat Healthy. What you eat can affect your blood pressure. A recent project, called D-A-S-H – “Dietary Approaches to Stop Hypertension” – demonstrated that a food plan low in saturated fat, total fat, and cholesterol; high in dietary fiber, potassium, calcium, and magnesium; and moderately high in protein – results in blood pressure reductions similar to those seen with medications. The food plan used in this study was similar to the meal plans recommended by HIPRC. There are numerous HIPRC nutrition kits to help you follow your food plan. Use your HIPRC Food Diary to monitor what you eat. Reduce the Sodium in Your Diet. For some people who have high blood pressure, reducing the amount of sodium they eat or drink helps bring down their blood pressure. While this doesn’t work for everyone, most people could benefit from eating less sodium. Americans eat much more sodium than they need. Because this is an important topic in nutrition, there is one entire HIPRC kit devoted just to this topic - “Reducing the Sodium In Your Diet.” Limit Your Alcohol. High blood pressure is one complication of drinking too much alcohol. If you drink, do so in moderation - no more than two drinks a day. One drink is defined as one ounce of 100 proof liquor, five ounces of wine, or 12 ounces of beer. Because women absorb more alcohol than men and lighter weight people feel the effects of alcohol more than heavier people, these individuals should probably limit themselves to no more than one drink per day. When faced with choices for beverages in a social setting, choose wine or beer over hard liquor. Mix wine with soda water or fruit juices to dilute the alcohol. After one alcoholic beverage, switch to a non-alcoholic beer or wine, diet soft drink, or special water. Also remember, alcohol is a major source of calories. If you are trying to manage your weight, limiting your alcohol is a good idea. Copyright 2000 INTERxVENTCANADA, Inc. All Rights Reserved. Understand the Role of Drug Therapy
_______________________________________________________________________ When making the decision to start you on drug therapy for high blood pressure, your doctor will consider three important factors: How high your blood pressure is Your other risk factors for heart disease Other diseases and complications of high blood pressure you may have Generally, drugs shouldn’t be the first step in controlling your blood pressure unless it is so severe that immediate action is necessary. If you have high blood pressure, your doctor will likely use a stepwise approach with lifestyle as the first step – weight loss, healthy eating, and regular exercise. HIPRC is the foundation for lifestyle management and managing high blood pressure. After about three months, if you have not been able to bring your blood pressure under control by making lifestyle changes, a medication may also be prescribed. While it might be possible to step down your drug therapy or discontinue it over time, when you start the medication, you should expect to take it for the rest of your life. Your doctor will work with you to find the best drug or combination of drugs and the right dosage for you. This may require “trial and error” because no one drug is perfect for everyone. All of the drugs can have side effects. Some do not interact well with other drugs you must take for other health conditions, such as diabetes medications if you have diabetes. Some blood pressure medicines have a negative effect on your blood cholesterol values, for example, causing the HDL (“good”) cholesterol to go down and triglycerides to go up. So, if you also have high blood cholesterol, that must enter into the decision about your high blood pressure drug therapy. Fortunately, there are many different blood pressure medications for your doctor to choose from. A summary of the major types of blood pressure medications is presented below. Both trade name and generic name are given, along with information about some side effects and special precautions. Your doctor and pharmacist can also provide you with other useful information about your medications. Copyright 2000 INTERxVENTCANADA, Inc. All Rights Reserved. Most Common Medications for Lowering Blood Pressure*
Side Effects and Special Precautions
Trade Name (Generic Name) Diuretics (Water Pills) Increase in uric acid (gout) Increase in calcium All loop diuretics may cause decrease in Lasix (furosemide) Demadex (torsemide) Potassium-sparing diuretics All potassium-sparing diuretics may cause Aldactone may cause enlarged breasts and Beta-Adrenergic Blockers (Beta-Blockers) Hide symptoms of low blood glucose in Worsen leg pain with activity in persons with Increase triglycerides and decrease HDL (“good”) cholesterol (except for Sectral, Cartrol, Levatol, Visken) Greater than expected increase in blood pressure if medication is stopped (most with Catapres and least with Tenex) Aldomet may cause liver and immune system * Source: Adapted from The Sixth Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Archives of Internal Medicine, November 21, 1997. This chart may not be a complete list of available medications and does not imply endorsement of any type or brand of medication by HIPRC. This list does not contain every possible side effect, negative reaction, interaction, or precaution for these drugs. Only your doctor can recommend or prescribe these medications. Copyright 2000 INTERxVENTCANADA, Inc. All Rights Reserved. Most Common Medications for Lowering Blood Pressure (Continued)
Side Effects and Special Precautions
Trade Name (Generic Name) Other Adrenergic Blockers (continued) Hylorel and Ismelin may cause blood pressure Serpasil may cause nasal congestion, drowsiness, depression, and make peptic ulcer worse May cause blood pressure to fall when you stand up (may be very severe after the first Hytrin (terazosin) Combined alpha-and beta-bockers May cause side effects similar to those of Normodyne, Trandate (labetalol) Angiotensin Converting Enzyme Inhibitors (ACE Inhibitors) Lotensin (benazepril) Mavik (trandolapril) Angiotensin II Receptor Blockers Cardizem SR, Cardizem CD, Dilacor XR, Procardia XL, Adalat CC (nifedipine) Sular (nisoldipine) Isoptin SR, Calan SR, Verelan, Covera HS Headaches Fluid retension Rapid heart rate Apresoline may cause Lupus syndrome Loniten may cause excessive hair growth Copyright 2000 INTERxVENTCANADA, Inc. All Rights Reserved. Combination Blood Pressure Lowering Medications
Types of Drugs
Trade Name (Generic Name)
Tenoretic (atenolol + chlorthalidone) Ziac (bisoprolol + hydrocholorothiazide) Lopressor HCT (metoprolol + hydrochlorothiazide) Corzide (nadolol + bendroflumethiazide) Inderide, Inderide LA (propranolol + hydrochlorothiazide) Timolide (timolol + hydrochlorothiazide) Lotensin HCT (benazepril + hydrochlorothiazide) Capozide (captopril + hydrochlorothiazide) Vaseretic (enalapril + hydrochlorothiazide) Prinzide, Zestoretic (lisinopril + hydrochlorothiazide) Teczem (diltiazem + enalapril) Tarka (verapamil + trandolapril) Lexxel (felodipine + enalapril) Dyazide, Maxide (triamterene + hydrochlorothiazide) Aldactazide (spironolactone + hydrochlorothiazide) Moduretic (amiloride + hydrochlorothiazide) Esimil (guanethidine + hydrochlorothiazide) Apresazide (hydralazine + hydrochlorothiazide) Aldoril (methyldopa + hydrochlorothiazide) Hydropres (reserpine + hydrochlorothiazide) Ser-Ap-Es (reserpine + hydrochlorothiazide) Combipres (clonidine + chlorthalidone) Aldochlor (methyldopa + chlorothiazide) Demi-Regroton (reserpine + chlorthalidone) Diupres (reserpine + chlorothiazide) Minizide (prazosin + polythiazide) Copyright 2000 INTERxVENTCANADA, Inc. All Rights Reserved.
Questions for Your Doctor
Before you agree to a specific drug therapy for controlling your blood pressure, it is your
right, and responsibility, to know about the medications you will take. Ask your doctor
these 10 questions.
1. Why do you think I should take this medicine?
2. What’s the generic as well as the trade name of this drug?
3. What is the dosage I should take?
4. Are you sure it will interact positively with other medications I’m taking? (Be
prepared to list all medications you’re taking, including over-the-counter medications) 5. How do you recommend I take this drug? (For example, with meals or on an empty 6. What side effects should I be watching for? Should I report them to you right away or 7. For how long should I expect to take this drug? 8. When should I have my blood pressure re-checked? 9. Are there any other tests, such as blood tests, that I will need while taking this 10. If you are involved in an exercise plan: Will this drug effect my heart rate during
Check your prescription before you leave the pharmacy to be sure it is correct. Feel
free to ask the pharmacist any questions you may have. Store you medicine in a room where the humidity is low and the temperature is fairly constant. The bathroom is not necessarily the best storage place. Store all medicines in their original containers. Do not remove labels. Do not mix several kinds of medicines in one container. Keep all medicines out of the reach of children. Take your medicine at the same time each day. Establish a regular, easy to remember routine. Ask someone to remind you or ask if you have taken your medicine. If you miss a day’s dosage, don’t double up the next day. Never stop taking your medicine without talking to your doctor. The medicine only controls your blood pressure while you are taking it. If you stop, your blood pressure goes back up. If this happens too quickly, it could be dangerous. Keep a record of all side effects of medications and report them to your doctor. Copyright 2000 INTERxVENTCANADA, Inc. All Rights Reserved. Preventing and Managing High Blood Pressure
_______________________________________________________________________ Before Your Next Visit
In the time between your visits with your mentor, you should read and complete your
educational kits. Use this sheet to record your work. Think of this as “homework.”
Bring this sheet with you to your next visit.
Tell three things you will do to lower your blood pressure or prevent it from getting
I will: Complete the statements in “Check Yourself” to be sure you understand the key
1. The goal of prevention and management of high blood pressure is to reduce the risk for
complications of high blood pressure in the _ _ _ _ _ _ way possible. 2. If you have high blood pressure, you may be able to bring your blood pressure down into the normal range by _ _ _ _ _ _ _ _ some of your lifestyle habits. 3. If you must take _ _ _ _ _ _ _ _ _ _ to control your blood pressure, you should still 4. If you are _ _ _ _ _ _ _ _ _ _ your heart has to work harder to pump blood through 5. People who _ _ _ _ _ _ _ _ are less likely to develop high blood pressure. 6. Do not exercise if your resting systolic blood pressure is above _ _ _ mmHg and/or diastolic blood pressure is above _ _ _ mmHg. 7. Certain blood pressure drugs can lower your _ _ _ _ _ _ _ _ _ during exercise. 8. For some people who have high blood pressure, reducing the amount of _ _ _ _ _ _ they eat or drink helps bring down their blood pressure. 9. High blood pressure is one complication of drinking too much _ _ _ _ _ _ _. Copyright 2000 INTERxVENTCANADA, Inc. All Rights Reserved. 10. Drugs should not be the first step in controlling blood pressure unless it is so _ _ _ _ _ _ that immediate action is necessary. 11. After about _ _ _ _ _ months, if you have not been able to bring your blood pressure under control by making lifestyle changes, a medication may be prescribed. 12. When you start blood pressure medication, you should expect you will take it for the 13. All drugs can have _ _ _ _ _ _ _ _ _ _ _. 14. Some blood pressure drugs do not _ _ _ _ _ _ _ _ well with other drugs you must take 15. Your doctor will work with you to find the best drug or combination of drugs and the 16. If you stop your medication, your blood pressure is likely to _ _ _ _ _ _ _ _.
Answers: 1) safest; 2) changing; 3) medication; 4) overweight; 5) exercise; 6) 200, 115; 7) heart rate;
8) sodium; 9) alcohol; 10) severe; 11) three; 12) life; 13) side effects; 14) interact; 15) dosage; 16) increase
Write any questions for your mentor here.
Copyright 2000 INTERxVENTCANADA, Inc. All Rights Reserved.
This Provisional PDF corresponds to the article as it appeared upon acceptance. Copyedited andfully formatted PDF and full text (HTML) versions will be made available soon. A Controlled Trial of the Litebook Light-Emitting Diode (LED) Light Therapy Device for Treatment of Seasonal Affective Disorder (SAD) BMC Psychiatry 2007, 7 :38 Article type Submission date Acceptance date