Medi Klinik Shahrol

01/12/2025

Vaksin Influenza & Pneumococcal boleh diperolehi skrg 😁

28/11/2025

Esok Dr Shahrol akan bertugas sehingga 10.30 pagi shj. Selepas itu klinik dijaga oleh doktor ganti.
Harap maklum .

27/11/2025

Latest Updates in ACS

21/11/2025

Weekend ini Dr Shahrol menghadiri kelas Perubatan Functional dan Integratif. Klinik buka spt biasa dijaga oleh Dr Lokum .

04/11/2025

Resistant hypertension in a diabetic patient
Resistant hypertension is defined as blood pressure that remains above target despite the use of three antihypertensive medications at optimal doses, including a diuretic, or when four or more drugs are needed to control it.

🧠 Key Criteria
Confirmed diagnosis:
Office BP ≥140/90 mmHg (or ≥130/80 mmHg in diabetics) despite ≥3 drugs, one of which is a diuretic.
OR controlled BP but requiring ≥4 medications.
True vs. pseudo-resistance:
Rule out poor adherence, incorrect BP measurement, white coat effect, and suboptimal drug dosing.

🔍 Why it matters
Resistant hypertension is a red flag for:
Secondary causes (e.g., primary aldosteronism, renal artery stenosis, obstructive sleep apnea, pheochromocytoma).
End-organ damage (e.g., LVH, CKD, retinopathy).
Increased cardiovascular risk (stroke, MI, heart failure).
It requires a structured evaluation to rule out secondary causes, optimize therapy, and assess end-organ damage. Labs should target renal, endocrine, and cardiovascular systems. Management includes lifestyle, pharmacologic intensification, and specialist referral.

🧪 Stepwise Evaluation: Labs and Diagnostics
Confirm true resistance:
Ensure adherence, correct BP measurement, and exclude white coat effect (ambulatory BP monitoring).
Basic labs:
Electrolytes, BUN, creatinine: assess renal function.
eGFR and urine albumin-to-creatinine ratio: screen for diabetic nephropathy.
HbA1c, fasting glucose: glycemic control.
Lipid panel: cardiovascular risk.
Secondary hypertension workup:
Renin and aldosterone levels: screen for primary aldosteronism (especially if hypokalemia).
TSH: rule out hypothyroidism.
24-hour urinary metanephrines or plasma free metanephrines: pheochromocytoma.
Sleep study: if clinical suspicion of obstructive sleep apnea.
Renal artery Doppler or CTA/MRA: if renal artery stenosis suspected.
Cardiac evaluation:
ECG: LVH or ischemia.
Echocardiogram: LV function, hypertrophy, diastolic dysfunction.

💊 Pharmacologic Management
Triple therapy must include a diuretic:
Thiazide-like diuretics (chlorthalidone or indapamide) preferred over hydrochlorothiazide.
If eGFR

03/11/2025

🔴10 Takeaway Message From New Blood Pressure Guidelines:⤵️

1️⃣ High BP is the top modifiable risk for CVD, stroke, dementia, CKD, and death.

2️⃣ Work with communities to screen all adults and apply guideline-based BP prevention and treatment.

3️⃣ Use multidisciplinary teams to address medication access and barriers to BP control.

4️⃣ BP categories: Normal

AbstractAimThe “2025 AHA/ACC/AANP/AAPA/ABC/ACCP/ACPM/AGS/AMA/ASPC/NMA/PCNA/SGIM Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults” retires and rep...

20/10/2025

Jom ke klinik utk vaksinasi 😁

13/10/2025

Stock Vaksin Influenza masih ada tetapi terhad, perlu segera jika ingin dapatkan vaksinasi tersebut kerana permintaan tinggi skrg. Vaksin Denggi dan Pneumococcal juga masih boleh didapati di Medi Klinik Shahrol 😁