1	Hypertension, EPO and Cardiac disease Assoc Prof Simon Roger MD FRACP Renal Physician Gosford, Australia
2	Westmead Hospital
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13	Ambulatory BP Monitoring
14	Ambulatory BP Monitoring
15	Ambulatory BP Monitoring
16	Ambulatory BP Monitoring
17	What about Blood Pressure?
18	Slower Decline in Renal Function with Lower Blood Pressure Goals
19	What is the target BP ? General: <135/80
20	What drugs should be used to reach those targets ? ACE-inhibitors Capoten Renitec Tritace Coversyl Prinivil Generic Angiotensin II receptor blockers Avapro/Karvea Atacand Teveten Micardis
21	What drugs should be used to reach those targets ? Calcium channel blockers Norvasc Plendil Zanidip Isoptin/amprace Cardiazem/vasocardol Beta blockers Minax/betaloc/lopressor Tenormin/noten
22	What about the recent drug trials? ALLHAT Minipress/pressin and Norvasc/diuretic/ACE-inhibitor (lisinopril) ASCOT Norvasc and Coversyl vs Tenormin and diuretic
23	What about drug trials in dialysis patients?
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25	"How do we recognize and..." How do we recognize and apply appropriate clinical advice and evidence for individual patients?
26	How many tablets ?
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32	What can you do to lower BP ? Weight loss If overweight – 2mmHg/1kg weight loss Equal to a blood pressure tablet
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34	Causes of Kidney Failure (2003) Glomerulonephritis 35% Diabetes 22% Hypertension 12% Reflux nephropathy 6% Polycystic kidney disease 6% Analgesic nephropathy ¯ 5%
35	Other Causes of Chronic Kidney Disease
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37	The Deadly Quartet
38	The Deadly Quartet
39	What is the HbA₁c ?
40	What is the HbA₁c ?
41	What can you do to lower BP ? Weight loss If overweight – 2mmHg/1kg weight loss Equal to a blood pressure tablet Salt
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44	Foods with High Sodium Content Tinned vegetables and juices Silverbeet/spinach/olives Bread Breakfast cereals Crackers/savory biscuits Processed and natural cheeses Condensed milk Baking powder and soda Salted nuts/popcorn/potato chips/pretzels Sausage/bacon/ham Luncheon meats Meat and fish pastes Margarine/butter Salad dressings Some mineral waters Vegemite/marmite Soy/Worchester/BBQ/ sweet and sour sauces Monosodium glutamate Takeaway packaged food
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46	What about potassium?
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48	High potassium foods Avocado Baked beans Cauliflower Potato Tomato Turnip Cereals Yoghurt Nuts Apricots Banana Dried fruits Kiwi fruit Grapefruit juice Orange juice Tomato juice Chocolate
49	What can you do to lower BP ? Weight loss If overweight – 2mmHg/1kg weight loss Equal to a blood pressure tablet Salt Alcohol
50	Alcohol and BP
51	What can you do to lower BP ? Weight loss Salt Alcohol Smoking
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53	What can you do to lower BP ? Weight loss Salt Alcohol Smoking Regular exercise
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56	Nomenclature
57	Action of EPO
58	How many RBC’s are made every second ?
59	Red Cell Production 2,000,000 cells/second 120,000,000 cells/minute 173,000,000,000 cells/day 63,072,000,000,000 cells/year 4,415,040,000,000,000 cells/70 years
60	History of EPO French scientists in Sth America Viault (1890): change in red cell count with altitude Carnot and Deflandre (1906): haemopoietine
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62	Nomenclature
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64	What are the Non-erythropoietic Effects of Erythropoietin? Nomenclature What about erythropoietin’s other actions?
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68	What are the Essential Ingredients?
69	What are the Problems with Oral Iron?
70	Why is IV Iron Better?
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72	Erythropoietin and the treatment of anaemia
73	Known Benefits of Epoetin Correction of anaemia Lowers blood transfusion requirements Improvement in quality of life Reduction in LVH Enhanced cognitive function Makes then feel good: “doctor, can I have my injection more often?” Increased exercise tolerance
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78	The Heart and Chronic Kidney Disease
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80	Haemoglobin and Anaemia Much of the morbidity and mortality among end-stage renal disease patients receiving dialysis is cardiovascular in origin Cardiovascular disease mortality rates in ESRD patients are 20–40 times higher than in the general population
81	CKD - echocardiography
82	How does this happen? It’s like the elastic in your undies …. Stretch them enough and they won’t stay up!
83	How does this happen? It’s like the elastic in your undies …. Stretch them enough and they won’t stay up!
84	CKD - echocardiography
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86	LVMi in chronic kidney disease - What is important ?
87	Cumulative Survival vs LVMi
88	Haemoglobin and Anaemia Much of the morbidity and mortality among end-stage renal disease patients receiving dialysis is cardiovascular in origin Cardiovascular disease mortality rates in ESRD patients are 20–40 times higher than in the general population Only 15% have normal left ventricular structure and function at dialysis initiation Observational studies: anaemia appears to play a role in cardiac damage
89	Odds Ratio for Factors Affecting LV Growth
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92	To tidy up…… Role of blood pressure and treatment Benefits of anaemia correction Try to protect the heart from damage
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