from pptx import Presentation
from pptx.util import Inches, Pt, Emu
from pptx.dml.color import RGBColor
from pptx.enum.text import PP_ALIGN, MSO_ANCHOR
from pptx.util import Inches, Pt
import copy

prs = Presentation()
prs.slide_width = Inches(13.333)
prs.slide_height = Inches(7.5)

# ─────────────────── COLOR PALETTE ───────────────────
DARK_BLUE   = RGBColor(0x0D, 0x2B, 0x55)   # deep navy
MID_BLUE    = RGBColor(0x1A, 0x5E, 0x9B)   # medium blue
ACCENT_TEAL = RGBColor(0x00, 0xA6, 0x9A)   # teal accent
LIGHT_BLUE  = RGBColor(0xD6, 0xEA, 0xF8)   # pale blue bg
WHITE       = RGBColor(0xFF, 0xFF, 0xFF)
DARK_TEXT   = RGBColor(0x1C, 0x1C, 0x2E)
SOFT_GRAY   = RGBColor(0xF0, 0xF4, 0xF8)
YELLOW_ACC  = RGBColor(0xFF, 0xC3, 0x00)
RED_WARN    = RGBColor(0xC0, 0x39, 0x2B)
GREEN_ACC   = RGBColor(0x1E, 0x8B, 0x4C)
ORANGE_ACC  = RGBColor(0xE6, 0x7E, 0x22)

blank_layout = prs.slide_layouts[6]

# ─────────────────── HELPER FUNCTIONS ───────────────────

def add_rect(slide, x, y, w, h, fill_color, alpha=None):
    shape = slide.shapes.add_shape(1, Inches(x), Inches(y), Inches(w), Inches(h))
    shape.fill.solid()
    shape.fill.fore_color.rgb = fill_color
    shape.line.fill.background()
    return shape

def add_textbox(slide, x, y, w, h, text, font_size, bold=False, color=WHITE,
                align=PP_ALIGN.LEFT, italic=False, wrap=True):
    tb = slide.shapes.add_textbox(Inches(x), Inches(y), Inches(w), Inches(h))
    tf = tb.text_frame
    tf.word_wrap = wrap
    tf.margin_left = Inches(0.05)
    tf.margin_right = Inches(0.05)
    tf.margin_top = Inches(0.03)
    tf.margin_bottom = Inches(0.03)
    p = tf.paragraphs[0]
    p.alignment = align
    run = p.add_run()
    run.text = text
    run.font.size = Pt(font_size)
    run.font.bold = bold
    run.font.italic = italic
    run.font.color.rgb = color
    run.font.name = "Calibri"
    return tb

def add_multiline_textbox(slide, x, y, w, h, lines, font_size, color=DARK_TEXT,
                           bold=False, line_spacing=1.15, align=PP_ALIGN.LEFT):
    """lines: list of (text, bold, color, font_size_override or None)"""
    tb = slide.shapes.add_textbox(Inches(x), Inches(y), Inches(w), Inches(h))
    tf = tb.text_frame
    tf.word_wrap = True
    tf.margin_left = Inches(0.1)
    tf.margin_right = Inches(0.05)
    tf.margin_top = Inches(0.05)
    tf.margin_bottom = Inches(0.05)
    first = True
    from pptx.oxml.ns import qn
    from lxml import etree
    for (text, is_bold, txt_color, fsize) in lines:
        if first:
            p = tf.paragraphs[0]
            first = False
        else:
            p = tf.add_paragraph()
        p.alignment = align
        run = p.add_run()
        run.text = text
        run.font.size = Pt(fsize if fsize else font_size)
        run.font.bold = is_bold
        run.font.color.rgb = txt_color if txt_color else color
        run.font.name = "Calibri"
        # line spacing
        pPr = p._p.get_or_add_pPr()
        lnSpc = etree.SubElement(pPr, qn('a:lnSpc'))
        spcPct = etree.SubElement(lnSpc, qn('a:spcPct'))
        spcPct.set('val', str(int(line_spacing * 100000)))
    return tb

def header_bar(slide, title, subtitle=None):
    """Full-width dark blue header bar"""
    add_rect(slide, 0, 0, 13.333, 1.2, DARK_BLUE)
    add_rect(slide, 0, 1.2, 13.333, 0.06, ACCENT_TEAL)
    add_textbox(slide, 0.3, 0.05, 12, 0.7, title, 32, bold=True, color=WHITE, align=PP_ALIGN.LEFT)
    if subtitle:
        add_textbox(slide, 0.3, 0.75, 12, 0.45, subtitle, 16, bold=False, color=LIGHT_BLUE, align=PP_ALIGN.LEFT)

def footer_bar(slide, text="Wells Pharmacotherapy Handbook 9e | DiPiro Pharmacotherapeutics"):
    add_rect(slide, 0, 7.2, 13.333, 0.3, DARK_BLUE)
    add_textbox(slide, 0.3, 7.22, 12.5, 0.25, text, 9, color=RGBColor(0xAA, 0xCC, 0xFF), align=PP_ALIGN.LEFT)

def slide_bg(slide, color=SOFT_GRAY):
    add_rect(slide, 0, 0, 13.333, 7.5, color)

# ═══════════════════════════════════════════════════════
# SLIDE 1 — TITLE SLIDE
# ═══════════════════════════════════════════════════════
slide = prs.slides.add_slide(blank_layout)
add_rect(slide, 0, 0, 13.333, 7.5, DARK_BLUE)
add_rect(slide, 0, 0, 0.25, 7.5, ACCENT_TEAL)
add_rect(slide, 0.25, 0, 0.05, 7.5, MID_BLUE)

# Big title
add_textbox(slide, 1.2, 1.5, 11, 1.4, "HYPERTENSION", 72, bold=True, color=WHITE, align=PP_ALIGN.LEFT)
add_rect(slide, 1.2, 3.0, 7, 0.07, ACCENT_TEAL)
add_textbox(slide, 1.2, 3.15, 11, 0.6, "Pharmacotherapy: Pathophysiology, Classification & Drug Management", 22, bold=False, color=LIGHT_BLUE, align=PP_ALIGN.LEFT)
add_textbox(slide, 1.2, 3.85, 11, 0.45, "Based on Wells Pharmacotherapy Handbook 9e (pp.554–588) & DiPiro Pharmacotherapeutics", 15, bold=False, color=RGBColor(0x80, 0xA8, 0xD4), align=PP_ALIGN.LEFT)

# Decorative circles
for (cx, cy, cr, col) in [(11.5, 1.2, 1.1, MID_BLUE), (12.3, 0.3, 0.7, RGBColor(0x1A, 0x4A, 0x7A)),
                           (11.0, 6.5, 0.8, RGBColor(0x0A, 0x3A, 0x6A))]:
    s = slide.shapes.add_shape(9, Inches(cx), Inches(cy), Inches(cr*2), Inches(cr*2))
    s.fill.solid(); s.fill.fore_color.rgb = col; s.line.fill.background()

add_textbox(slide, 1.2, 6.9, 6, 0.3, "Prepared for Pharmacotherapy Review", 11, color=RGBColor(0x60, 0x90, 0xC0))

# ═══════════════════════════════════════════════════════
# SLIDE 2 — OVERVIEW / TABLE OF CONTENTS
# ═══════════════════════════════════════════════════════
slide = prs.slides.add_slide(blank_layout)
slide_bg(slide)
header_bar(slide, "Presentation Overview", "Topics Covered in This Session")
footer_bar(slide)

topics = [
    ("1", "Definition & Epidemiology", "Understanding blood pressure criteria and global burden"),
    ("2", "Pathophysiology", "Mechanisms driving elevated blood pressure"),
    ("3", "Classification & Staging", "JNC 8, ACC/AHA 2017 guidelines"),
    ("4", "Clinical Evaluation", "Diagnosis, workup, and secondary causes"),
    ("5", "Non-Pharmacologic Therapy", "Lifestyle modifications – DASH, exercise, weight"),
    ("6", "Pharmacologic Overview", "Drug classes, MOA, and selection principles"),
    ("7", "First-Line Drug Classes", "Thiazides, ACEi, ARBs, CCBs – deep dive"),
    ("8", "Compelling Indications", "Special populations and comorbidity-guided therapy"),
    ("9", "Resistant Hypertension", "Definition, workup, and additional agents"),
    ("10", "Hypertensive Emergencies", "Urgency vs. Emergency – acute management"),
]

col1_x, col2_x = 0.4, 6.9
for i, (num, title, desc) in enumerate(topics):
    col_x = col1_x if i < 5 else col2_x
    row_y = 1.45 + (i % 5) * 1.1
    add_rect(slide, col_x, row_y, 0.45, 0.55, MID_BLUE)
    add_textbox(slide, col_x+0.02, row_y+0.02, 0.42, 0.52, num, 18, bold=True, color=WHITE, align=PP_ALIGN.CENTER)
    add_textbox(slide, col_x+0.55, row_y, 5.8, 0.3, title, 13, bold=True, color=DARK_BLUE)
    add_textbox(slide, col_x+0.55, row_y+0.28, 5.8, 0.28, desc, 10, color=RGBColor(0x55, 0x55, 0x77))

# ═══════════════════════════════════════════════════════
# SLIDE 3 — DEFINITION & EPIDEMIOLOGY
# ═══════════════════════════════════════════════════════
slide = prs.slides.add_slide(blank_layout)
slide_bg(slide)
header_bar(slide, "Definition & Epidemiology", "Hypertension — The Silent Killer")
footer_bar(slide)

# Left column - definition boxes
boxes = [
    (DARK_BLUE, "DEFINITION (ACC/AHA 2017)",
     "BP ≥ 130/80 mmHg on two or more separate occasions. Previously ≥140/90 mmHg (JNC 7). The 2017 guideline lowered the threshold to identify at-risk patients earlier and reduce cardiovascular events."),
    (MID_BLUE, "NORMAL BP",
     "Systolic < 120 mmHg AND Diastolic < 80 mmHg. Ideal target for cardiovascular risk minimization."),
    (ACCENT_TEAL, "ELEVATED BP (Pre-hypertension)",
     "Systolic 120–129 mmHg AND Diastolic < 80 mmHg. Lifestyle modification recommended; no drug therapy unless comorbidities exist."),
]
for idx, (col, title, body) in enumerate(boxes):
    y = 1.45 + idx * 1.75
    add_rect(slide, 0.35, y, 5.9, 1.55, col)
    add_textbox(slide, 0.45, y+0.05, 5.7, 0.38, title, 12, bold=True, color=WHITE)
    add_textbox(slide, 0.45, y+0.42, 5.7, 1.05, body, 11, color=WHITE, wrap=True)

# Right column - epidemiology stats
add_rect(slide, 6.7, 1.45, 6.3, 5.75, WHITE)
add_rect(slide, 6.7, 1.45, 6.3, 0.45, DARK_BLUE)
add_textbox(slide, 6.8, 1.47, 6.1, 0.4, "EPIDEMIOLOGY & BURDEN", 13, bold=True, color=WHITE)

epi_data = [
    ("~1.28 Billion", "Adults worldwide have hypertension (WHO 2023)", MID_BLUE),
    ("~47%", "Of US adults affected (ACC/AHA 2017 criteria)", ACCENT_TEAL),
    ("~20%", "Of hypertensives are unaware of their condition", ORANGE_ACC),
    ("#1 Cause", "Of preventable cardiovascular morbidity/mortality", RED_WARN),
    ("$131 Billion", "Annual direct cost in the United States", GREEN_ACC),
    ("46% Control", "Only 46% of US hypertensives have controlled BP", MID_BLUE),
]
for idx, (stat, desc, col) in enumerate(epi_data):
    y = 2.02 + idx * 0.85
    add_rect(slide, 6.85, y, 1.6, 0.65, col)
    add_textbox(slide, 6.87, y+0.04, 1.58, 0.58, stat, 16, bold=True, color=WHITE, align=PP_ALIGN.CENTER)
    add_textbox(slide, 8.55, y+0.1, 4.3, 0.55, desc, 11, color=DARK_TEXT, wrap=True)

# ═══════════════════════════════════════════════════════
# SLIDE 4 — PATHOPHYSIOLOGY
# ═══════════════════════════════════════════════════════
slide = prs.slides.add_slide(blank_layout)
slide_bg(slide)
header_bar(slide, "Pathophysiology of Hypertension", "CO × SVR = MAP — Multiple Dysregulated Systems")
footer_bar(slide)

add_textbox(slide, 0.4, 1.35, 12.5, 0.35,
    "BP = Cardiac Output (CO) × Systemic Vascular Resistance (SVR). Any factor raising CO or SVR elevates BP.",
    13, bold=True, color=DARK_BLUE)

# Central formula box
add_rect(slide, 4.5, 1.78, 4.3, 0.7, DARK_BLUE)
add_textbox(slide, 4.5, 1.82, 4.3, 0.65, "BP  =  CO  ×  SVR", 26, bold=True, color=WHITE, align=PP_ALIGN.CENTER)

mechanisms = [
    ("RAAS ACTIVATION", MID_BLUE,
     "• Angiotensin II → vasoconstriction\n• Aldosterone → Na⁺/H₂O retention\n• Increased plasma volume → ↑CO\n• Stimulates sympathetic nervous system\n• End-organ remodeling (LVH, nephropathy)"),
    ("SYMPATHETIC OVERACTIVITY", DARK_BLUE,
     "• Elevated catecholamines (NE, Epi)\n• ↑ Heart rate and stroke volume → ↑CO\n• Peripheral vasoconstriction → ↑SVR\n• Renal Na⁺ reabsorption via β₁ receptors\n• Blunted baroreceptor reflex"),
    ("ENDOTHELIAL DYSFUNCTION", ACCENT_TEAL,
     "• Reduced nitric oxide (NO) production\n• Increased endothelin-1 (vasoconstrictor)\n• Oxidative stress, inflammation\n• Impaired vasodilatory response\n• Promotes atherosclerosis"),
    ("RENAL MECHANISMS", GREEN_ACC,
     "• Impaired pressure-natriuresis\n• ↑ Renal tubular Na⁺ reabsorption\n• Reduced GFR → volume expansion\n• Intrarenal RAAS upregulation\n• Structural nephron loss (Guyton curve shift)"),
    ("STRUCTURAL/GENETIC", ORANGE_ACC,
     "• Arterial stiffness (↑ pulse pressure)\n• Vascular smooth muscle hypertrophy\n• Polygenic predisposition (ACE gene, etc.)\n• Age-related elastin degradation\n• Low birth weight / fetal programming"),
    ("INSULIN RESISTANCE", RED_WARN,
     "• Compensatory hyperinsulinemia\n• ↑ SNS activity, Na⁺ retention\n• Endothelial dysfunction\n• Commonly co-exists with obesity, DM2\n• Metabolic syndrome amplifies CV risk"),
]

cols = [(0.3, 2.6), (4.55, 2.6), (8.8, 2.6),
        (0.3,  5.0), (4.55, 5.0), (8.8, 5.0)]

for idx, (title, col, body) in enumerate(mechanisms):
    x, y = cols[idx]
    add_rect(slide, x, y, 4.1, 2.2, col)
    add_textbox(slide, x+0.1, y+0.06, 3.9, 0.35, title, 11, bold=True, color=WHITE)
    add_rect(slide, x, y+0.42, 4.1, 0.04, WHITE)
    add_textbox(slide, x+0.1, y+0.5, 3.9, 1.65, body, 10.5, color=WHITE, wrap=True)

# ═══════════════════════════════════════════════════════
# SLIDE 5 — CLASSIFICATION (ACC/AHA 2017)
# ═══════════════════════════════════════════════════════
slide = prs.slides.add_slide(blank_layout)
slide_bg(slide)
header_bar(slide, "Classification of Blood Pressure", "ACC/AHA 2017 Guideline (Most Current)")
footer_bar(slide)

# Classification table
categories = [
    ("NORMAL", "< 120", "AND", "< 80", GREEN_ACC,
     "No intervention needed. Encourage healthy lifestyle. Reassess annually."),
    ("ELEVATED", "120–129", "AND", "< 80", ORANGE_ACC,
     "Lifestyle modification only. No antihypertensive drugs unless compelling indication. Reassess in 3–6 months."),
    ("STAGE 1 HTN", "130–139", "OR", "80–89", RGBColor(0xE0, 0x7B, 0x00),
     "10-yr ASCVD risk guides therapy: If ≥10% → drug + lifestyle; If <10% → lifestyle alone x3 months."),
    ("STAGE 2 HTN", "≥ 140", "OR", "≥ 90", RED_WARN,
     "Lifestyle PLUS antihypertensive drug therapy. Usually initiate 2-drug combination. Follow-up in 1 month."),
    ("HYPERTENSIVE\nCRISIS", "≥ 180", "AND/OR", "≥ 120", RGBColor(0x7B, 0x00, 0x00),
     "Urgency: No end-organ damage → oral meds, gradual reduction.\nEmergency: End-organ damage → IV therapy, ICU admission."),
]

headers = ["CATEGORY", "SYSTOLIC (mmHg)", "", "DIASTOLIC (mmHg)", "MANAGEMENT"]
col_w = [2.3, 2.1, 0.5, 2.2, 5.8]
col_x = [0.3, 2.65, 4.78, 5.32, 7.58]
row_h = 0.62

# Header row
add_rect(slide, 0.3, 1.38, 12.7, 0.48, DARK_BLUE)
for i, (hdr, cw, cx) in enumerate(zip(headers, col_w, col_x)):
    add_textbox(slide, cx+0.05, 1.4, cw-0.1, 0.44, hdr, 11, bold=True, color=WHITE, align=PP_ALIGN.CENTER)

for idx, (cat, sbp, op, dbp, col, mgmt) in enumerate(categories):
    y = 1.88 + idx * row_h
    bg = SOFT_GRAY if idx % 2 == 0 else WHITE
    add_rect(slide, 0.3, y, 12.7, row_h - 0.03, bg)
    add_rect(slide, 0.3, y, 2.28, row_h - 0.03, col)
    add_textbox(slide, 0.32, y+0.06, 2.24, row_h-0.12, cat, 11, bold=True, color=WHITE, align=PP_ALIGN.CENTER)
    add_textbox(slide, 2.66, y+0.1, 2.05, 0.45, sbp, 16, bold=True, color=col, align=PP_ALIGN.CENTER)
    add_textbox(slide, 4.79, y+0.1, 0.48, 0.45, op, 10, bold=True, color=DARK_TEXT, align=PP_ALIGN.CENTER)
    add_textbox(slide, 5.33, y+0.1, 2.15, 0.45, dbp, 16, bold=True, color=col, align=PP_ALIGN.CENTER)
    add_textbox(slide, 7.62, y+0.05, 5.7, row_h-0.08, mgmt, 9.5, color=DARK_TEXT, wrap=True)

add_textbox(slide, 0.3, 5.05, 12.7, 0.3,
    "* JNC 7 used ≥140/90 as Stage 1 threshold. ACC/AHA 2017 lowered Stage 1 to 130/80, expanding the hypertensive population by ~31 million US adults.",
    9.5, color=RGBColor(0x55, 0x55, 0x77), italic=True)

# ═══════════════════════════════════════════════════════
# SLIDE 6 — NON-PHARMACOLOGIC THERAPY
# ═══════════════════════════════════════════════════════
slide = prs.slides.add_slide(blank_layout)
slide_bg(slide)
header_bar(slide, "Non-Pharmacologic Therapy", "Lifestyle Modifications — Foundation of All Hypertension Treatment")
footer_bar(slide)

add_textbox(slide, 0.4, 1.35, 12.5, 0.3,
    "Lifestyle changes are recommended for ALL hypertensive patients and can reduce SBP by 4–20 mmHg each. They may eliminate the need for drugs in Stage 1.",
    12, bold=True, color=DARK_BLUE)

interventions = [
    ("DASH DIET", DARK_BLUE, "↓ 8–14 mmHg SBP",
     "Dietary Approaches to Stop Hypertension:\n• Rich in fruits, vegetables, whole grains\n• Low-fat dairy products (Ca²⁺, Mg²⁺, K⁺)\n• Reduced saturated/total fat\n• ≤2,300 mg sodium/day\n• Increased potassium (4,700 mg/day)\n• 8–14 mmHg BP reduction achievable"),
    ("SODIUM RESTRICTION", MID_BLUE, "↓ 2–8 mmHg SBP",
     "• Target: <1,500 mg/day (ideal) or <2,300 mg/day\n• Avoid processed foods, canned soups, fast food\n• Salt substitutes (KCl) can help – caution in CKD/ACEi users (hyperkalemia risk)\n• Even modest reduction (1.75 g/day) lowers BP by ~5/2.7 mmHg"),
    ("WEIGHT LOSS", ACCENT_TEAL, "↓ 5–20 mmHg / 10 kg lost",
     "• ~1 mmHg reduction per kg weight lost\n• Target BMI < 25 kg/m²\n• Waist circumference: <102 cm (M), <88 cm (F)\n• Weight loss improves insulin sensitivity\n• Reduces RAAS and SNS activity"),
    ("PHYSICAL ACTIVITY", GREEN_ACC, "↓ 4–9 mmHg SBP",
     "• 150 min/week moderate aerobic exercise\n• Brisk walking, swimming, cycling\n• Resistance training 2-3×/week\n• Dynamic aerobic exercise preferred\n• Reduces sympathetic tone and arterial stiffness"),
    ("ALCOHOL MODERATION", ORANGE_ACC, "↓ 2–4 mmHg SBP",
     "• Limit: ≤2 drinks/day (men), ≤1 drink/day (women)\n• Heavy drinking acutely raises BP\n• Associated with resistant hypertension\n• 1 standard drink = 14 g ethanol\n• Reduces triglycerides and arrhythmia risk"),
    ("SMOKING CESSATION", RED_WARN, "CV Risk Reduction",
     "• Does not directly lower resting BP\n• Eliminates transient BP spikes from nicotine\n• Dramatically reduces total cardiovascular risk\n• Nicotine patches, varenicline, bupropion\n• Critical for overall CV risk management"),
]

cols_pos = [(0.3, 1.78), (4.55, 1.78), (8.8, 1.78),
            (0.3, 4.55), (4.55, 4.55), (8.8, 4.55)]

for idx, (title, col, effect, body) in enumerate(interventions):
    x, y = cols_pos[idx]
    add_rect(slide, x, y, 4.1, 2.55, col)
    add_textbox(slide, x+0.1, y+0.06, 2.8, 0.32, title, 11, bold=True, color=WHITE)
    add_rect(slide, x+2.85, y+0.04, 1.2, 0.34, YELLOW_ACC)
    add_textbox(slide, x+2.87, y+0.06, 1.18, 0.3, effect, 9, bold=True, color=DARK_TEXT, align=PP_ALIGN.CENTER)
    add_rect(slide, x, y+0.4, 4.1, 0.04, WHITE)
    add_textbox(slide, x+0.1, y+0.48, 3.9, 2.0, body, 10, color=WHITE, wrap=True)

# ═══════════════════════════════════════════════════════
# SLIDE 7 — PHARMACOLOGIC OVERVIEW
# ═══════════════════════════════════════════════════════
slide = prs.slides.add_slide(blank_layout)
slide_bg(slide)
header_bar(slide, "Pharmacologic Therapy — Overview", "Drug Selection Principles & Treatment Algorithm")
footer_bar(slide)

add_textbox(slide, 0.4, 1.32, 12.5, 0.32,
    "Goal BP: < 130/80 mmHg for most adults (ACC/AHA 2017). Individualize based on ASCVD risk, comorbidities, and tolerability.",
    12, bold=True, color=DARK_BLUE)

# Treatment algorithm flow
steps = [
    ("STEP 1\nSTAGE 1 HTN\n(10-yr ASCVD ≥10%)", DARK_BLUE,
     "Monotherapy\n• Thiazide diuretic, OR\n• ACE inhibitor / ARB, OR\n• Calcium channel blocker\nFollow-up: 1 month"),
    ("STEP 2\nINADEQUATE\nRESPONSE", MID_BLUE,
     "2-Drug Combination\n• Maximize first drug, THEN add second\n• Preferred: ACEi/ARB + CCB or Thiazide\n• Avoid ACEi + ARB combination\nFollow-up: 1 month"),
    ("STEP 3\nSTILL NOT\nAT GOAL", ACCENT_TEAL,
     "3-Drug Combination\n• ACEi/ARB + CCB + Thiazide diuretic\n• Most evidence-based 3-drug combo\n• Assess adherence before escalating\nFollow-up: 1 month"),
    ("STEP 4\nRESISTANT\nHTN", RED_WARN,
     "Add 4th Agent\n• Aldosterone antagonist (spironolactone)\n• Beta-blocker\n• Alpha-blocker\n• Direct vasodilator\nRule out secondary causes"),
]

for idx, (stage, col, rx) in enumerate(steps):
    x = 0.4 + idx * 3.22
    add_rect(slide, x, 1.75, 3.1, 1.1, col)
    add_textbox(slide, x+0.1, 1.78, 2.9, 1.05, stage, 11, bold=True, color=WHITE, align=PP_ALIGN.CENTER)
    add_rect(slide, x, 2.9, 3.1, 2.8, RGBColor(0xF8, 0xFB, 0xFF))
    add_rect(slide, x, 2.9, 3.1, 0.04, col)
    add_textbox(slide, x+0.1, 2.95, 2.9, 2.7, rx, 10.5, color=DARK_TEXT, wrap=True)
    if idx < 3:
        add_textbox(slide, x+3.12, 2.28, 0.12, 0.5, "→", 28, bold=True, color=MID_BLUE, align=PP_ALIGN.CENTER)

# Key principles box
add_rect(slide, 0.4, 5.82, 12.5, 1.25, DARK_BLUE)
add_textbox(slide, 0.5, 5.87, 12.3, 0.32, "KEY PRESCRIBING PRINCIPLES", 12, bold=True, color=YELLOW_ACC)
principles = ("• Initiate with low dose and titrate up  •  2-drug combos if BP >20/10 above goal  •  ACEi + ARB combination is contraindicated  "
              "•  Avoid beta-blocker as first-line unless compelling indication  •  Monitor renal function & electrolytes (ACEi/ARBs, diuretics)  "
              "•  Generic drugs preferred for cost & adherence  •  Fixed-dose combinations improve adherence by ~20%")
add_textbox(slide, 0.5, 6.22, 12.3, 0.8, principles, 10.5, color=WHITE, wrap=True)

# ═══════════════════════════════════════════════════════
# SLIDE 8 — THIAZIDE DIURETICS
# ═══════════════════════════════════════════════════════
slide = prs.slides.add_slide(blank_layout)
slide_bg(slide)
header_bar(slide, "First-Line Agent: Thiazide Diuretics", "Preferred Initial Therapy in Most Uncomplicated Hypertension")
footer_bar(slide)

# Left panel
add_rect(slide, 0.3, 1.38, 6.3, 5.8, WHITE)
add_rect(slide, 0.3, 1.38, 6.3, 0.42, DARK_BLUE)
add_textbox(slide, 0.4, 1.4, 6.1, 0.38, "MECHANISM OF ACTION & PHARMACOLOGY", 12, bold=True, color=WHITE)

left_content = [
    ("Mechanism of Action", True, MID_BLUE, 12),
    ("Inhibit Na⁺-Cl⁻ cotransporter (NCC) in the distal convoluted tubule (DCT). Initially increase urinary Na⁺ and water excretion → reduce plasma volume and cardiac output. With chronic use, CO normalizes but peripheral vascular resistance decreases (main long-term effect).", False, DARK_TEXT, 10.5),
    ("", False, None, 6),
    ("Key Drugs & Doses", True, MID_BLUE, 12),
    ("• Hydrochlorothiazide (HCTZ): 12.5–50 mg/day\n• Chlorthalidone: 12.5–25 mg/day ★ PREFERRED\n• Indapamide: 1.25–2.5 mg/day\n  → Chlorthalidone has longer t½ (40–60 h vs. 6–15 h for HCTZ), greater 24-hr BP control, and superior cardiovascular outcomes data (ALLHAT trial)", False, DARK_TEXT, 10.5),
    ("", False, None, 6),
    ("Adverse Effects", True, RED_WARN, 12),
    ("• Hypokalemia (most common) — monitor K⁺\n• Hyponatremia (especially elderly)\n• Hypomagnesemia\n• Hyperuricemia / precipitate gout\n• Hyperglycemia / glucose intolerance\n• Dyslipidemia (minor, transient)\n• Sexual dysfunction\n• Photosensitivity", False, DARK_TEXT, 10.5),
    ("", False, None, 6),
    ("Drug Interactions", True, ORANGE_ACC, 12),
    ("• NSAIDs reduce diuretic efficacy\n• Lithium toxicity (↑ reabsorption)\n• Corticosteroids → additive hypokalemia\n• Digoxin toxicity worsened by hypokalemia", False, DARK_TEXT, 10.5),
]
add_multiline_textbox(slide, 0.4, 1.84, 6.1, 5.25, left_content, 10.5)

# Right panel
add_rect(slide, 6.85, 1.38, 6.15, 5.8, WHITE)
add_rect(slide, 6.85, 1.38, 6.15, 0.42, MID_BLUE)
add_textbox(slide, 6.95, 1.4, 5.95, 0.38, "CLINICAL USE & EVIDENCE", 12, bold=True, color=WHITE)

right_content = [
    ("Compelling Indications", True, MID_BLUE, 12),
    ("• Elderly patients (highly effective)\n• African Americans (first-line per JNC 8 & ACC/AHA)\n• Heart failure with fluid overload\n• Isolated systolic hypertension\n• Osteoporosis (thiazides reduce urinary Ca²⁺ loss)\n• High-sodium diet patients", False, DARK_TEXT, 10.5),
    ("", False, None, 6),
    ("ALLHAT Trial Evidence", True, GREEN_ACC, 12),
    ("The landmark ALLHAT trial (N=33,357) showed chlorthalidone was as effective as amlodipine and lisinopril in preventing primary coronary events and was SUPERIOR in preventing heart failure and stroke. This established thiazides as foundational first-line therapy.", False, DARK_TEXT, 10.5),
    ("", False, None, 6),
    ("Contraindications / Cautions", True, RED_WARN, 12),
    ("• Anuria / severe renal failure (GFR <30 — ineffective)\n• Known hypersensitivity to sulfonamides\n• Gout (use with caution)\n• Hypokalemia already present\n• Pregnancy (category D for HCTZ in late pregnancy)", False, DARK_TEXT, 10.5),
    ("", False, None, 6),
    ("Monitoring Parameters", True, DARK_BLUE, 12),
    ("• Serum K⁺, Na⁺, Mg²⁺ at baseline and 1 month\n• BUN, creatinine (renal function)\n• Fasting glucose and lipids\n• Uric acid if history of gout\n• Blood pressure response in 1–4 weeks", False, DARK_TEXT, 10.5),
]
add_multiline_textbox(slide, 6.95, 1.84, 5.95, 5.25, right_content, 10.5)

# ═══════════════════════════════════════════════════════
# SLIDE 9 — ACE INHIBITORS
# ═══════════════════════════════════════════════════════
slide = prs.slides.add_slide(blank_layout)
slide_bg(slide)
header_bar(slide, "First-Line Agent: ACE Inhibitors (ACEi)", "Preferred in DM, CKD, Proteinuria, HFrEF, and Post-MI")
footer_bar(slide)

add_rect(slide, 0.3, 1.38, 6.3, 5.8, WHITE)
add_rect(slide, 0.3, 1.38, 6.3, 0.42, DARK_BLUE)
add_textbox(slide, 0.4, 1.4, 6.1, 0.38, "MECHANISM & PHARMACOLOGY", 12, bold=True, color=WHITE)

left_content = [
    ("Mechanism of Action", True, MID_BLUE, 12),
    ("Block ACE enzyme → prevent conversion of Angiotensin I → Angiotensin II. This reduces vasoconstriction and aldosterone secretion (less Na⁺/H₂O retention). Also prevents bradykinin breakdown → accumulates → contributes to cough (side effect) and vasodilation.", False, DARK_TEXT, 10.5),
    ("", False, None, 6),
    ("Key Drugs & Doses", True, MID_BLUE, 12),
    ("• Lisinopril: 10–40 mg once daily\n• Enalapril: 5–40 mg/day (1–2 doses)\n• Ramipril: 2.5–20 mg/day\n• Benazepril: 10–40 mg/day\n• Captopril: 25–150 mg BID-TID (short-acting, less used)\n• Quinapril, Fosinopril, Perindopril also available\n★ Most are prodrugs (except captopril & lisinopril)", False, DARK_TEXT, 10.5),
    ("", False, None, 6),
    ("Adverse Effects", True, RED_WARN, 12),
    ("• Dry cough (10–15% — bradykinin mediated)\n  → Switch to ARB if intolerable\n• Hyperkalemia (monitor if CKD, K⁺ supplements)\n• First-dose hypotension (volume-depleted patients)\n• Acute kidney injury (bilateral RAS, volume depletion)\n• Angioedema (rare, 0.1–0.2% — CONTRAINDICATED thereafter)\n• Teratogenic (Category D/X in 2nd & 3rd trimester)", False, DARK_TEXT, 10.5),
]
add_multiline_textbox(slide, 0.4, 1.84, 6.1, 5.25, left_content, 10.5)

add_rect(slide, 6.85, 1.38, 6.15, 5.8, WHITE)
add_rect(slide, 6.85, 1.38, 6.15, 0.42, MID_BLUE)
add_textbox(slide, 6.95, 1.4, 5.95, 0.38, "CLINICAL USE & COMPELLING INDICATIONS", 12, bold=True, color=WHITE)

right_content = [
    ("Compelling Indications", True, MID_BLUE, 12),
    ("• Diabetes mellitus (renoprotective – reduces proteinuria)\n• CKD with proteinuria (slow progression)\n• HFrEF (reduce mortality — CONSENSUS, SOLVD trials)\n• Post-MI with reduced EF (SAVE, AIRE, TRACE trials)\n• High CVD risk (HOPE trial: 22% RR reduction)\n• Non-diabetic proteinuric CKD\n• Prevention of recurrent stroke (PROGRESS trial)", False, DARK_TEXT, 10.5),
    ("", False, None, 6),
    ("Renoprotection Mechanism", True, GREEN_ACC, 12),
    ("ACEi preferentially dilate the efferent arteriole > afferent arteriole (Ang II normally constricts efferent), reducing intraglomerular pressure. This slows progression of diabetic and non-diabetic nephropathy even beyond BP-lowering effects.", False, DARK_TEXT, 10.5),
    ("", False, None, 6),
    ("Contraindications", True, RED_WARN, 12),
    ("• History of ACEi-induced angioedema (absolute)\n• Pregnancy — 2nd & 3rd trimester (absolute)\n• Bilateral renal artery stenosis\n• Combined use with ARB (↑ AKI/hyperkalemia risk)\n• Combined with aliskiren in DM or GFR <60\n• Severe hyperkalemia (K⁺ > 5.5 mEq/L)", False, DARK_TEXT, 10.5),
    ("", False, None, 6),
    ("Monitoring", True, DARK_BLUE, 12),
    ("• K⁺ and Cr within 1–2 weeks of initiation\n• Acceptable: Cr rise ≤30% of baseline\n• BP response; watch for first-dose hypotension\n• Signs of angioedema (especially first month)", False, DARK_TEXT, 10.5),
]
add_multiline_textbox(slide, 6.95, 1.84, 5.95, 5.25, right_content, 10.5)

# ═══════════════════════════════════════════════════════
# SLIDE 10 — ARBs
# ═══════════════════════════════════════════════════════
slide = prs.slides.add_slide(blank_layout)
slide_bg(slide)
header_bar(slide, "First-Line Agent: Angiotensin Receptor Blockers (ARBs)", "RAAS Blockade Without the Cough — ACEi Equivalent in Most Indications")
footer_bar(slide)

add_rect(slide, 0.3, 1.38, 6.3, 5.8, WHITE)
add_rect(slide, 0.3, 1.38, 6.3, 0.42, DARK_BLUE)
add_textbox(slide, 0.4, 1.4, 6.1, 0.38, "MECHANISM & PHARMACOLOGY", 12, bold=True, color=WHITE)

left_content = [
    ("Mechanism of Action", True, MID_BLUE, 12),
    ("Selectively block AT₁ receptors (Angiotensin II type 1), preventing Ang II from causing vasoconstriction and aldosterone release. Unlike ACEi:\n• Do NOT prevent bradykinin breakdown → minimal cough\n• Ang II still binds AT₂ receptors (vasodilatory, anti-proliferative effects preserved)\n• More complete RAAS blockade at the receptor level", False, DARK_TEXT, 10.5),
    ("", False, None, 6),
    ("Key Drugs & Doses", True, MID_BLUE, 12),
    ("• Losartan: 25–100 mg/day (also lowers uric acid)\n• Valsartan: 80–320 mg/day\n• Olmesartan: 20–40 mg/day (most potent)\n• Candesartan: 8–32 mg/day\n• Irbesartan: 150–300 mg/day\n• Telmisartan: 20–80 mg/day (longest t½ ~24h)\n• Azilsartan: 40–80 mg/day", False, DARK_TEXT, 10.5),
    ("", False, None, 6),
    ("Adverse Effects", True, RED_WARN, 12),
    ("• Hyperkalemia (similar to ACEi)\n• First-dose hypotension\n• AKI (same precautions as ACEi)\n• Teratogenic (same as ACEi — avoid pregnancy)\n• UNLIKE ACEi: No cough, angioedema extremely rare\n• Olmesartan: sprue-like enteropathy (rare)\n• Dizziness, headache (minor)", False, DARK_TEXT, 10.5),
]
add_multiline_textbox(slide, 0.4, 1.84, 6.1, 5.25, left_content, 10.5)

add_rect(slide, 6.85, 1.38, 6.15, 5.8, WHITE)
add_rect(slide, 6.85, 1.38, 6.15, 0.42, MID_BLUE)
add_textbox(slide, 6.95, 1.4, 5.95, 0.38, "CLINICAL USE & KEY EVIDENCE", 12, bold=True, color=WHITE)

right_content = [
    ("When to Prefer ARB Over ACEi", True, MID_BLUE, 12),
    ("• Patient cannot tolerate ACEi cough\n• History of ACEi-induced angioedema\n• When equivalent RAAS blockade is desired without cough side effect\n• Note: ARBs are NOT second-line — they are first-line equals to ACEi", False, DARK_TEXT, 10.5),
    ("", False, None, 6),
    ("Key Evidence", True, GREEN_ACC, 12),
    ("• LIFE trial: Losartan superior to atenolol for stroke in HTN + LVH\n• RENAAL: Losartan slows CKD progression in DM2\n• IDNT: Irbesartan renoprotective in DM2 nephropathy\n• ONTARGET: ARB non-inferior to ACEi for CV outcomes; combination HARMFUL\n• ValHeFT: Valsartan reduces HF hospitalizations", False, DARK_TEXT, 10.5),
    ("", False, None, 6),
    ("ACEi + ARB Combination", True, RED_WARN, 12),
    ("CONTRAINDICATED in clinical practice. The ONTARGET trial showed dual RAAS blockade doubled risk of AKI, hypotension, and hyperkalemia WITHOUT additional cardiovascular benefit. Avoid in all patients.", False, DARK_TEXT, 10.5),
    ("", False, None, 6),
    ("Contraindications", True, RED_WARN, 12),
    ("• Pregnancy (all trimesters — absolutely contraindicated)\n• Bilateral renal artery stenosis\n• Severe hyperkalemia\n• Combined with ACEi (ONTARGET risk)\n• Combined with aliskiren in DM or GFR <60 (FDA warning)", False, DARK_TEXT, 10.5),
]
add_multiline_textbox(slide, 6.95, 1.84, 5.95, 5.25, right_content, 10.5)

# ═══════════════════════════════════════════════════════
# SLIDE 11 — CALCIUM CHANNEL BLOCKERS
# ═══════════════════════════════════════════════════════
slide = prs.slides.add_slide(blank_layout)
slide_bg(slide)
header_bar(slide, "First-Line Agent: Calcium Channel Blockers (CCBs)", "Dihydropyridines vs. Non-Dihydropyridines — Know the Difference")
footer_bar(slide)

# Two subclass columns
for col_x, col_color, subclass, moa, drugs, ae, ci, notes in [
    (0.3, DARK_BLUE, "DIHYDROPYRIDINES (DHP)", 
     "Block L-type voltage-gated Ca²⁺ channels in vascular smooth muscle > cardiac tissue. Cause arterial vasodilation → reduce SVR. Minimal effect on heart rate or AV conduction. Reflex tachycardia may occur with short-acting agents.",
     "• Amlodipine: 2.5–10 mg/day ★ MOST USED\n• Nifedipine XL: 30–90 mg/day\n• Felodipine: 2.5–10 mg/day\n• Nicardipine: 20–40 mg TID\n• Isradipine: 2.5–5 mg BID\n• Clevidipine: IV (hypertensive emergency)",
     "• Peripheral edema (ankle — most common, dose-dependent)\n• Reflex tachycardia (especially short-acting nifedipine)\n• Flushing, headache, dizziness\n• Gingival hyperplasia\n• Worsening edema with prolonged standing",
     "• Systolic HF with decompensation\n• Short-acting agents post-MI (worsen outcomes)\n• Known DHP hypersensitivity",
     "Preferred in elderly patients, isolated systolic HTN, angina, and Raynaud's. Amlodipine is safe in HF. African Americans respond well."),
    (6.85, MID_BLUE, "NON-DIHYDROPYRIDINES (Non-DHP)",
     "Block L-type Ca²⁺ channels in both cardiac and vascular tissue. Decrease SA node automaticity, AV conduction velocity, and myocardial contractility (negative inotropic, chronotropic, dromotropic effects). Also cause vasodilation.",
     "• Diltiazem SR: 120–480 mg/day (divided)\n• Verapamil SR: 120–480 mg/day\n  ★ Verapamil is most cardioselective\n  ★ Diltiazem has balanced cardiac/vascular effect\n  (Avoid combining with beta-blockers!)",
     "• Constipation (verapamil — most common GI AE)\n• Bradycardia, AV block\n• Worsening of HFrEF (negative inotropy)\n• Peripheral edema (less than DHPs)\n• Verapamil: Grapefruit juice interaction\n  (↑ drug levels via CYP3A4 inhibition)",
     "• HFrEF (negative inotropy worsens)\n• Sick sinus syndrome / high-degree AV block\n• Concomitant beta-blocker use (risk of complete AV block)\n• Wolff-Parkinson-White syndrome (verapamil)\n• Systolic BP <90 mmHg",
     "Preferred for rate control in AFib with HTN, angina, and SVT. NOT first-line for HTN alone. Useful when beta-blockers contraindicated."),
]:
    add_rect(slide, col_x, 1.38, 6.15, 5.8, WHITE)
    add_rect(slide, col_x, 1.38, 6.15, 0.42, col_color)
    add_textbox(slide, col_x+0.1, 1.4, 5.95, 0.38, subclass, 13, bold=True, color=WHITE)
    content = [
        ("Mechanism of Action", True, col_color, 11),
        (moa, False, DARK_TEXT, 10),
        ("", False, None, 5),
        ("Key Drugs & Doses", True, col_color, 11),
        (drugs, False, DARK_TEXT, 10),
        ("", False, None, 5),
        ("Adverse Effects", True, RED_WARN, 11),
        (ae, False, DARK_TEXT, 10),
        ("", False, None, 5),
        ("Contraindications", True, RED_WARN, 11),
        (ci, False, DARK_TEXT, 10),
        ("", False, None, 5),
        ("Clinical Pearl", True, GREEN_ACC, 11),
        (notes, False, DARK_TEXT, 10),
    ]
    add_multiline_textbox(slide, col_x+0.1, 1.84, 5.95, 5.25, content, 10)

# ═══════════════════════════════════════════════════════
# SLIDE 12 — BETA-BLOCKERS
# ═══════════════════════════════════════════════════════
slide = prs.slides.add_slide(blank_layout)
slide_bg(slide)
header_bar(slide, "Beta-Blockers in Hypertension", "No Longer First-Line — But Essential in Compelling Indications")
footer_bar(slide)

add_textbox(slide, 0.4, 1.35, 12.5, 0.32,
    "Beta-blockers were downgraded from first-line by JNC 8 and ACC/AHA 2017 due to inferior outcomes vs. other agents for primary HTN. Still preferred when compelling indications exist.",
    11.5, bold=True, color=DARK_BLUE)

# Three-column layout
for col_x, col_color, title, content_lines in [
    (0.3, DARK_BLUE, "MECHANISM & DRUGS",
     [("Mechanism of Action", True, MID_BLUE, 12),
      ("Block β-adrenergic receptors:\n• β₁ (heart): ↓ HR, ↓ contractility → ↓ CO\n• β₁ (kidney): ↓ renin release → ↓ Ang II\n• β₂ (vasculature): vasoconstriction possible with non-selective agents\n• Central nervous system: ↓ sympathetic outflow (lipophilic agents)", False, DARK_TEXT, 10.5),
      ("", False, None, 6),
      ("Drug Classification", True, MID_BLUE, 12),
      ("Cardioselective (β₁):\n• Metoprolol succinate (tartrate)\n• Atenolol, bisoprolol, nebivolol\nNon-selective (β₁+β₂):\n• Propranolol, carvedilol*, nadolol\nMixed α/β blockers:\n• Carvedilol* (also α₁ blockade)\n• Labetalol (IV for HTN emergency)\n  *Carvedilol preferred in HF", False, DARK_TEXT, 10.5),
      ("", False, None, 6),
      ("Nebivolol: Unique Mechanism", True, GREEN_ACC, 12),
      ("Also stimulates endothelial β₃ receptors → releases NO → vasodilation. Metabolically neutral. Useful in patients with metabolic syndrome.", False, DARK_TEXT, 10.5)]),

    (4.55, MID_BLUE, "COMPELLING INDICATIONS",
     [("When Beta-Blockers ARE Preferred", True, GREEN_ACC, 12),
      ("• Post-MI (↓ mortality — proven)\n• HFrEF (carvedilol, metoprolol, bisoprolol)\n• Stable angina pectoris\n• Atrial fibrillation (rate control)\n• Thyrotoxicosis (propranolol)\n• Essential tremor (propranolol)\n• Aortic dissection (labetalol or esmolol + nitroprusside)\n• Migraine prophylaxis\n• Hypertension in young patients with high sympathetic tone", False, DARK_TEXT, 10.5),
      ("", False, None, 6),
      ("Why NOT First-Line for HTN?", True, RED_WARN, 12),
      ("ASCOT trial: amlodipine ± perindopril was superior to atenolol ± thiazide in reducing CV events and mortality. LIFE trial: losartan reduced stroke more than atenolol in HTN+LVH. Beta-blockers increase new-onset diabetes risk vs. other agents.", False, DARK_TEXT, 10.5),
      ("", False, None, 6),
      ("Dosing (Common Examples)", True, MID_BLUE, 12),
      ("• Metoprolol succinate: 25–200 mg/day\n• Carvedilol: 6.25–25 mg BID\n• Atenolol: 25–100 mg/day\n• Bisoprolol: 2.5–10 mg/day\n• Labetalol: 200–800 mg BID\n• Nebivolol: 5–40 mg/day", False, DARK_TEXT, 10.5)]),

    (8.8, ACCENT_TEAL, "ADVERSE EFFECTS & CAUTIONS",
     [("Adverse Effects", True, RED_WARN, 12),
      ("• Bradycardia, AV block\n• Fatigue, exercise intolerance\n• Cold extremities (peripheral vasconstriction)\n• Bronchoconstriction (especially non-selective)\n• Masking hypoglycemia symptoms (DM patients)\n• Weight gain, dyslipidemia (except nebivolol/carvedilol)\n• Sexual dysfunction\n• CNS: depression, nightmares (lipophilic agents)\n• Rebound hypertension on abrupt withdrawal", False, DARK_TEXT, 10.5),
      ("", False, None, 6),
      ("Contraindications", True, RED_WARN, 12),
      ("Absolute:\n• Severe reactive airway disease / asthma\n• High-degree AV block (unless paced)\n• Cardiogenic shock\nRelative:\n• COPD (cardioselective preferred)\n• DM (use with caution, especially non-selective)\n• Peripheral arterial disease\n• Depression (especially propranolol)", False, DARK_TEXT, 10.5),
      ("", False, None, 6),
      ("NEVER Abruptly Discontinue!", True, RED_WARN, 12),
      ("Taper over 2–4 weeks to avoid rebound tachycardia, hypertension, and acute coronary syndrome in patients with CAD.", False, DARK_TEXT, 10.5)]),
]:
    add_rect(slide, col_x, 1.75, 4.1, 5.4, WHITE)
    add_rect(slide, col_x, 1.75, 4.1, 0.38, col_color)
    add_textbox(slide, col_x+0.1, 1.77, 3.9, 0.34, title, 12, bold=True, color=WHITE)
    add_multiline_textbox(slide, col_x+0.1, 2.18, 3.9, 4.9, content_lines, 10.5)

# ═══════════════════════════════════════════════════════
# SLIDE 13 — COMPELLING INDICATIONS TABLE
# ═══════════════════════════════════════════════════════
slide = prs.slides.add_slide(blank_layout)
slide_bg(slide)
header_bar(slide, "Compelling Indications — Drug Selection by Comorbidity", "Evidence-Based Drug Choices for Special Populations (JNC 8 / ACC/AHA)")
footer_bar(slide)

add_textbox(slide, 0.3, 1.35, 12.7, 0.28,
    "These are conditions where a specific drug class has been shown to IMPROVE OUTCOMES BEYOND simple BP control:",
    11, bold=True, color=DARK_BLUE)

compelling = [
    ("Heart Failure (HFrEF)", DARK_BLUE,
     ["ACEi or ARB", "Beta-blocker*", "Diuretic (loop)", "Aldosterone antagonist", "ARNI (sacubitril/valsartan)"],
     "*Carvedilol, bisoprolol, or metoprolol succinate only"),
    ("Post-Myocardial Infarction", MID_BLUE,
     ["ACEi or ARB", "Beta-blocker", "Aldosterone antagonist (if EF ≤40%)"],
     "Reduce remodeling, sudden death, and recurrent MI"),
    ("High CAD Risk / Stable Angina", ACCENT_TEAL,
     ["ACEi or ARB", "Beta-blocker", "CCB (DHP or non-DHP)"],
     "Thiazide can be added for BP control"),
    ("Diabetes Mellitus", GREEN_ACC,
     ["ACEi or ARB (renoprotection)", "Thiazide", "CCB (DHP)", "Beta-blocker (if angina/post-MI)"],
     "ACEi/ARB delay progression of diabetic nephropathy"),
    ("Chronic Kidney Disease (CKD)", RGBColor(0x5B, 0x2D, 0x8E),
     ["ACEi or ARB (first-line if proteinuria)", "Loop diuretic (if GFR <30)"],
     "Goal BP <130/80; monitor K⁺ and Cr closely"),
    ("Recurrent Stroke Prevention", RGBColor(0x7F, 0x3C, 0x00),
     ["ACEi + Thiazide combination", "(PROGRESS trial evidence)"],
     "Reduces stroke recurrence by 43% (combination)"),
    ("Elderly / ISH", ORANGE_ACC,
     ["Thiazide (chlorthalidone preferred)", "CCB (amlodipine)", "ACEi or ARB"],
     "Start low, titrate slowly; watch orthostatic hypotension"),
    ("African Americans", RED_WARN,
     ["Thiazide diuretic", "CCB (DHP)", "ACEi/ARB (if DM or CKD)"],
     "ACEi/ARB less effective as monotherapy in African Americans; thiazide or CCB preferred"),
]

row_h = 0.76
for idx, (condition, col, drugs, note) in enumerate(compelling):
    ci = idx % 4
    ri = idx // 4
    x = 0.3 + ci * 3.25
    y = 1.72 + ri * 2.62
    add_rect(slide, x, y, 3.1, row_h, col)
    add_textbox(slide, x+0.08, y+0.08, 2.95, row_h-0.12, condition, 11, bold=True, color=WHITE)
    add_rect(slide, x, y+row_h, 3.1, 1.75, WHITE)
    drug_text = "\n".join([f"✓ {d}" for d in drugs])
    add_textbox(slide, x+0.08, y+row_h+0.06, 2.95, 1.3, drug_text, 9.5, color=DARK_TEXT, wrap=True)
    add_rect(slide, x, y+row_h+1.52, 3.1, 0.22, LIGHT_BLUE)
    add_textbox(slide, x+0.06, y+row_h+1.54, 3.0, 0.2, note, 8, color=MID_BLUE, italic=True, wrap=True)

# ═══════════════════════════════════════════════════════
# SLIDE 14 — RESISTANT HYPERTENSION
# ═══════════════════════════════════════════════════════
slide = prs.slides.add_slide(blank_layout)
slide_bg(slide)
header_bar(slide, "Resistant Hypertension", "BP ≥130/80 Despite 3+ Drugs Including a Diuretic — At Optimal Doses")
footer_bar(slide)

# Definition box
add_rect(slide, 0.3, 1.38, 12.7, 0.7, DARK_BLUE)
add_textbox(slide, 0.4, 1.42, 12.5, 0.62,
    "DEFINITION: BP above goal despite adherence to maximally tolerated doses of ≥3 antihypertensive drugs from different classes, including a diuretic. "
    "Controlled resistant HTN = BP at goal on ≥4 drugs.", 12, bold=False, color=WHITE, wrap=True)

# Two columns
# Left — Causes
add_rect(slide, 0.3, 2.18, 6.1, 5.0, WHITE)
add_rect(slide, 0.3, 2.18, 6.1, 0.38, RED_WARN)
add_textbox(slide, 0.4, 2.2, 5.9, 0.34, "CAUSES / CONTRIBUTING FACTORS", 12, bold=True, color=WHITE)

causes_content = [
    ("Lifestyle & Adherence Issues", True, RED_WARN, 11),
    ("• Non-adherence to medications (most common)\n• High sodium intake (>3 g/day)\n• Obesity and sleep apnea\n• Excessive alcohol consumption\n• Inadequate physical activity", False, DARK_TEXT, 10.5),
    ("", False, None, 5),
    ("Secondary Causes (Must Rule Out)", True, DARK_BLUE, 11),
    ("• Primary hyperaldosteronism (most common secondary HTN)\n• Obstructive sleep apnea (OSA)\n• Renal parenchymal disease / renovascular HTN\n• Pheochromocytoma (paroxysmal HTN, headache, diaphoresis)\n• Cushing's syndrome (cortisol excess)\n• Thyroid disorders (hypo/hyperthyroidism)\n• Coarctation of aorta", False, DARK_TEXT, 10.5),
    ("", False, None, 5),
    ("Drug-Induced HTN", True, ORANGE_ACC, 11),
    ("• NSAIDs / COX-2 inhibitors\n• Oral contraceptives (estrogen component)\n• Sympathomimetics (decongestants, stimulants)\n• Erythropoietin, calcineurin inhibitors (tacrolimus)\n• Cocaine/amphetamines\n• Licorice (glycyrrhizin — pseudoaldosteronism)", False, DARK_TEXT, 10.5),
]
add_multiline_textbox(slide, 0.4, 2.62, 5.9, 4.5, causes_content, 10.5)

# Right — Management
add_rect(slide, 6.6, 2.18, 6.4, 5.0, WHITE)
add_rect(slide, 6.6, 2.18, 6.4, 0.38, MID_BLUE)
add_textbox(slide, 6.7, 2.2, 6.2, 0.34, "WORKUP & MANAGEMENT", 12, bold=True, color=WHITE)

mgmt_content = [
    ("Diagnostic Workup", True, MID_BLUE, 11),
    ("1. Confirm true resistance (exclude white-coat HTN)\n   → 24-hr ambulatory BP monitoring (ABPM)\n2. Medication reconciliation (adherence, interactions)\n3. Labs: Basic metabolic panel, aldosterone/renin ratio\n4. Sleep study (if OSA suspected)\n5. Renal artery duplex ultrasound if renovascular suspected\n6. Urine metanephrines (if pheo suspected)", False, DARK_TEXT, 10.5),
    ("", False, None, 5),
    ("Pharmacologic Add-On Therapy", True, GREEN_ACC, 11),
    ("• Spironolactone 25–50 mg/day\n  ★ Most evidence-based 4th-line agent (PATHWAY-2 trial)\n  ★ Especially effective if primary hyperaldosteronism component\n• Eplerenone: Alternative to spironolactone (fewer antiandrogenic SE)\n• Amiloride: Potassium-sparing diuretic option\n• Alpha-blocker: Doxazosin 1–16 mg/day\n• Clonidine 0.1–0.3 mg BID (centrally acting)\n• Minoxidil (most potent vasodilator — last resort)", False, DARK_TEXT, 10.5),
    ("", False, None, 5),
    ("PATHWAY-2 Trial Evidence", True, ORANGE_ACC, 11),
    ("Spironolactone was the most effective add-on agent in patients with resistant HTN already on 3 drugs, reducing SBP by 8.7 mmHg vs. placebo. Confirms primary aldosteronism as a key driver of resistant HTN.", False, DARK_TEXT, 10.5),
]
add_multiline_textbox(slide, 6.7, 2.62, 6.2, 4.5, mgmt_content, 10.5)

# ═══════════════════════════════════════════════════════
# SLIDE 15 — HYPERTENSIVE EMERGENCY
# ═══════════════════════════════════════════════════════
slide = prs.slides.add_slide(blank_layout)
slide_bg(slide)
header_bar(slide, "Hypertensive Urgency vs. Emergency", "Critical Distinction — Management Differs Dramatically")
footer_bar(slide)

# Top two comparison boxes
for x, col, title, bp, eod, mgmt_text in [
    (0.3, ORANGE_ACC, "HYPERTENSIVE URGENCY", "SBP ≥180 or DBP ≥120 mmHg", "NO acute end-organ damage",
     "• Oral antihypertensive therapy\n• Reduce BP gradually over 24–48 hours\n• Target: <160/100 mmHg initially\n• Agents: Oral labetalol, clonidine, captopril, amlodipine\n• Most can be managed in clinic/ED observation\n• Avoid rapid reduction (ischemia risk)\n• Identify and address precipitating cause\n• Ensure follow-up within 1–3 days"),
    (6.85, RED_WARN, "HYPERTENSIVE EMERGENCY", "SBP ≥180 or DBP ≥120 mmHg", "WITH acute end-organ damage",
     "• IV antihypertensive therapy required\n• ICU admission mandatory\n• Reduce MAP by ≤25% in first hour\n• Then to 160/100–110 mmHg over 2–6 hours\n• Then normalize over 24–48 hours (avoid cerebral hypoperfusion)\n• EXCEPTION: Aortic dissection → target SBP <120 mmHg ASAP\n• Identify and treat specific end-organ damage"),
]:
    add_rect(slide, x, 1.38, 6.1, 0.6, col)
    add_textbox(slide, x+0.1, 1.4, 5.9, 0.28, title, 15, bold=True, color=WHITE)
    add_textbox(slide, x+0.1, 1.66, 5.9, 0.28, f"{bp}  |  {eod}", 11, color=WHITE, italic=True)
    add_rect(slide, x, 2.0, 6.1, 2.5, WHITE)
    add_textbox(slide, x+0.1, 2.05, 5.9, 2.4, mgmt_text, 10.5, color=DARK_TEXT, wrap=True)

# End-organ damage types
add_rect(slide, 0.3, 4.58, 12.7, 0.35, DARK_BLUE)
add_textbox(slide, 0.4, 4.6, 12.5, 0.3, "END-ORGAN DAMAGE IN HYPERTENSIVE EMERGENCIES", 13, bold=True, color=WHITE)

eod_items = [
    ("Hypertensive Encephalopathy", MID_BLUE, "Confusion, seizure, altered consciousness\n→ Labetalol, nicardipine\n   (nitroprusside if refractory)"),
    ("Acute Coronary Syndrome", DARK_BLUE, "Chest pain, ST changes, troponin rise\n→ IV nitroglycerin + beta-blocker\n   (avoid hydralazine)"),
    ("Acute HF / Pulmonary Edema", ACCENT_TEAL, "Dyspnea, orthopnea, crackles\n→ IV nitroglycerin + loop diuretic\n   (clevidipine alternative)"),
    ("Aortic Dissection", RED_WARN, "Tearing pain, unequal BP in arms\n→ IV esmolol + nitroprusside\n   Target SBP <120 mmHg urgently"),
    ("Hypertensive Nephropathy", GREEN_ACC, "Rising Cr, oliguria, hematuria\n→ Fenoldopam (renoprotective)\n   Nicardipine; avoid ACEi if bilateral RAS"),
    ("Eclampsia / Pre-eclampsia", ORANGE_ACC, "Pregnancy + HTN + seizure/proteinuria\n→ IV labetalol or hydralazine\n   MgSO₄ for seizure prevention; deliver fetus"),
]

col_w2 = 2.1
for idx, (name, col, text) in enumerate(eod_items):
    x = 0.3 + idx * (col_w2 + 0.02)
    add_rect(slide, x, 4.97, col_w2, 0.45, col)
    add_textbox(slide, x+0.05, 4.99, col_w2-0.1, 0.42, name, 9.5, bold=True, color=WHITE, wrap=True)
    add_rect(slide, x, 5.44, col_w2, 1.72, WHITE)
    add_textbox(slide, x+0.05, 5.48, col_w2-0.1, 1.65, text, 9, color=DARK_TEXT, wrap=True)

# ═══════════════════════════════════════════════════════
# SLIDE 16 — OTHER DRUG CLASSES
# ═══════════════════════════════════════════════════════
slide = prs.slides.add_slide(blank_layout)
slide_bg(slide)
header_bar(slide, "Additional Antihypertensive Drug Classes", "Aldosterone Antagonists, Alpha-Blockers, Central Agents, Direct Vasodilators")
footer_bar(slide)

other_drugs = [
    ("ALDOSTERONE ANTAGONISTS", DARK_BLUE,
     "Spironolactone / Eplerenone",
     "MOA: Block mineralocorticoid receptors → ↓ Na⁺ reabsorption, ↓ K⁺ excretion\n\nIndications:\n• Resistant HTN (4th agent — PATHWAY-2 trial)\n• HFrEF (RALES, EPHESUS trials)\n• Primary hyperaldosteronism\n• Post-MI with reduced EF + diabetes\n\nADRs: Hyperkalemia (serious), gynecomastia/menstrual irregularity (spironolactone — eplerenone is more selective and avoids these)\n\nMonitor: K⁺ and Cr within 1 week of initiation"),

    ("ALPHA-1 BLOCKERS", MID_BLUE,
     "Doxazosin / Prazosin / Terazosin",
     "MOA: Block α₁ adrenergic receptors on vascular smooth muscle → vasodilation (↓ SVR)\n\nIndications:\n• Resistant HTN (add-on)\n• Benign prostatic hyperplasia (dual benefit)\n• Pheochromocytoma (phenoxybenzamine — non-selective)\n\nADRs: First-dose orthostatic hypotension (major — take first dose at bedtime), reflex tachycardia, fluid retention\n\nCaution: ALLHAT showed doxazosin arm had ↑ HF risk vs. chlorthalidone → not preferred monotherapy"),

    ("CENTRAL α₂ AGONISTS", ACCENT_TEAL,
     "Clonidine / Methyldopa / Guanfacine",
     "MOA: Stimulate central α₂ receptors in brainstem → ↓ sympathetic outflow → ↓ CO and SVR\n\nIndications:\n• Resistant HTN (clonidine)\n• Hypertension in pregnancy (methyldopa — drug of choice)\n• ADHD (guanfacine, clonidine)\n\nADRs: Sedation, dry mouth, constipation, rebound HTN on abrupt withdrawal (clonidine)\n\nKey: Clonidine patch available (better adherence, but risk of contact dermatitis)"),

    ("DIRECT VASODILATORS", RED_WARN,
     "Hydralazine / Minoxidil / Nitroprusside",
     "MOA: Direct relaxation of arteriolar smooth muscle → ↓ SVR\n\nIndications:\n• Hydralazine: Pregnancy HTN, HFrEF (with isosorbide in African Americans — A-HeFT trial)\n• Minoxidil: Severe/resistant HTN (last resort)\n• Nitroprusside: IV — hypertensive emergency\n\nADRs:\n• Hydralazine: Reflex tachycardia, lupus-like syndrome (>200 mg/day), fluid retention\n• Minoxidil: Hirsutism, severe fluid retention, pericardial effusion, reflex tachycardia\n• Nitroprusside: Cyanide/thiocyanate toxicity (prolonged use)"),
]

for idx, (title, col, subtitle, body) in enumerate(other_drugs):
    x = 0.3 + idx * 3.28
    add_rect(slide, x, 1.38, 3.1, 0.52, col)
    add_textbox(slide, x+0.08, 1.4, 2.95, 0.28, title, 11, bold=True, color=WHITE)
    add_textbox(slide, x+0.08, 1.67, 2.95, 0.23, subtitle, 10, bold=False, color=WHITE, italic=True)
    add_rect(slide, x, 1.92, 3.1, 5.3, WHITE)
    add_rect(slide, x, 1.92, 3.1, 0.04, col)
    add_textbox(slide, x+0.1, 1.98, 2.9, 5.2, body, 10, color=DARK_TEXT, wrap=True)

# ═══════════════════════════════════════════════════════
# SLIDE 17 — MONITORING & FOLLOW-UP
# ═══════════════════════════════════════════════════════
slide = prs.slides.add_slide(blank_layout)
slide_bg(slide)
header_bar(slide, "Monitoring, Follow-Up & Patient Counseling", "Ensuring Long-Term BP Control and Safety")
footer_bar(slide)

# BP goals box
add_rect(slide, 0.3, 1.38, 12.7, 0.8, DARK_BLUE)
add_textbox(slide, 0.4, 1.4, 12.5, 0.36, "TARGET BP GOALS (ACC/AHA 2017)", 13, bold=True, color=YELLOW_ACC)
goals = "General Adults: <130/80 mmHg  |  Age ≥65 (community): <130/80 mmHg  |  CKD: <130/80 mmHg  |  DM: <130/80 mmHg  |  Pregnancy: <140/90 mmHg  |  Aortic Dissection: <120/80 mmHg"
add_textbox(slide, 0.4, 1.76, 12.5, 0.38, goals, 10.5, color=WHITE, wrap=True)

# Three columns
for col_x, col_color, title, content_lines in [
    (0.3, DARK_BLUE, "MONITORING SCHEDULE",
     [("Initial Treatment", True, MID_BLUE, 11),
      ("• Baseline labs before starting therapy\n• Recheck BP in 1 month after starting\n• Electrolytes + creatinine for ACEi/ARB/diuretics within 1–4 weeks", False, DARK_TEXT, 10.5),
      ("", False, None, 6),
      ("Once Stable", True, MID_BLUE, 11),
      ("• BP monitoring every 3–6 months\n• Annual labs (BMP, lipids, UA)\n• Annual cardiovascular risk reassessment\n• Fundoscopic exam for retinopathy", False, DARK_TEXT, 10.5),
      ("", False, None, 6),
      ("Home BP Monitoring", True, GREEN_ACC, 11),
      ("Strongly encouraged. Morning + evening readings. Average ≥12 readings over ≥3 days. Preferred device: validated upper arm cuff. Helps detect white-coat and masked HTN.", False, DARK_TEXT, 10.5)]),

    (4.55, MID_BLUE, "ADHERENCE STRATEGIES",
     [("Why Patients Don't Take Meds", True, RED_WARN, 11),
      ("• Asymptomatic disease (no perceived need)\n• Cost of medications\n• Side effects (especially cough, ED, fatigue)\n• Complexity of regimen\n• Lack of patient education\n• Cultural beliefs", False, DARK_TEXT, 10.5),
      ("", False, None, 6),
      ("Improving Adherence", True, GREEN_ACC, 11),
      ("• Once-daily dosing when possible\n• Fixed-dose combination pills (preferred)\n• Patient education on CV risk\n• Self-monitoring empowers patients\n• Address side effects proactively\n• Simplify regimen at each visit\n• Consider pill organizers, reminders\n• Generic medications to reduce cost\n• Pharmacist-led MTM programs", False, DARK_TEXT, 10.5)]),

    (8.8, ACCENT_TEAL, "PATIENT COUNSELING POINTS",
     [("Key Education Messages", True, DARK_BLUE, 11),
      ("1. HTN is often silent — symptoms ≠ control\n2. Take medications EVERY day, even if feeling fine\n3. Do NOT stop without consulting provider\n4. Report side effects (especially cough, swelling, dizziness)\n5. Diet and exercise remain essential even on medications\n6. Monitor BP at home and keep a log\n7. Limit alcohol and avoid recreational drugs\n8. Reduce sodium — read food labels\n9. Inform all providers of ALL medications\n10. Pregnancy planning — some drugs must be stopped", False, DARK_TEXT, 10.5),
      ("", False, None, 6),
      ("Red Flag Symptoms (Seek ER)", True, RED_WARN, 11),
      ("Severe headache, visual changes, chest pain, shortness of breath, facial/tongue swelling (angioedema), one-sided weakness → could indicate hypertensive emergency", False, DARK_TEXT, 10.5)]),
]:
    add_rect(slide, col_x, 2.25, 4.1, 4.9, WHITE)
    add_rect(slide, col_x, 2.25, 4.1, 0.38, col_color)
    add_textbox(slide, col_x+0.1, 2.27, 3.9, 0.34, title, 12, bold=True, color=WHITE)
    add_multiline_textbox(slide, col_x+0.1, 2.68, 3.9, 4.4, content_lines, 10.5)

# ═══════════════════════════════════════════════════════
# SLIDE 18 — SUMMARY / KEY TAKEAWAYS
# ═══════════════════════════════════════════════════════
slide = prs.slides.add_slide(blank_layout)
add_rect(slide, 0, 0, 13.333, 7.5, DARK_BLUE)
add_rect(slide, 0, 0, 0.25, 7.5, ACCENT_TEAL)
add_rect(slide, 0, 7.1, 13.333, 0.4, MID_BLUE)
add_textbox(slide, 0.45, 0.2, 12.5, 0.75, "KEY TAKEAWAYS — Hypertension Pharmacotherapy", 28, bold=True, color=WHITE)
add_rect(slide, 0.45, 0.98, 8.5, 0.06, ACCENT_TEAL)

takeaways = [
    ("1", "BP ≥130/80 mmHg = Hypertension (ACC/AHA 2017). All patients benefit from lifestyle modifications first.", YELLOW_ACC),
    ("2", "First-line drugs: Thiazide diuretics, ACE inhibitors, ARBs, and DHP calcium channel blockers — supported by the most evidence.", LIGHT_BLUE),
    ("3", "Compelling indications DRIVE drug selection: ACEi/ARB for DM/CKD, beta-blocker for post-MI/HF, chlorthalidone for elderly.", WHITE),
    ("4", "ACEi + ARB combination is CONTRAINDICATED — increases AKI/hyperkalemia risk without added benefit (ONTARGET).", RGBColor(0xFF, 0x99, 0x99)),
    ("5", "Beta-blockers are NOT first-line for uncomplicated HTN. Use when there are compelling indications (HF, post-MI, angina, AFib).", WHITE),
    ("6", "Resistant HTN: BP ≥130/80 on 3+ drugs (incl. diuretic). Add spironolactone as the evidence-based 4th agent (PATHWAY-2).", LIGHT_BLUE),
    ("7", "Hypertensive Emergency = BP ≥180/120 + end-organ damage → IV therapy, ICU. Reduce MAP ≤25% in first hour.", RGBColor(0xFF, 0x99, 0x99)),
    ("8", "Monitor K⁺ and creatinine with ACEi/ARBs and diuretics. Watch for first-dose hypotension and angioedema.", YELLOW_ACC),
    ("9", "Adherence is the #1 challenge — simplify regimens, use combination pills, educate patients, and involve pharmacists.", WHITE),
    ("10", "Target <130/80 mmHg for most adults. Individualize for frail elderly, pregnancy, aortic dissection, etc.", LIGHT_BLUE),
]

for idx, (num, text, col) in enumerate(takeaways):
    ci = idx % 2
    ri = idx // 2
    x = 0.45 + ci * 6.4
    y = 1.15 + ri * 1.18
    add_rect(slide, x, y, 0.48, 0.88, ACCENT_TEAL)
    add_textbox(slide, x+0.02, y+0.16, 0.46, 0.55, num, 22, bold=True, color=WHITE, align=PP_ALIGN.CENTER)
    add_rect(slide, x+0.5, y, 5.8, 0.88, MID_BLUE)
    add_textbox(slide, x+0.6, y+0.1, 5.65, 0.75, text, 11, color=col, wrap=True)

add_textbox(slide, 0.45, 7.15, 12.3, 0.28,
    "Sources: Wells Pharmacotherapy Handbook 9e (pp.554–588) | DiPiro Pharmacotherapeutics | ACC/AHA 2017 Hypertension Guidelines",
    9, color=RGBColor(0x80, 0xA0, 0xC8))

# ─────────── SAVE ───────────
output_path = "/tmp/workspace/hypertension-ppt/Hypertension_Pharmacotherapy.pptx"
prs.save(output_path)
print(f"Saved: {output_path}")
print(f"Slides: {len(prs.slides)}")