HYPERTENSION

DEFENITION:
Hypertension is defined as the high blood pressure as the systolic blood
pressure (SBP) is >140 mm hg and the diastolic blood pressure (DBP) is >100
mm hg.
INCIDENCE:
The prevalence of the hypertension is increases with the age above 55
yrs. The mens are more affected than women.
STAGES:
STAGES
Pre HTN
Stage 1 HTN
Stage 2 HTN

SBP
120 139 mm hg
140 159 mm hg
>160 mm hg

DBP
80 89 mm hg
90-99 mm hg
> 100 mm hg

ETIOLOGY:
PRIMARY CAUSES:
Unknown or idiopathic.
Contributing factors are increased SNS activity.
Alcohol consumption.
Diabetes mellitus.
Greater body weight.
Increased sodium intake.
Overproduction of the sodium retaining hormones.
SECONDARY CAUSES:

Congenital narrowing of the aorta.

Endocrine disorders( Cushing syndrome )
Medications( estrogen therapies and NSAIDs )
Neurologic disorders( brain tumor )
Pregnancy, sleep apnea.
Renal diseases( renal artery stenosis )

PATHOPHYSIOLOGY:
Due to the etiological factors
Decreased cardiac output
Decreased renal blood flow
Increases the CNS stimulation on the renal
Stimulate rennin secretion from the kidney
Activates the Angiotensin
Angiotensin - I
Angiotensin - II
Vasoconstriction
Increased the blood pressure
CLINICAL MANIFESTATIONS:

Called as silent killer.

Angina.
Dizziness.
Dyspnea.
Fatigue.
Giddiness.
Head ache.
Nose bleeds.
Palpitations.
Reduced activity intolerance.

ASSESSMENT AND DIAGNOSIS:

History collection.
Physical examination.
12 lead ECG.
Blood urea nitrogen.
Complete blood count.
Liver function tests.
Routine urine analysis.
Serum glucose, potassium, chloride, carbon dioxide, calcium.
Serum lipid profile (total lipids, LDL, VLDL,LDL)
Serum ureic acid.
TSH hormone levels.

MANAGEMENT:
LIFE STYLE MODIFICATIONS:

Reduce the body weight by increases the physical activity.

Moderation of the alcohol consumption.
Avoidance of the smoking and the tobacco chewing.
DASH (Dietary Approaches to Stop Hypertension) should be
followed eating plan.

NUTRITIONAL THERAPY:

Restriction of the sodium contained diets.

Restrict the cholesterol and the saturated fats.
Maintain the adequate intake of the potassium.
Maintain the adequate intake of the calcium and magnesium.

PHARMACOLOGICAL THERAPY:
Administration of the mentioned drugs.
ACE inhibitors caprtopril, enalopril, lisinopril.
Alpha 1 adrenergic blockers terazosin, parzosin, doxazosin
Angiotensin II inhibitors losartan, vaslartan.
Beta 1 adrenergic blockers propanolol, esmolol. Metroprolol.

 Ca channel blockers nifidipine, felodipine, amlodipine.

Direct vasodilators felodipine, minoxidil, nitroglycride.
Diuretics - furosemide, torsemide, chlorothiazide.
COMPLICATIONS:

Coronary artery diseases.

Left ventricular hypertrophy.
Cardiac failure.
Ischemic stroke.
Retinal damage.
Nephrosclerosis.
Renal damage.