HYPERTENSION

DEF; varies according to age

WHO >140/90 mmHg [at least 3 readings
If DBP > 105 mmHg [first reading is enough]r

PREVALENCE

TZ; 56% rural areas ; 10% urban areas

TERMS
;pulse pressure = SBPDBP.
Mean B/P
=DBP + 1/3 pulse pressure
Labile HT.[borderline] =150/90 -160/100
White coat pseudoor office hypertension.
Malignant HT.= DBP> 120 mmHg.

GRADING;

MILD HT;DBP= 90104 mmHg

MODERATE HT; DBP = 105114 mmHg.
SEVERE HT; DBP > 115 mmHg.
ISH: SBP > 160 MMHG With normal DBP.
TYPES; A; PRIMARY HT;
Genetic predisposion,Obesity,Physical
inactivity Alcohol intake.Smoking,
Diabetes,Gout Polycythaemia.

SECONDARY HYPERTENSION
RENAL;[a] Renal parenchymal disease
e.g. AGN,CGN.PKD, CTD,SLE.

[b] Renal vascular disease ; RAS.

[c] Renin producing tumours.

ENDOCRINE; Acromegaly,Hypothyrodism,
Hyperthyrodism,Hypercalcemia,Carcinoid,
Cushings Primary
aldosterinism,Pheochrocytoma Exogenous
hormone-oestrogen/glucoco/mineraloco.

Secondary causes cont.

[3] Coarctation of the aorta.
[4] Pregnancy induced HT.
[5] Neurological disorders; acute
porphyria, lead poisoning,Guillain- barre
syndrome,Increased i/cranial pressure.
[6] Acute distresssurgery,burns.hypoglycemia pancreatitis.
[7] Alcohol and Drugs

HISTORY
Asymptomatic/
H/ache,Dyspnea,Palpitations Blurred
vision,Dizziness, Sweats,Pallor,Tinnitus
FHx: HT,DM,IHD.CVA. Hyperlipidemia.
SHx: Smoking,Alcohol,Diet [Na+ intake]
DHx Oral
ontracep.NSADs,decongestants ,

PHYSICAL EXAMINATION
PULSE;asymmetrical
Aortoarteritis/SychronicityCoarct of aorta.
Vascular bruit carotid/ Renal bruit
Fundus.
Cushings; round face/truncal obesity
CVS: apex beat/ S2/ S4/ S3
RES: basal crackles
GIT: palpable kidneys [APKs]

INVESTIGATIONS
URINALYSIS
BUN, CREAT, SUGAR,CHOL. K+,Na+
Ca++, URIC ACID
ECG
CHEST X-RAY
FBP AND ESR
ECHOCARDIOGRAPHY

Investigations contd.
DEXAMETHASONE suppression test
Cushings syndrome
VMA or 24 Hour urinary catecholamine
Pheochromocytoma
Plasma aldosterone + Adrenal venography
1ry Aldostronism
Renal arteriogram or IVU--RAS

COMPLICATIONS

Acceler/Malignant HT
H/gic or Atherothrombotic Stroke
CCF
Nephrosclerosis
Aortic dissection
CAD
Arrhythmias
Peripheral vascular disease

TREATMENT [A] NON-DRUG

THERAPY
[1]; WEIGHT REDUCTION[1kg=1.6/1.2mmHg
[2]SALT Reduction{100mmol= 5.4/6.5 mmHg
[3]MODERATION OF ALCOHOL
[4] ISOTONIC EXERCISE
[5]STOP SMOKING
[6]K+/ Mg++/ Ca++ supplementation
[7] RELAXATION TECHNIQUE

[B] drug therapy.

Indications: [a] DBP>100mmg or
>95mmg with TOD [b] SBP > 170
[1] DIURETICS mmhg.

[2] BETA BLOCKERS

[3] CALCIUM CHANNEL BLOCKERS
[4]ACEI
[5] VASODILATORS hydrallazine/ minoxidil
[6] CENTRAL ADREN. BLOCKERSALDOMET
[7] PERIPH. NEURAL INHIBItors RESEPINE

HYPERTENSIVE EMERGENCIES.
CVA; HTve encephalopathy, Intacerebral
H/ge, Subarachnoid H/ge,
Atherothrombotic brain infartion,
Malignant hyprtension,
CARDIAC: Acute LVF, Acute coronary
insufficiency,Acute aortic
dissection, After CABG surgery
OTHERS: Pheochr crisis,Food or drug +
MAO inhibitors..

HYPERTENSIVE URGENCIES

[1] Accel and malignant HT

[2] Rebound HT
[3] Severe HT after kidney transplantation
AVAILABLE DRUGS;
Sodium nitroprusside IV 0.510 ug/kg/min.
Labetolol IV bolus 20-80 mg @ 510 min up to
300 mg.
Diazoxide IV 50-100 mg @ 5-10 min [600mg]
Hydrallazine

THAT IS HT. IN A NUTSHELL