Hypertension

Introduction
• Hypertension is one of the leading causes of the global
burden of disease.
• Approximately 7.6 million deaths ( 13 - 15% of the total)
and 92 million disability-adjusted life years worldwide
were attributable to high blood pressure in 200 l .
• Hypertension doubles the risk of cardiovascular
diseases ， including coronary heart disease (CHD) ，
congestive heart failure (CHF) ， ischemic and
hemorrhagic stroke, renal failure ， and peripheral
arterial disease.
Definition of Hypertension

• Hypertension is defined as systolic blood

pressure (SBP) of 140 mmHg or greater,
diastolic blood pressure (DBP) of 90 mmHg or
greater, or taking antihypertensive medication.

VI JNC, 1997
Mechanism of Hypertension
• Cardiac output and peripheral resistance are
the two determinants of arterial pressure.
Types of hypertension

Essential hypertension

Secondary hypertension

Malignant’ or accelerated phase hypertension‘

Isolated systolic hypertension

Essential hypertension
• Primary.
• Cause unknown
• ~95% of cases.
Secondary hypertension
• 5% of cases.
• Of known cause.
Causes of secondary HT
Causes of secondary hypertension
• Renal 80 %.
1. Glomerulonephritis (GN)
2.Renal Artery stenosis
• Endocrine.
• Other cause:
1. Coarctation of the aorta.
2. Pregnancy Induced HTN (Pre-eclampsia)
3. Sleep Apnea Syndrome.
Screening for Secondary Hypertension
1. Drug-resistant/induced hypertension.
2. Abrupt onset of hypertension.
3. Onset of hypertension at <30 year.
4. Exacerbation of previously controlled hypertension.
5. Disproportionate target organ damage (TOD) for
degree of hypertension.
6. Accelerated/malignant hypertension.
7. Onset of diastolic hypertension in older adults ( 65
y).
8. Unprovoked or excessive hypokalemia.
Isolated systolic hypertension
• The most common form of hypertension in the
UK—affects >50% of the over-60s.
• It results from stiffening of the large arteries
(arteriosclerosis).
• It is not benign: doubles risk of MI, triples risk of
CVA.
• Treatment reduces this excess risk and is as, if
not more, effective than treating moderate
hypertension in middle-aged patients
Investigations
MANAGEMENT
None pharmacological
1. Weight loss
2. Healthy diet.
3. Reduce intake of dietary sodium.
4. Enhance intake of dietary potassium.
5. Physical activity.
6. Moderate alcohol consumption.
Pharmacological

Primary agents

Secondary agents
Primary agents

ACE Inhibitors
Diuretics CCB
ARBs
Thiazide • Enalapril • Amlidopine •
Indapamide • Ramipril • Diltiazem •
Secondary agents

Diuretics Beta blocker Alpha blocker

Loop: • Carvidolol • Doxazocine •

furosemide .Bisoprolol • Prazocine •
:K sparing •
spironolactone •
Target Blood Pressure

mmHg 130/80<

Multiple antihypertensive agents

may be needed to achieve the
desired target
Malignant or accelerated phase
:hypertension
• Refers to a rapid rise in BP leading to vascular
damage
• Usually there is severe hypertension (eg systolic
>200, diastolic>130mmHg) + bilateral retinal
haemorrhages and exudates; papilloedema may
or may not be present.
• Clinical presentation :
1. Headache
2. Visual disturbance.
• Requires urgent treatment.
• It may also precipitate acute renal failure,
heart failure, or encephalopathy, which are
hypertensive emergencies.
• Untreated, 90% die in 1yr; treated, 70%
survive 5yrs.
• It is more common in younger patients and in
black patients.
Intravenous treatment
1. Labetolol.
2. Hydralazine.
3. Sodium nitroprusside.
4. Nitroglycerin.
5. Enalaprilate.
6. …………………….. .