HYPERTENSSION

DR: AHMAR ISHTIAQUE

 DEFINATION 01

ETIOLOGY 02
RISK FACTORS 03
CLINICAL SYMPTOMS 04
OBJECTIVES. COMLICATIONS 05
DIAGNOSIS 06
MANAGEMENT 07
DEFINATION:

HTN is also known as high blood pressure, is a

long term medical condition in which blood
pressure in the arteries is persistently ele-
vated.

The systolic blood pressure (SBP) > 140mmHg.

Diastolic Blood Pressure (DBP) > 90mmHg.
 TYPES:

Grade I (mild) : SBP=140-159, DBP= 90-99. mmHg

Grade II (moderate): SBP= 160-179, DBP= 100-109.

mmHg

Grade III (severe) : SBP> 180, DBP> 110. mmHg

 ETIOLOGY.

Essential (primary) HTN: It Accounts For 95% of cases of HTN

Onset= 25-55 years.
Family history +(ive)
Pathogenesis Is Not Clearly understood.

May be due to some factors like:

Renal dysfunction
Peripheral resistance vessel tone.
Endothelial dysfunction
Autonomic tone
Neurohumoral factors
 ETIOLOGY:

Secondary HTN: 5% of cases

Due to specific disease which leads to sodium retention OR
peripheral vesoconstriction.
 RISK FACTORS:

• AGE: Risk of CAD increase after 50

• Alcohol, Smoking, DM
• Excessive dietary intake of sodium
• Gender
• Family Hx
• Stress
 CLINICAL SYMPTOMS

Some Time HTN does not cause any symptom so its also silent killer disease

In some patients symptoms appears like:

Severe head ache
Blurred vision
Nausea
Fatigue
Epistaxis
Chest pain
SOB
 COMPLICATIONS:

Neurologic: Trasient Ischemic Attack; Stroke

Ruptured Aneurysms.

Cardiac: Coronary Artery Diseases (CAD)

Left Ventricular Hypertrophy (LVH)
Congestive Heart failure (CHF)

Vascular: Aortic dissection

Aortic aneurysm

Renal: Proteinuria
Renal failure
 COMPLICATIONS:

Retinopathy: Grade I = arteriolar thickening & narrowing

Grade II = GI+ Constriction of veins at arterial crossing
i.e. “Arteriovenous nipping”
Grade III = GII+ Retinal hemorrhages & exudates.
Grade IV = GIII+ Papilledema
 DIAGNOSIS:

Investigations for all patients:

 Urinalysis: For blood, proteins, glucose.
 Blood urea, electrolytes & creatinine.
 Blood glucose.
 Serum folate & HDL cholesterol.
 Thyroid function test.
 12-lead ECG (Left ventricular hypertrophy, coronary artery disease)
 DIAGNOSIS:

Investigations For Selected Patients:

I. Chest X-ray: To detect the cardiomegaly, heart failure, coarctation of aorta.
II. Ambulatory BP recording: To assess the borderline hypertension
III. Echocardiogram: To detect or quantify LVH
IV. Renal US: To detect possible renal disease
V. Renal angiography: To detect or confirm the renal artery stenosis.
VI. Urinary catecholamines: To detect possible phaeochromocytoma.
VII. Urinary cortisol & dexamethasone suppression test: To detect cushings syndrome.
VIII.Plasma renin activity & aldosterone: To detect possible primary aldosteronism.
 MANAGEMENT:

Goals:
Blood Pressure < 140/90 mmHg.
Blood Pressure <130/80 mmHg if DM or renal disease.

1. Life Style Modifications:

I) Weight loss: Goal BMI= 18.5-24.9
II) Aerobic Exercise > 30 mints/day for > 5 days/week.
III) Diet rich in fruits & vegetables / less in saturated fat.
IV) Sodium restriction to < 2.4g/day ideally < 1.5g/day
V) Limit alcohol consumption.
 MANAGEMENT:

Pharmacologic Treatment:
Offer pharmacologic treatment to the patients with:
I. BP > 160/100 mmHg
II. BP > 140/90 mmHg + Cardiovascular disease, End organ
damage like nephropathy, retinopathy, TIA.
 Management:

The influence of comorbidity on the choice of anti-hypertensive drug therapy.

MANAGEMENT.
THANK
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