Hypertension

• Pathogenesis
• Investigation
• Diagnosis

By Swati kotagi
Factors affecting Blood pressure
• Blood pressure is a function of cardiac output & peripheral vascular resistance
 Renin-angiotensin-aldosterone system & Atrial natriuretic peptide
• Factors released from the kidneys, adrenals & myocardium interact to influence vascular tone & to regulate blood volume
by adjusting sodium balance
 Pathogenesis of Hypertension
Environmental
Mechanisms of Essential Hypertension:- factors
Insufficient
(Heavy salt intake,
renal sodium
Genetic stress, obesity,
excretion
factors smoking, physical
inactivity

Alteration in net
sodium
reabsorption

Increase in
blood volume

Increase cardiac Peripheral

output vasoconstriction

Increase in
Blood pressure
Mechanisms of Secondary Hypertension:-

Renovascular
hypertension Primary
hyperaldosteronism

Decreased glomerular
flow

Activation of Renin-angiotensin-
aldosterone pathway

Single gene
Liddle disorders
syndrome
Sodium reabsorption &
increased blood volume

Increased blood pressure

Investigations-

objectives-
• Confirm the diagnosis by obtaining accurate, representative BP
measurements
• Identify contributory factors & any underlying causes
• Assess other risk factors & quantify Cardiovascular risk
• Detect any complications that are already present
• Identify comorbidity that may influence the choice of
antihypertensive therapy
Approach to the patient:-

1. History-
• Family history of hypertension & cardiovascular disease
• Dietary & psychosocial history
• Other risk factors: weight change, smoking, diabetes
• Evidence of secondary hypertension: history of renal disease,
muscle weakness, tremor, hyperthyroidism or hypothyroidism,
snoring
• Evidence of target organ damage: stroke, angina, congestive heart
failure, myocardial infarction
• Previous therapies: responses & side effects
2. Signs & symptoms-
● Hypertension headache
● Dizziness
● Vomiting
● Nausea
● Chest pain
● Confusion
● Anxiety
● Buzzing in ears
● Abnormal heart rhythm
● Blurred vision
3. Physical-
• Blood pressure in both arms
• Supine & standing blood pressure
• Funduscopic examination if retina
• Quality of femoral & pedal pulses
• Cardiac rate & rhythm
• Signs of congestive heart failure
• Sings of secondary hypertension
4. Laboratory tests-
• Urinalysis for blood, protein, glucose
• Blood urea, electrolytes & creatinine
• Blood glucose
• Serum total & HDL cholesterol
• Thyroid function tests
• 12-lead ECG(left ventricular hypertrophy, coronary artery disease)
Diagnosis-

Note:
• Risk factors like CHF, MI, Renal disorders, DM are also considered for diagnosis of the blood pressure category
Thank you