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HYPERTENSION
HYPERTENSION
 Blood pressure refers to the force
exerted by circulating blood on the walls
of blood vessels. The pressure of the
circulating blood decreases as blood
moves through arteries, arterioles,
capillaries, and veins; the term blood
pressure generally refers to arterial
pressure.
NORMAL BLOOD
PRESSURE
 In the U.S., the optimal arterial pressure
(sometimes referred to as the ‘gold
standard’) targets are:
 Systolic: less than 120 mmHg
 Diastolic: less than 80 mmHg
 HYPERTENSION,
most
commonly
referred to as "high blood pressure", is a
medical condition in which the blood
pressure is chronically elevated.

It is the one of the major risk factors
for
cardiovascular
mortality,
which
accounts for 20 – 50 % of all deaths.
CLASSIFICATION OF
BLOOD PRESSURE
 1 – Classification of blood pressure upon
measurements.
 2 – Classification of blood pressure upon
complications.
 3 - Classification of blood pressure upon
causes.
1 – Classification of blood pressure upon measurements
Category
Systolic BP
Diastolic BP
mm of Hg
mm of Hg
Normal
<130
<85
High
normal
130 - 139
85 – 90
Hypertensi Stage I mild
on
Stage
moderate
140 - 159
90 – 99

Stage III severe
II 160 - 179
>180
100 – 109
>110
2 – Classification of blood pressure upon complications
Stage
Organ
Changes
I
No manifestation of organ changes.
II
At least one of the following manifestations of organ changes.
III
Heart
Left ventricular hypertrophy.
Eye
Focal and generalized narrowing of the retinal arteries
Renal
Micro albuminuria, proteinuria, slight increase in plasma creatinine
level.
vascular
Evidence of atherosclerosis plaque, in aorta, carotid, iliac or femoral
arteries.
Heart
Angina pectoris, Myocardial infarction, heart failure.
Brain
Stroke, Transient Ischemic Attack, hypertensive encephalopathy,
vascular dementia.
Eye
Retinal haemorages and exudates with or without papilloedema
(malignant hypertension)
Kidney
Plasma Creatinine concentration > 2 mg/dl, renal failure.
Vessel
Dissecting aneurysm, systematic arterial occlusive disease.
3 – Classification of blood
pressure upon causes.
 A – Essential Hypertension,
 In 90 percent to 95 percent of high blood
pressure cases, the American Heart
Association says there's no identifiable
cause. This type of high blood pressure,
called essential hypertension or primary
hypertension, tends to develop gradually
over many years.
B - Secondary
Hypertension
 The other 5 percent to 10 percent of high
blood pressure cases are caused by an
underlying condition. This type of high
blood
pressure,
called
secondary
hypertension, tends to appear suddenly
and cause higher blood pressure than
does primary hypertension. Various
conditions can lead to secondary
hypertension, including,
I -Kidney abnormalities
 Renal Hypertension ,Hypertension produced
by diseases of the kidney. This includes
diseases such as polycystic kidney disease or
chronic glomerulonephritis. Hypertension can
also be produced by diseases of the renal
arteries supplying the kidney. This is known as
renovascular hypertension; it is thought that
decreased perfusion of renal tissue due to
stenosis of a main or branch renal artery
activates the renin-angiotensin system.
 II - TUMOURS OF THE ADRENAL GLAND,
Adrenal Hypertension
 Hypertension is a feature of a variety of adrenal
cortical abnormalities. In primary aldosteronism
there is a clear relationship between the
aldosterone-induced sodium retention and the
hypertension.
 III - CERTAIN CONGENITAL HEART
DEFECTS.
 Congenital narrowing of aorta.
 Iv – toxemias of pregnancy.
 V - GENETIC CAUSES
 Hypertension can be caused by mutations in
single genes, inherited on a mendelian basis.
HIGH BLOOD PRESSURE HAS MANY RISK
FACTORS.
 A - Some you can't control (non-modifiable):
 AGE. The risk of high blood pressure
increases as you age increases. Through
early middle age, high blood pressure is
more common in men. Women are more
likely to develop high blood pressure after
menopause.
 Over time, the number of collagen fibers in
artery and arteriole walls increases, making
blood vessels stiffer.
 RACE. High blood pressure is particularly
common among blacks, often developing at an
earlier age than it does in whites. Serious
complications, such as stroke and heart attack,
also are more common in blacks.
 Genetic Hypertension is one of the most
common complex disorders, with genetic
heritability averaging 30%. More than 50 genes
have been examined in association studies with
hypertension, and the number is constantly
growing
 FAMILY HISTORY. High blood pressure tends to
run in families.
B - Other risk factors for high blood
pressure are within your control
(Modifiable).
 I - EXCESS WEIGHT. The greater your body mass, the
more blood you need to supply oxygen and nutrients to
your tissues. As the volume of blood circulated through
your blood vessels increases, so does the pressure on
your artery walls.
 II – PHYSICAL INACTIVITY. People who are inactive
tend to have higher heart rates. The higher your heart
rate, the harder your heart must work with each
contraction — and the stronger the force on your
arteries. Lack of physical activity also increases the risk
of being overweight.
 III - TOBACCO USE. The chemicals in tobacco
can damage the lining of your artery walls, which
promotes narrowing of the arteries.
 IV - SALT INTAKE, high intake increases blood
pressure and low intak decreases the blood
pressure
 V - LOW POTASSIUM INTAKE. Potassium
helps balance the amount of sodium in your
cells. If you don't consume or retain enough
potassium, you may accumulate too much
sodium in your blood.
 VI – SATURATED FAT, saturated fat intake
raises blood pressure.
 Vii – DIETARY FIBER, more consumption
of fat decreases blood pressure.
 VIii - EXCESSIVE ALCOHOL. Over time,
heavy drinking can damage your heart.
 ix - STRESS. High levels of stress can
lead to a temporary but dramatic increase
in blood pressure. If you try to relax by
eating more
 IX – SOCIO ECONOMIC STATUS, a
higher prevalence of hypertension in upper
socio economic groups.
 X - CERTAIN CHRONIC CONDITIONS
also may increase your risk of high blood
pressure, including high cholesterol,
diabetes, kidney disease and sleep apnea.
Sometimes pregnancy contributes to high
blood pressure.
 Additional tests often include:
 Testing of urine samples for proteinuria - again
to pick up underlying kidney disease or evidence
of hypertensive renal damage.
 Electrocardiogram (EKG/ECG) - for evidence of
the heart being under strain from working
against a high blood pressure. Also may show
resulting thickening of the heart muscle (left
ventricular hypertrophy) or of the occurrence of
previous silent cardiac disease (either subtle
electrical conduction disruption or even a
myocardial infarction).
 Chest X-ray - again for signs of cardiac
enlargement or evidence of cardiac failure.
COMPLICATIONS
 While elevated blood pressure alone is not an
illness, it often requires treatment due to its
short- and long-term effects on many organs.
The risk is increased for:
 Cerebrovascular accident (CVAs or strokes)
 Myocardial infarction (heart attack)
 Hypertensive cardiomyopathy (heart failure due
to chronically high blood pressure)
 Hypertensive retinopathy - damage to the retina
 Hypertensive nephropathy - chronic renal failure
due to chronically high blood pressure
 Hypertensive encephalopathy - confusion,
headache, convulsion due to vasogenic edema
in brain due to high blood pressure.
PREVENTION,
 Lifestyle
modification
(nonpharmacologic
treatment)
 WEIGHT REDUCTION and regular aerobic
exercise (e.g., jogging) are recommended as the
first steps in treating mild to moderate
hypertension. Regular mild exercise improves
blood flow and helps to reduce resting heart rate
and blood pressure. These steps are highly
effective in reducing blood pressure, although
drug therapy is still necessary for many patients
with moderate or severe hypertension to bring
their blood pressure down to a safe level.
 REDUCING SODIUM (SALT) diet is proven very
effective: it decreases blood pressure in about
60% of people (see above). Many people
choose to use a salt substitute to reduce their
salt intake.
 ADDITIONAL DIETARY CHANGES beneficial to
reducing blood pressure includes the DASH diet
(Dietary Approaches to Stop Hypertension),
which is rich in fruits and vegetables and low fat
or fat-free dairy foods. This diet is shown
effective based on National Institutes of Health
sponsored research. In addition, an increase in
daily calcium intake has the benefit of increasing
dietary potassium, which theoretically can offset
the effect of sodium and act on the kidney to
decrease blood pressure. This has also been
shown to be highly effective in reducing blood
pressure.
 DISCONTINUING TOBACCO USE AND
ALCOHOL CONSUMPTION has been shown to
lower blood pressure. The exact mechanisms
are not fully understood, but blood pressure
(especially systolic) always transiently increases
following alcohol and/or nicotine consumption.
Besides, abstention from cigarette smoking is
important for people with hypertension because
it reduces the risk of many dangerous outcomes
of hypertension, such as stroke and heart attack.
Note that coffee drinking (caffeine ingestion)
also increases blood pressure transiently, but
does not produce chronic hypertension.
 RELAXATION THERAPY, such as
meditation, that reduces environmental
stress, reducing high sound levels and
over-illumination can be an additional
method of ameliorating hypertension.
Jacobson's Progressive Muscle Relaxation
and
biofeedback
are
also
used
[particularly
device
guided
paced
breathing . Obviously, the effectiveness of
relaxation therapy relies on the patient's
attitude and compliance.
 Treatment
COMMONLY USED DRUGS INCLUDE
 ACE inhibitors such as creatine captopril,
enalapril, fosinopril (Monopril), lisinopril (Zestril),
quinapril, ramipril (Altace)
 Angiotensin II receptor antagonists: eg,
telmisartan
(Micardis,
Pritor),
irbesartan
(Avapro), losartan (Cozaar), valsartan (Diovan),
candesartan (Amias)
 Alpha blockers such as doxazosin, prazosin, or
terazosin
 Beta blockers such as atenolol, labetalol,
metoprolol (Lopressor, Toprol-XL), propranolol.
 Calcium channel blockers such as nifedipine
(Adalat)[23] amlodipine (Norvasc), diltiazem,
verapamil
 Direct renin inhibitors such as aliskiren
(Tekturna)
 Diuretics:
eg,
bendroflumethiazide,
chlortalidone, hydrochlorothiazide (also called
HCTZ)
 Combination products (which usually contain
HCTZ and one other drug)
WHO approaches in the prevention of Hypertension.
1. Primary Prevention:
a. Population strategy:
All whole espectire of individual risk levels
through multifactorial approach.
1. Nutrition:
a. Reduction of salt intake not more th 5 g/day
b. Moderate fat intake.
2 – weight reduction, corect body mass index <25.
3 – exercise promotion.
4 – behavioural change.
5 – health education.
6 – self care.
HIGH RISK STRATEGY
 The main aim of this approach is to
prevent the attainment of blood pressure
at which the institution of treatment would
be consider.
 A – detection of early high risk group.
 B – to take treatment
SECONDARY PREVENTION
 I – Early case detection
 Ii – Treatment.
 Iii – Patient compliance