HYPERTENSION

HYPERTENSION

1. Defintion

   • Sustained increase in blood pressure, Systolic >140 & Diastolic > 90 mm of Hg

2. Stages

3. Classification

   • Primary HTN
     • Causes
       • Genics
       • Environmental factors
         • Stress
         • Obesity
           • Risk Factors
             • Diabetes
               • Cancer
                 • Sleep Apnea
                   • GERD
                     • High BP
                       • Heart Disease
           • Definition
             • A medical condition in which excess body fat has accumulated to the extent that it may have an adverse effect on health.
               • it is defined by
                 • Body Mass Index (BMI)
                   • Further evaluated by
                     • Waist-hip ratio
                       • ratio of the circum- ference of the waist to that of the hips.
         • Smoking
           • Nicotine - Vasoconstrictor
         • Physical inactivity
   • Secondary HTN
     • Causes
       • Endocrine
         • Adrenocortical hyperfunction
           • HYPO/HYPER-thyrodism
             • Pregnancy-induced
               • Primary aldosteronism
                 • Cushing syndrome
       • Cardiovascular
         • Coarctation of
           • Aorta
           • polyarteritis nodosa
         • Increased intravascular volume
       • Renal
         • Renal artery fibromuscular dysplasia
           • Renin-producing tumors
             • Acute glomerulonephritis
               • Renal artery stenosis
                 • Chronic renal disease
                   • Polycystic disease
                     • Renal vasculitis

4. Complications

   • Eye
     • Hypertensive retinopathy
   • Renal
     • Malignant hypetension (Infarction, Renal failure)
       • Benign nephrosclerosis
   • CNS
     • TIA
       • Subarachnoid heamorrhage
         • Stroke (Haemorrhage, infarction)
   • CVS
     • Left ventricular hypertrophy
       • Ischemic Heart Disease
         • atherosclerosis
           • Complications
             • dissection
               • aneurysm
             • embolism,
               • rupture
             • Peripheral vascular disease

5. Pathophysiology

   • Blood Pressure = Cardiac Output (CO) X Total Peripheral Resistance (TPR)
   • Increased Peripheral Vascular Resistance
     • Total Peripheral Resistance
       • increased by
         • factors that increase BLOOD VISCOSITY or reduce VESSEL DIAMETER
           • Increased pressure
             • causes
               • HYPERPLASIA of smooth muscles
                 • Thickened vessels
                   • with
                     • Narrowed Lumina
                       • Leading to
                         • Plaque formation
                 • causing weak vessels
                   • causing Hemorrhage
                     • Cerebrovascular accident (CVA)
   • increased Cardiac Afterload
     • increased by
       • Factors that increase HEART RATE & STROKE VOLUME
         • Increased workload of L ventricle
           • increased Myocardial O2 demand

6. Diagnostic Tests

   • serum Electrocyte
     • Especially
       • K+
   • Preventive measurements
     • Physical, B.P. checks
       • requires
         • High readings of two separate occasions to Dx
   • Routine urinalysis
     • Fasting glucose sugar
       • Creatine Levels

7. Management

   • Pharmacological
     • Mild hypertension can often be controlled with a single drug.
       • More severe hypertension may require treatment with several.
     • initiated with
       • diuretic,
       • β-blocker
         • Atenolol
       • ACE inhibitor
         • Enalapril
       • calcium channel blocker
     • HMG-CoA reductase inhibitors
       • Atorvastatin
   • Non-pharmacological
     • Lifestyle modification
       • Weight loss
         • exercise
           • stress reduction
             • DASH diet
               • Increasing potassium intake and restricting sodium

8. due to deregulation of

   • Arterial Blood Pressure
     • Main regulators
       • Baroreceptor Reflex
         • Fast, neurally mediated reflexes
           • control
             • A.B.P
               • via changes in
                 • output of the sympathetic
                 • parasympathetic nervous systems
                   • to
                     • Blood vessels
                     • Heart
         • Pressure sensors
           • Baroreceptors
             • in
               • Carotid sinus
               • aortic arch
             • relay information to vasomotor center in medulla
       • Renin-Angiotension II-Aldosterone System
         • Activated in response to
           • decrease in the Arterial Pressure
             • this leads to
               • renin release
                 • by
                   • juxtaglomerular cells in kidneys
                 • convert angiotensinogen into angiotensin I
                   • which is furthur converted into
                     • angiotensin II
                       • by
                         • ACE
                       • FOUR main actions
                         • Causes aldostrone release
                           • by
                             • adrenal cortex
                               • Leads to
                                 • sodium reabsorption
                         • Acts directly on the Na+H+ exchange
                           • for
                             • Na+ reabsorption
                         • Increases thirst and secretion of antidiur- etic hormone
                         • Acts on arterioles
                           • to cause
                             • Vasoconstriction
                               • increasing
                                 • TPR

9. Epidemiology

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