Clinical Pharmacy.....Over view on the disease of Hypertension.

1. Hypertension

2. Each time the heart beats
(about 60-70 times a minute at
rest), it pumps out blood into
the arteries.
What Is Blood Pressure?
Your blood pressure is at its
highest when the heart beats,
pumping the blood.
When the heart is at
rest, between beats,
your blood pressure
falls.
Your blood pressure is always given as these two numbers with one above
or before the other.
This is called SYSTOLIC pressure.
120/80
This is called DIASTOLIC pressure.
Bottom number

3. Category
Systolic
(Top Number)
Diastolic
(Bottom Number)
Normal Less than 120 Less than 80
What Is Normal Blood Pressure?
“Normal” blood pressure is when both numbers
are lower than 120/80.

4. If your blood pressure is in the prehypertensive range:
It means that you don’t have high blood pressure now, but you are likely to
develop it in the future.
Unless you take ACTION to prevent it!
“Prehypertension”
Prehypertension 120-139 80-89

5. Medical Education & Information – for all Media, all Disciplines, from all over the World
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2013 ESH/ESC Guidelines for the management of arterial hypertension
The Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC) - J Hypertension 2013;31:1281-1357
Definitions and classification of office BP levels (mmHg)*
Category Systolic Diastolic
Optimal <120 and <80
Normal 120–129 and/or 80–84
High normal 130–139 and/or 85–89
Grade 1 hypertension 140–159 and/or 90–99
Grade 2 hypertension 160–179 and/or 100–109
Grade 3 hypertension ≥180 and/or ≥110
Isolated systolic hypertension ≥140 and <90
* The blood pressure (BP) category is defined by the highest level of BP, whether systolic or diastolic. Isolated systolic hypertension should be
graded 1, 2, or 3 according to systolic BP values in the ranges indicated.
Hypertension:
SBP >140 mmHg ± DBP >90 mmHg

6. What Is High Blood Pressure?
A blood pressure of 140/90is considered high blood pressure.
High Blood Pressure Systolic Diastolic
Stage 1 140-159 90-99
Stage 2 160 or higher 100 or higher
“Hypertension”

7. Kieran McGlade Nov 2001 Department of General Practice QUB
Aetiology of Hypertension
• Primary – 90-95% of cases – also termed “essential” of
“idiopathic”
• Secondary – about 5% of cases
– Renal or renovascular disease
– Endocrine disease
• Phaeochomocytoma
• Cusings syndrome
• Conn’s syndrome (hyperaldosteronism)
• Acromegaly and hypothyroidism
– Coarctation of the aorta
– Iatrogenic
• Hormonal / oral contraceptive
• NSAIDs

8. • Renovascular disease is a progressive condition that causes
narrowing or blockage of the renal arteries or veins. These
are the blood vessels that take blood to and from the
kidneys. It's the general term used for three disorders:
renal artery occlusion, renal vein thrombosis, and renal
atheroembolism.
• Phaeochomocytoma is a small vascular tumor of the
adrenal medulla, causing irregular secretion of epinephrine
and norepinephrine, leading to attacks of raised blood
pressure, palpitations, and headache.
• Cusings syndrome is a metabolic disorder caused by
overproduction of corticosteroid hormones by the adrenal
cortex and often involving obesity and high blood pressure.

9. Coarctation of the aorta
• Coarctation

10. Hypertension:
Predisposing factors
• Advancing Age
• Sex (men and postmenopausal women)
• Family history of cardiovascular disease
• Sedentary life style & psycho-social stress
• Smoking ,High cholesterol diet, Low fruit
consumption
• Obesity & wt. gain
• Co-existing disorders such as diabetes,
and hyperlipidaemia
• High intake of alcohol

11. Haemodynamic Pattern
in Hypertension
Young :  BP = CO X TPR
Elderly :  BP =  CO X   TPR

12. What can high blood pressure do to your body?
Heart Attack
High blood pressure is a
major risk factor for heart
attack. The arteries bring
oxygen-carrying blood to the
heart muscle. If the heart
cannot get enough oxygen,
chest pain, can occur. If the
flow of blood is blocked, a
heart attack results.
Blindness
High blood pressure can eventually
cause blood vessels in the eye to
burst or bleed. Vision may become
blurred or otherwise impaired and
can result in blindness.
Kidney disease
Kidneys act as filters to rid the
body of waste. High blood
pressure can narrow and
thicken the blood vessels of
the kidneys. The kidneys
filter less fluid and waste
builds up in the blood. The
kidneys may fail altogether.
High blood pressure is the most important
risk factor for stroke. Very high pressure can
cause a break in a weakened blood vessel,
which then bleeds in the brain. This can
cause a stroke. If a blood clot blocks one of
the narrowed arteries, it can also cause a
stroke.
Stroke
As people get older, arteries
throughout the body
"harden," especially those in
the heart, brain, and
kidneys. High blood pressure
is associated with these
"stiffer" arteries. This, in
turn, causes the heart and
kidneys to work harder.
Arteries
Heart failure
The heart is unable to
pump enough blood to
supply the body's needs.

13. Diagnosis

14. Clinical manifestations
• No specific complains or manifestations other than
elevated systolic and/or diastolic BP (Silent Killer
)
• Morning occipital headache
• Dizziness
• Fatigue
• In severe hypertension, epistaxis or blurred vision

15. Self-Measurement of BP
 Provides information on:
1. Response to antihypertensive therapy
2. Improving adherence with therapy
3. Evaluating white-coat HTN
 Home measurement of >135/85 mmHg is generally
considered to be hypertensive.
 Home measurement devices should be checked
regularly.

16. Measuring
Blood Pressure
• Patient seated quietly for at least
5minutes in a chair, with feet on the
floor and arm supported at heart
level
•An appropriate-sized cuff (cuff bladder encircling at least
80% of the arm)
•At least 2 measurements
Continue…

17. • Systolic Blood Pressure is the point at which
the first of 2 or more sounds is heard
• Diastolic Blood Pressure is the point of
disappearance of the sounds (Korotkoff 5th)
Continue…
Measuring
Blood Pressure

18. • Ambulatory BP Monitoring - information about
BP during daily activities and sleep.
• Correlates better than office measurements
with target-organ injury.
Continue…
Measuring
Blood Pressure

19. Laboratory Tests
 Routine Tests
• Electrocardiogram
• Urinalysis
• Blood glucose,
• Serum potassium, creatinine, or the corresponding estimated GFR,
and calcium
• Lipid profile, after 9- to 12-hour fast, that includes high-density and
low-density lipoprotein cholesterol, and triglycerides
 Optional tests
• Measurement of urinary albumin excretion or albumin/creatinine
ratio
 More extensive testing for identifiable causes is not generally indicated
unless BP control is not achieved

20. How to treat ?

21. Treatment Overview
Goals of therapy
Lifestyle modification
Pharmacologic treatment
 Algorithm for treatment of hypertension
Follow up and monitoring

22. Goals of Therapy
Reduce Cardiac and renal morbidity and mortality.
Treat to BP <140/90 mmHg or BP <130/80 mmHg in
patients with diabetes or chronic kidney disease.

23. Non pharmacological
Treatment of hypertension
Avoid harmful habits ,smoking ,alcohal
Reduce salt and high fat diets
Loose weight , if obese
Regular exercise
DASH
diet

24. Life style modifications
• Lose weight, if overweight
• Increase physical activity
• Reduce salt intake
• Stop smoking
• Limit intake of foods rich in fats and
cholesterol
• increase consumption of fruits and
vegetables
• Limit alcohol intake

25. Lifestyle Modification
Modification Approximate SBP reduction
(range)
Weight reduction 5–20 mmHg / 10 kg weight loss
Adopt DASH eating
plan
8–14 mmHg
Dietary sodium
reduction
2–8 mmHg
Physical activity 4–9 mmHg
Moderation of alcohol
consumption
2–4 mmHg

26. Antihypertensive Drugs
Continue….
AT1 receptor
ARB

27. Drug therapy for hypertension
Class of drug Example Initiating dose Usualmaintenance
dose
Diuretics Hydrochlorothiazide 12.5 mg o.d. 12.5-25 mg o.d.
-blockers Atenolol 25-50 mg o.d. 50-100 mg o.d.
Calcium Amlodipine 2.5-5 mg o.d. 5-10 mg o.d.
channel
blockers
-blockers prazosin 2.5 mg o.d 2.5-10mg o.d.
ACE- inhibitors ramipril 1.25-5 mg o.d. 5-20 mg o.d.
Angiotensin-II Losartan 25-50 mg o.d. 50-100 mg o.d.
receptor blockers