INTRODUCTION• Hypertension (high blood preassure) alsocalled silent killer is a chronic medical conditioncharacterized by constant elevation of the systolicor diastolic pressure above 140/90 mmHg.• Because hypertension is almostwithout symptoms except for headaches in somepatients, it hides in the body without knowing it.•The fact that hypertension is asymptomatic makes itdifficult for patients to accept the diagnosis and complywith treatment.
In India more than over 140 million peopleare believed to be suffering from high bloodpressure in the country and the number isexpected to cross the 214 million mark in2030. Hypertension is a major risk factor forcardio-vascular diseases.INTRODUCTION
OBJECTIVES At the end of this presentation you shouldunderstand Define,classify and diagnosis ofhypertension Types of HT Identify risk factors &complications Treatment guidelines Complications and prevention methods
DEFINITION Hypertension is defined as a systolic bloodpressure (SBP) of 140 mm Hg or more, or adiastolic blood pressure (DBP) of 90 mmHg.
Blood pressure is the force applied against the walls ofthe arteries as the heart pumps blood through the body.The pressure is determined by the force and amount ofblood pumped and the size and flexibility of the arteries.
TYPES Primary Hypertension-unknownetiology Secondary Hypertension-due to someother medical condition Hypertension in pregnancy Malignant Hypertension with endorgan damage Paraoxysmal Hypertension
SIGNS AND SYMPTOMS Severe headache Nausea or vomiting Bad headache Confusion Changes in your vision Nosebleeds
Measurement of BP The patient must be properly preparedand positioned Caffeine,exercise and smoking shouldbe avoided for atleast 30 minutesbefore. Average of atleast three readings onthree different occassions should berecorded.
A-B-C-D Blood PressureMedications:A: ACE inhibitors (angiotensin converting enzyme)prevent the formationof the hormone angiotensin 2 which causes blood vessels to becomenarrow making the vessels relax, becoming wider, lowering your bloodpressure.B: Beta Blockers reduce nerve impulses to the heart and blood vesselsmaking the heart beat slower with less force to drop your blood pressureand the heart doesnt work a hard.C: Calcium channel blockers block calcium from entering the muscle cellsof the heart and blood vessels making them relax and lowering your bloodpressure.D: Diuretics, or water pills, work in the kidney by flushing out excess waterand sodium from the body.
Beta BlockerATENOLOL Decreases myocardial contractility Fall in cardiac output Decreases blood pressure Additionally it reduces renin secretionDosage- Atenolol 25-100mg once daily
ACE INHIBITORSEnalapril Acts by inbiting the conversion ofangiotensin 1 to angiotensin 2 thuspreventing the vasoconstriction Used in diabetics.Dosage Initial dose (oral): 5 mg orally once a day. Maintenance dose (oral): 10 to 40 mg orallyper day in 1 to 2 divided doses.
Side effects- First dose hypotension Dry cough UrticariaContraindiation Renal failure PregnancyACE INHIBITORS
CALCIUM CHANNEL BLOCKERAmlodipine Acts by relaxing the smooth muscle inthe arterial wall, decreasing total peripheralresistance thereby reducing blood pressure;in angina, amlodipine increases blood flowto the heart muscle. Initial dose: 2.5 -5 mg orally once a dayMaintenance dose: 5 to 10 mg orally once aday
Side effects- Headache Edema Fatigue Nausea Dizziness Muscle crampsContraindications- Pregnancy Breast feedingCALCIUM CHANNEL BLOCKER
TREATMENT IN DIABETICSBlood Pressure No diabetes Diabetes No diabetes DiabetesOptimal <140/85 <140/80 <130/80 <130/75Audit Standard <150/90 <140/85 <140/85 <140/80Measured in clinic Mean daytime ABPMor home measurement