This document discusses hypertension (high blood pressure) including its causes, risk factors, signs and symptoms, diagnosis, and treatment. It defines normal blood pressure and stages of hypertension. Primary (essential) hypertension has no identifiable cause while secondary hypertension is caused by underlying conditions like kidney, adrenal or thyroid diseases. Uncontrolled high blood pressure can damage organs and increase risks of heart attack, stroke, vision loss, and kidney disease. Treatment involves lifestyle changes and may include medications like diuretics, ACE inhibitors, calcium channel blockers, and others.

1. Hypertension:
Dr.Sami

2. Hypertension:
High Blood Pressure:

3. Normal Blood Pressure:
 The force of circulating blood on the walls of the arteries.
 There are two types of blood pressure:
 Systolic blood pressure refers to the pressure inside your arteries when heart
is pumping;
 Diastolic blood pressure is the pressure inside your arteries when heart is
resting between beats

4. Stage Approximate age
Systolic BP,
mmHg
Diastolic BP,
mmHg
Infants 0 to 12 months 75–100 50–70
Toddlers and
preschoolers
1 to 5 years 80–110 50–80
School age 6 to 12 years 85–120 50–80
Adolescents 13 to 18 years 95–140 60–90

5. Hypertension:
 Hypertension (HTN or HT), also known as high blood pressure (HBP), is a
long-term medical condition in which the blood pressure in the arteries is
persistently elevated.
 High blood pressure typically does not cause symptoms.
 Long-term high blood pressure, however, is a major risk factor for stroke,
coronary artery disease, heart failure, atrial fibrillation, peripheral
arterial disease, vision loss, chronic kidney disease, and dementia

6. Classifications:
 Primary (essential) hypertension
 Secondary hypertension

7. Primary Hypertension:
 Idiopathic hypertension is the form of hypertension that by definition has no
identifiable secondary cause.
 It is the most common type affecting 85% of those with high blood pressure.
 The remaining 15% is accounted for by various causes of secondary
hypertension.
 Hypertension can increase the risk of cerebral, cardiac, and renal Disorders.

8. Risk factors of Primary Hypertension:
 Essential hypertension has no identifiable cause. However, several risk
factors have been identified.
 Genetic variation
 Aging
 Obesity
 Salt ( Sodium Intake )
 Smoking, Alcohol
 Diabetes
 Vitamin deficiency
 Lack of exercise

9. Signs & Symptoms:
 Hypertension is generally a silent condition. Many people won’t experience
any symptoms. It may take years or even decades for the condition to reach
levels severe enough that symptoms become obvious.
 Symptoms of severe hypertension can include:
 headaches
 shortness of breath
 nosebleeds
 flushing
 dizziness
 chest pain
 visual changes
 blood in the urine

10. Secondary Hypertension
 Secondary hypertension (or, less commonly, inessential hypertension) is a
type of hypertension that is caused by an identifiable primary cause or by a
known disease or condition.
 It is much less common than the other type, called essential hypertension,
affecting only 15% of hypertensive patients.

11. Causes of Secondary Hypertension
 Kidney disease:
 An injury to the kidney or arteries that are too narrow can lead to poor
blood supply to the organ.
 This can trigger higher production of a hormone called renin. Renin leads to
production of substances in the body (like the protein molecule angiotensin
II) that can raise blood pressure.

12.  Renin converts angiotensinogen, (which is produced in the liver), to the
hormone angiotensin I. An enzyme known as ACE or angiotensin-converting
enzyme found in the lungs metabolizes angiotensin I into angiotensin II.
Angiotensin II causes blood vessels to constrict and blood pressure to
increase.

13.  Adrenal disease:
 Located on top of the kidneys, the adrenal glands produce and regulate
hormones. (Produce hormones that help regulate your metabolism, immune
system, blood pressure, response to stress and other essential functions).
 When there is a problem with these glands, hormones in the body can become
unbalanced and cause several conditions.

14.  Hyperparathyroidism:
 In this condition, the parathyroid glands (located in the neck), which plays
a key role in the regulation of calcium levels in the blood. Overproduction
of this hormones and this condition may lead to high blood pressure.

15.  Thyroid problems:
 The thyroid gland produces hormones that regulate the body's metabolic
rate controlling heart, muscle and digestive function,
 Abnormal thyroid function may also lead to high blood pressure.

16.  Coarctation (constriction or tightening) of the aorta:
 Coarctation of the aorta is a birth defect in which a part of the aorta is
narrower than usual (the main artery on the left side of the heart).
 Coarctation restricts normal blood flow

17.  Obstructive sleep apnea:
 In this condition, a person is awakened frequently from sleep and has pauses
in breathing during sleep due to collapsed passages in the upper airways.
 Obstructive sleep apnea occurs when the muscles that support the soft
tissues in your throat, such as your tongue and soft palate, temporarily
relax.
 When these muscles relax, your airway is narrowed or closed, and
breathing is momentarily cut off.
 Sudden drops in blood oxygen levels that occur during sleep apnea
increase blood pressure

18.  Side effects from certain medications can also contribute to secondary
hypertension. Medications like:
 Hormonal contraceptives (birth control pills)
 Non-steroidal anti-inflammatory agents (NSAIDs)
 Diet pills
 Stimulants (a substance that raises levels of physiological or nervous activity
in the body.)
 Antidepressants
 Immune system suppressants

19. Signs & Symptoms:
 Symptoms of secondary hypertension can vary depending on the type of
condition or disease that is acting in combination with high blood pressure.
 Pheochromocytoma: Sweating, increased frequency or force of heartbeats,
headache, anxiety
 Cushing’s syndrome: Weight gain, weakness, abnormal growth of body hair or
loss of menstrual periods (in women), purple striations (lines) on the skin of
the abdomen

20.  Thyroid problems: Fatigue (tiredness), weight gain or weight loss,
intolerance to heat or cold
 Conn’s syndrome or primary aldosteronism: Weakness due to low levels of
potassium in the body
 Obstructive sleep apnea: excessive fatigue or sleepiness during daytime,
snoring, pauses in breathing during sleep

21. Complications of Hypertension:
 The excessive pressure on artery walls caused by high blood pressure can
damage blood vessels as well as organs. The higher blood pressure and the
longer it goes uncontrolled, the greater the damage.
 Heart attack or stroke.
 High blood pressure can cause hardening and thickening of the arteries
(atherosclerosis), which can lead to a heart attack, stroke or other
complications.
 Aneurysm.
 Increased blood pressure can cause your blood vessels to weaken and bulge,
forming an aneurysm. If an aneurysm ruptures, it can be life-threatening.

22.  Heart failure.
 To pump blood against the higher pressure in your vessels, the heart has to
work harder. This causes the walls of the heart's pumping chamber to
thicken (left ventricular hypertrophy). Eventually, the thickened muscle
may have a hard time pumping enough blood to meet your body's needs,
which can lead to heart failure.
 Weakened and narrowed blood vessels in your kidneys.
 This can prevent these organs from functioning normally.

23.  Thickened, narrowed or torn blood vessels in the eyes.
 This can result in vision loss.
 Metabolic syndrome.
 This syndrome is a group of disorders of body's metabolism, including
increased waist size, high triglycerides, decreased high-density lipoprotein
(HDL) cholesterol (the "good" cholesterol) and high insulin levels. These
conditions make you more likely to develop diabetes, heart disease and
stroke

24.  Trouble with memory or understanding.
 Uncontrolled high blood pressure may also affect your ability to think,
remember and learn. Trouble with memory or understanding concepts is more
common in people with high blood pressure.
 Dementia.
 Narrowed or blocked arteries can limit blood flow to the brain, leading to a
certain type of dementia. A stroke that interrupts blood flow to the brain also
can cause vascular dementia.

25. Diagnose:
 Doctor will ask questions about
 Medical history and do a physical examination.
 Blood Pressure Measurement:
 Blood pressure measurements fall into several categories:

26. Ranges of BP in Adults:
 Five categories define blood pressure readings for adults:
 Healthy:
 A healthy blood pressure reading is 120/80 millimeters of mercury (mm Hg).
 Elevated:
 The systolic number is between 120 and 129 mm Hg, and the diastolic
number is less than 80 mm Hg. Doctors usually don’t treat elevated blood
pressure with medication. Instead, doctor may encourage lifestyle changes to
help lower your numbers.

27.  Stage 1 hypertension:
 The systolic number is between 130 and 139 mm Hg, or the diastolic number
is between 80 and 89 mm Hg.
 Stage 2 hypertension:
 The systolic number is 140 mm Hg or higher, or the diastolic number is 90
mm Hg or higher.

28.  Hypertensive crisis:
 The systolic number is over 180 mm Hg, or the diastolic number is over 120
mm Hg.
 Blood pressure in this range requires urgent medical attention. If any
symptoms such as chest pain, headache, shortness of breath, or visual
changes occur when blood pressure is this high, medical care in the
emergency room is needed.

29. Tests:
 If pt. have high blood pressure, doctor may recommend tests to confirm the
diagnosis and check for underlying conditions that can cause hypertension.
 Ambulatory monitoring.
 This 24-hour blood pressure monitoring test is used to confirm if pt. have
high blood pressure. The device used for this test measures blood pressure at
regular intervals over a 24-hour period and provides a more accurate picture
of blood pressure changes over an average day and night. However, these
devices aren't available in all medical centers, and they may not be
reimbursed.

31.  Lab tests.
 Doctor may recommend a urine test (urinalysis) and blood tests, including a
cholesterol test.
 Electrocardiogram (ECG or EKG).
 This quick and painless test measures your heart's electrical activity.
 Echocardiogram.
 Depending on your signs and symptoms and test results, doctor may order an
echocardiogram to check for more signs of heart disease. An echocardiogram
uses sound waves to produce images of the heart.
 Ultra Sound of Kidney.

32. Treatment:
 Life Style Modification:
 Changing lifestyle can help control and manage high blood pressure. doctor
may recommend that you make lifestyle changes including:
 Getting at least 150 minutes of physical activity each week (about 30 minutes
a day, 5 days a week)
 Not smoking
 Eating a healthy diet, including limiting sodium (salt) and alcohol
 Managing stress
 Maintaining a healthy weight or losing weight if you're overweight or obese
 Limiting the amount of alcohol you drink

33. Medications
 Medications used to treat high blood pressure include:
 Diuretics.
 Diuretics, sometimes called water pills, are medications that help kidneys
eliminate sodium and water from the body. These drugs are often the first
medications tried to treat high blood pressure.
 Angiotensin-converting enzyme (ACE) inhibitors.
 These medications help relax blood vessels by blocking the formation of a
natural chemical that narrows blood vessels. Angiotensin II

34.  Angiotensin II receptor blockers (ARBs).
 These medications relax blood vessels by blocking the action, not the
formation, of a natural chemical that narrows blood vessels.
 Calcium channel blockers:
 These medications block some of the calcium from entering the cardiac
muscles of heart. This leads to less forceful heartbeats and a lower blood
pressure.

35.  Alpha blockers.
 These medications reduce nerve signals to blood vessels, lowering the
effects of natural chemicals (Angiotensin II) that narrow blood vessels.
 Beta blockers.
 These medications that relax the heart muscles and widen your blood vessels,
causing heart to beat slower and with less force.
 Renin inhibitors.
 slows the production of renin enzyme that produced by kidneys that starts a
chain of chemical steps that increases blood pressure.

36.  Vasodilators.
 They work directly on the muscles in the walls of your arteries, preventing
the muscles from tightening and your arteries from narrowing.
 Central-acting agents.
 These medications prevent brain from telling nervous system to increase your
heart rate and narrow your blood vessels.