• Exact cause of primary HTN is still unknown.
• It is suspected that multiple factors are responsible for
Essential HTN like:
- Genetic predosposition
- Life style
- Obesity ETC
• Recently there are data available to support the view that
neurovascular compression of the RVLM is
associated with essential hypertension in some subjects.
In the 1970s, Dr. Peter Jannetta, a neurosurgeon
developed a technique for “microvascular
decompression” of the medulla to treat trigeminal
neuralgia and hemifacial spasm, which he attributed to
pulsatile compression of the vertebral and posterior
inferior cerebellar arteries impinging on the fifth and
seventh cranial nerves. Moving the arteries away from
the nerves led to reversal of the neurologic symptoms in
Some of these patients were also hypertensive, and
they showed reductions in blood pressure
Later, a few human studies claimed that surgical
decompression of the RVLM could sometimes
At first we have to take decision
• Weather it is HTN or not.
• Is it primary HTN or Secondary?.
• If secondary what is/are the cause/s?
• If primary – What will be our next approach?
• Do we really need Drugs or Lifestyle modification and
follow-up is enough?
• If necessary what will be the drug?
• Is there any special situation like pregnancy DM etc
• Is there any other disease?
The next flow-chart will help us
to reach in decision -
Routine Examination of a
• Routine Examination of urine
• Fasting blood for lipid and glucose
• Serum Urea, Creatinin and Electrolyte
• Body weight
Maintain normal body weight (BMI 20–25 kg/m2)
• Aerobic exercise
Perform >/= 30 min brisk walk most days of the week
Reduce intake of fat and saturated fat.
Reduce salt intake <100 mmol/day (<6 g NaCl or <2.4 g Na/day)
Limit alcohol to </=3 units/day men and </=2 units/day women
Consume >/=5 portions of fresh fruit and vegetables/day
• Cardiovascular risk reduction
Avoid cigarette smoking and increase oily fish intake