A clinical case discussion format for hypertension

1. HYPERTENSION
A clinical Case Discussion

2. HYPERTENSION
• Abnormally elevated blood pressure is a pathological condition which increases
the work load on the heart is termed as hypertension. It is a chronic condition of
the Cardio-vascular system.

3. JNC 8 CRITERIA FOR CLASSIFICATION OF HYPERTENSION

4. MAGNITUDE
RULE OF HALVES
•Of the total population, 50% have
hypertension both diagnosed and
undiagnosed.
•Only 50% out of all hypertensive
cases 50% seek medical attention.
•Of the total 50% of diagnosed
cases, 50% take medicine and 50%
do not.
• Of the 50% who take medicine,
only 50% are adeuately treated and
the rest 50 % are not.

5. PREVLANCE
GLOBAL
• An estimated 1.28 billion adults aged 30-79 years worldwide have
hypertension, most (two-thirds) living in low- and middle-income
countries
• An estimated 46% of adults with hypertension are unaware that they
have the condition.
INDIA
• Two recent nationwide studies to determine hypertension prevalence
have been performed-Fourth National Family Health Survey and Fourth
District Level Health Survey/Annual Health Survey.
• Age-adjusted hypertension was more in men (24.5%) than women
(20.0%). Hypertension is more common in developed states of the
country, urban populations and better socioeconomic status individuals.

6. RISK FACTORS

7. SYMPTOMS

8. ASSESSMENT OF HYPERTENSION
1. Assessment of medical history:
• Family history
• Symptoms of consequences of
hypertension
• Frequent intake of pain relieving drugs
(NSAIDS)
• Steroid intake for asthma
• Breathing difficulty particularly on
exertion
• Swelling of feet
• Urinary difficulties, history of passing
stones in the past
2. Asses Risk factors
• Lack of physical activity (or
sedentary lifestyle)
• Obesity or being overweight
• Abdominal obesity (Waist
circumference more than 90 cm in
male and 80 cm in females)
• High sodium intake/high salt intake
• Excess alcohol consumption

9. COMPLICATIONS OF HYPERTENSION
Heart:
Left ventricular hypertrophy
Diastolic dysfunction
CHF
Cardiac arrhythmias
Brain:
Brain infarction
Hemorrhage
Eye:
Micro-aneurysms
Hemorrhages
Hard exudates
Cotton-wool spots
Kidneys
Macro albuminuria
Micro albuminuria

10. ASSESSMENT OF HYPERTENSION
3) Physical examination:
• BP measurement
• Measurement of body weight and height to obtain BMI
• Measurement of Waist circumference.
• Palpating all peripheral pulses
• Auscultation for bruit (renal, carotid, abdominal and others)
• Eye evaluation if ophthalmology facility is available
The management should include Life-style management and Drug
Therapy

11. LABORATORY INVESTIGATIONS AND ECG
• Blood tests: Sodium, potassium, serum creatinine and estimated glomerular
filtration rate (eGFR). If available, lipid profile and fasting glucose.
• Urine test: Dipstick urine test.
• 12-lead ECG: Detection of atrial fibrillation, left ventricular hypertrophy
(LVH), ischemic heart disease.
OTHERS: CT Scan , MRI , Ultrasound , Echo-cardiography.

12. PREVENTION OF HYPERTENSION
• WHO recommendations
1.Primary Prevention : “ All measures to reduce the incidence of disease in
a population by reducing the risk of the onset”.
A. Population Strategy – Shift community distribution of BP towards lower
level or biological normality.
B. High-Risk Strategy – To prevent the attainment of levels of BP at which the
instititution of treatment would be considered.
2.Secondary Prevention. To detect & control HTN in affected individuals.
A. Early Case detection.
B. Treatment
C. Patient Compliance.

13. LIFESTYLE MODIFICATION

15. PHARMACOTHERAPY