2. HYPERTENSION
Hypertension is defined as arterial blood pressure that exceeds an arbitrarily established
to limit. In adults a pressure of less than 140/90 is considered within the range of normal.
Either systolic or diastolic pressure may be elevated.
An increase in diastolic compared with the systolic pressure is regarded as a stronger
predictor of hypertension associated cardiovascular complications.
Hypertension is considered to be major risk factor for coronary heart disease, stroke,
congestive heart failure, peripheral vascular disease and chronic renal failure.
3. CLASSIFICATION:
Hypertension is classified by severity.In90 percentage of cases that etioloy of the elevated
blood pleasure is unknown and the hypertension thus classified primary or essential
hypertension in place than 10% of cases the cause of hypertension secondary to another
condition.
Blood pressure mm/Hg Category
Diastolic Normal BP
<85 High normal BP
85- 89 Mild hypertension
90-104 Moderate hypertension
>115 Severe Hypertension
Systolic
<140 Normal BP
140-159 Borderline isolated systolic
hypertension
>160 Isolated Hypertension
4. SECONDARY HYPERTENSION:
The most prevalent cause of secondary hypertension are chronic renal disease , Coarctation of
the aorta, primary aldosteronism, pheochromocytoma and pregnancy.
Coarctation of the aorta is a narrowing od aorta caused by a deformity of the tunica media
resulting in a specific increase in systolic pressure
Primary aldosteronism refers to any of several disorders of the adrenal gland that result in the
hypertension of aldosterone, which in turn, causes sodium and water retention and potassium
loss.
Pheochromocytoma is a rare disorder in which a tumor on the adrenal medulla causes excessive
secretion of epinephrine and epinephrine. Secondary hypertension is also caused by Cushing ‘ s
disease, The hypertension of adrenocorticotropic hormone (ACTH) from the anterior pituitary,
which results in excess release of cortisol from the adrenal cortex.
Hypertensive disorders occurs in as many as 10% of all pregnancies. The most serious of these
condition is pregnancy induced hypertension, Which was formerly called toxaemia of
pregnancy.
5. The progression of symptoms from preeclampsia to eclampsia characterizes PIH. Preeclampsia
Usually develops after 20th week of pregnancy and is characterized by hypertension, edema and
proteinuria. If these condition to the more serious stage of eclampsia, convulsions and coma may occur
ESSENTIAL HYPERTENSION:
In general, renal function is thought to play a major role in the etiology of essential hypertension.
Some hypertensive individuals show an abnormal control of sodium excretion.
In other cases the place to be a hyperactive sympathetic nervous system in which Plasma Norepinephrine
adequately suppressed in response to a sodium load. The prevalence of hypertension increases with age in
women this this increase exercise after menopause black have higher rate of hypertension than whites up
38% of black and 29% of whites demonstrate hypertension .
Alcohol has a significant vasopressor effect and regular intake is associated with increased blood
pressure.
6. Chronic cigarette smoking is not associated with the high blood pressure levels however it is
associated with higher mortality rate among hypersensitive and is a major risk factor for
cardiovascular disease
Caffeine consumption causes a short term rise in literature but is not associated with chronic
hypertension mental and social or economic stress can cause a temporary rise in blood pressure
but there is no evidence that stresses causes sustained elevation
Obesity is clearly related to elevated blood pressure in many patients patient weight loss is
usually accompanied by a drop in blood pressure but even if pressure does not for
cardiovascular disease mortality and morbidity are reduced
High intakes of sodium chloride and cadmium and low dietary levels of calcium magnesium
and potassium are suggested to contribute to etiology of hypertension sodium is the major
cation in extracellular fluid and chloride is the Major anion.
7. Sodium is the major cation in extracellular fluid and cation is the major anion. Potassium is the
major cation and phosphate the major anion in the intracellular body fluids.
The sodium potassium pump and other energy requiring pumping systems maintain
concentrations of this ions.
Calcium is also a vital in regulating the movement of sodium and potassium across membranes.
Alternation in and balance within fluid compartments especially sodium balance, affect the total
body water balance and blood pressure.
Population studies demonstrate that the prevalence of hypertension is greater in populations
with higher sodium intake.
In most studies there is a subset of hypertensive individuals referred to as salt sensitive whose
blood pressure response to changes in sodium intake
8. Sodium chloride intake is generally restricted in the diet of hypertensive individual.
Investigators have suggested that the large intake of potassium may protect from hypertension.
Individuals with a low incidence of hypertension such as vegetarians, after consume lately low
amount of sodium and high amount of potassium
In addition studies with spontaneously hypertensive animal models demonstrate a decrease in
blood pressure in animals consuming a high sodium diet who are given supplementary potassium.
Magnesium intake and cadmium intake also affect blood pressure
Diet moderately or severely deficient in magnesium have been associated with increased blood
pressure in experimental animals current research suggest that a high calcium intake may protect
against hypertension
9. EFFECT OF UNCONTROLLED HYPERTENSION
Untreated hypertension usually progress slowly but it is potentially life threatening it increases the
workload of the heart and after damages the arterial walls.
Chronic uncontrolled hypertension is associated with an accelerated development of atherosclerosis and
in increase the incidence of coronary heart disease and stroke up especially if other risk factors such as
smoking hypercholesterolemia are also present uncontrolled hypertension may result in damage to organs
including the brain kidneys, eyes and extremities.
The heart may suffer congestive heart failure coronary artery disease kidneys can be damaged the renal
artery disease or fail because of nephrosclerosis.
Atherosclerosis in the brain can lead to transient ischemic attacks or stroke
Microvascular haemorrhage damages the eyes and brain
Atherosclerosis in vessels to the legs may cause clarification or decrease the pulse in lower extremities
10. • Stroke and congestive heart failure or most common consequences of hypertension
• When the heart compensates for the excessive workload by increasing the size of cardiac cells
leading to hypertrophy of the left ventricle, CHF occurs
• Eventually heart functions to rates and the heart feels as described later on CHF.
• Stroke occurs when blood supply to the brain fails and heart fails.
• Hypertension can cause damage to arterial walls that accelerates the formation of emboli, thrombi or
atherosclerosis, reducing the size of the lumen.
• The severity of the damaged is determined by the location and extent of the loss of circulation
• in some patient the blood pressure rises suddenly representatives a change from slowly progressive
burning hypertension to malignant hypertension that has a diastolic pressure greater than 140 mm hg.
• Symptoms of progressively increasing blood pressure include headache ,vertigo, tinnitus syncope
and dimmed vision
• Malignant hypertension progressed rapidly and usually fat is left untreated.
11. MANAGEMENT.
The management of hypertension has changed over the years from items to control hypertension only
when it became severe to present policy of aggressively treating fairly mild increases in blood pressure
The statistic support the belief that early treatment of high blood pressure reduces complication and
mortality due to hypertension. Since the National high blood pressure education program(NHBPEP) which
was launched in 1972 and the program have declined the deaths due to coronary artery disease strokes are
declined 25% and 50% respectively.
Management of hypertension currently include both nonpharmacological and pharmacological or drug.
Treatments non-pharmacological includes weight reduction and other dietary changes behaviour
modification to reduce stress and regular aerobic exercise
12. In individuals with mild hypertension that is and diastolic pressure of 90-104 mm hg non-
pharmacological methods special dietary or tried first it is estimated that mile hypertension can be
managed without drugs and 40% of such individual
In those whose diastolic pressure does not fall below 90 mm Hg with nonpharmacological
methods drugs are added to the therapy it is recommended that hypertensive individuals not
smokes, since smoking is a major cardiovascular risk factor
DIET
Important dietary consideration in the management of hypertension include weight control
restricted sodium intake assurance of adequate potassium magnesium and calcium intake and
restricted alcohol consumption
13. WEIGHT REDUCTION :
weight loss in one over waiting to individuals is considered to be the single most important
factor in the control of blood pressure. thus caloric intake and activity level should be adjusted to reach
ideal body weight even if the ideal body weight is not reached a partial reduction is advantageous in
lowering blood pressure and probably in reducing mortality and morbidity due to cardiovascular disease.
SODIUM RESTRICTION
When given a mild sodium restricted diet of 2-3 gram of sodium per day many individuals with mild
hypertension will show a decrease in blood pressure Mild sodium restriction is still advice because low
sodium diet will reduce potassium losses due to secondary hyperaldosteronism and allow use of lower drug
doses in most patients taking diuretics .It is considered that 1100-3300mg is a safe and adequate sodium
intake and only 200 mg is required to maintain sodium balance.
14. FOR USE IN CARDIOVASCULAR DISEASE SODIUM RESTRICTED DIETS ARE USED AT THE
FOLLOWING LEVELS:
Mild 2-3 g birthday is used in combination with drugs by patients with moderate heart damage and
mild hypertension.
Moderate sodium restriction of one gram per day is used to treat mild edema.
Strict sodium restriction 500 mg sodium per day is used for patient who have a team and severe
congestive heart failure
Alcohol restriction chronic consumption of more than 1oz of alcohol per day is clearly associated
with high blood pressure in many individuals it is recommended that people at risk for hypertension
reduce their alcohol intake to know more than 1 oz ethanol per day
15. POTASSIUM
Hypertensive individual should be increased to consume approximately 1875 - 25625 mg of
potassium daily.
patient should be instructed to be alert to symptoms of potential deficiency and anorexia, malaise
and muscle weakness. Patient instruct to increase their intake of potassium rich foods
OTHER DIET COMPONENTS
Individuals with hypertension may be increased to reduce the intake of saturated fat because
hypertensive patients after have hypercholesterolemia and an increased risk of coronary heart
disease
16. These studies suggest that intake of linoleic acid from polyunsaturated fats tends to reduce
blood pressure in animal models and humans with hypertension. This effect of linoleic acid is
ascribed to a greater synthesis of vasodilatory prostaglandins in the total body and kidneys as
demonstrated by increased urinary excretion of prostaglandin derivatives with increasing
levels of linoleic acid intake.
Intake of omega 3 fatty acids from fish oils we also have in antihypertensive effect due to
modulation of eicosanoid synthesis currently an active area of research
