Hypertension Definition & management & types & treatment

1. Hypertension
Created by Dr / Mohamed

2. Hypertension Defination
Is chronic medical condition refer to high blood pressure characterized by
consistently elevated blood pressure in the arteries , It is typically measured in
millimetres of mercury (mm Hg) and is expressed as two values:-
 Systolic Pressure:-This is the higher number and represents the pressure in the
arteries when the heart contracts (beats) and pumps blood into the circulatory
system.
 Diastolic Pressure:- This is the lower number and represents the pressure in the
arteries when the heart is at rest between beats.

3. Hypertension Stages
Stage Systolic Diastolic
Normal < 120 mmHg < 80mmHg
Pre hypertension 120 – 139 mmHg 80-89mmHg
Stage (1) 140 – 159 mmHg 90 – 99 mmHg
Stage (2) 160 or more mmHg 100 or more mmHg

4. Hypertension Risk Factors
 Age .
 Family history.
 Obesity .
 Too High salt intake .
 Alcohols .
 Smoking .
 Lack of exercise .

5. Hypertension Management
 Healthy Diet (Dash Diet) .
 Stop Alcohol Drinking.
 Quit Smoking .
 Exercise Regularly .
 Weight Management .

6. Hypertension Symptoms
Most People do not feel any symptoms so that
hypertension called (Silent Killer) .
NOTE
Most hypertension Symptoms :-
 Severe Headache .
 Chest Pain .
 Blurred Vision .
 Difficulty Breathing .
 Nose Bleeding .
 Vomiting and Nausea .

7. Hypertension Classification
Primary Hypertension Secondary hypertension
also known (idiopathic hypertension) or
(Essential hypertension) is elevated high
blood pressure without certain causes :-
Some causes related to Primary HTN :-
 Genetics .
 Age .
 Life style (smoking – Alcohol – stress ) .
 Obesity .
is elevated high blood pressure results from
certain causes :-
 Kidney diseases .
 Endocrine system disorders .
 Drugs have hypertension as (side effect) .

8. Hypertension sub types
White coat
hypertension
Resistant hypertension
Malignant
hypertension
Isolated
hypertension
Is elevated high blood
pressure occurs when
the doctor measure
blood pressure due to
stress .
Is elevated high blood
pressure despite use
more than one drug to
treat .
Is severe high blood
pressure lead to organ
damage .
Occurs when systolic
value is high but
diastolic value is
normal .

9. Hypertension investigations Tools
 Blood pressure measurement .
 Blood Tests .
 Kidney Tests .
 Urine Test .
 Lipid Tests .
 Glucose Tests .
 X-rays .
 Electrocardiogram (ECG) .
 Echocardiogram (ECHO) .
 Ambulatory Blood Pressure Monitoring (ABPM) .

10. Hypertension Compilcations
 Cardiovascular Diseases (heart failure – heart attack).
 Angina (Chest pain) .
 Aneurysm .
 Metabolic Syndrome
 Stroke .
 Kidney Diseases (CKD – Kidney failure) .
 Eye Problems (Retinopathy) .

11. Sympathetic Nervous System Activation
In Stress occurs Sympathetic Nervous System Activation through binding of between(
Adrenaline – Noradrenaline) and Adrenergic receptors (Alpha – beta receptors) lead to
increase Cardiac output and Vasoconstriction Lead to Hypertension .
Renin-Angiotensin-Aldosterone System (RAAS)
 When blood pressure drops Lead to the kidneys release renin enzyme .
 Renin acts on angiotensinogen (produced by the liver) to form angiotensin I then (ACE) converts
angiotensin I into angiotensin II.
 Angiotensin II causes Vasoconstriction and stimulates the release of aldosterone from the adrenal
glands which Lead to increase sodium reabsorption leading to water retention and an increase in
blood volume.
 Vasopressin (ADH Hormone) :-
 ADH refer to (Anti Diuretic Hormone) which released by (Pituitary gland) when blood pressure
drops pituitary gland secrete ADH which work on kidney to prevent water excretion which lead
to increase blood volume and increase blood pressure .

12. Hypertension Treatment
ABCD
ACE
Alpha blockers
ARBs
Beta blockers CCBs Diuretics
Direct Vasodilators

13. Hypertension Treatment
 Diuretics .
 Renin inhibitors .
 Angiotensinll Receptors Blockers (ARBs) .
 Angiotensin – converting Enzyme inhibitors (ACE) .
 Calcium Channels (CCBs) .
 Alpha blockers .
 Beta blockers .
 Direct Vasodilators .
 Nitrates .
 Central – Alpha 2 receptors Agonists.

14. Diuretics
Mechanism :- Help kidney to Prevent reabsorption of sodium and water that lead to reduce
blood volume and modify blood pressure .
 Charactized by “Ide” Suffix .
Diuretics split to 3 main classes are :-
 Thiazide Diuretics .
 Loop Diuretics .
 Potassium – sparing Diuretics ..

15. Thiazide Diuretics Loop Diuretics Potassium – sparing Diuretics
Mechanism :- Prevent
sodium reabsorption in the
distal convoluted tubules of
the kidneys.
Drugs :-
 Hydrochlorothiazide .
 Indapamide .
 Chlorthalidone .
 Metolazone .
Mechanism :- Loop
diuretics act on the loop of
Henle in the kidneys
inhibiting sodium and
chloride reabsorption .
Drugs :-
 Furosemide .
 Torsemide .
 Bumetanide .
Mechanism :- These diuretics
work by blocking the effects of
aldosterone hormone that
promotes salt and water retention .
Drugs :-
 Spironolactone .
 Amiloride .
 Triamterene .
 Eplerenone .

16. Contraindications Side effects
 Anuria .
 severe kidney disease .
 Hyperglycaemia .
 electrolyte imbalances .
 increased urination .
 breast enlargement in males .
 menstrual irregularities in
females .

17. Renin inhibitors
Mechanism :- inhibit renin enzyme which responsible for (angiotensin I
Production) lead to vasodilation and modify blood pressure .
Renin inhibitors Drugs :-
 Aliskiren .

18. Contraindications Side effects
 Systolic heart failure.  Hyperkalaemia.
 Cough.
 Diarrhea.

19. Angiotensinll Receptors Blockers (ARBs)
Mechanism :- acts as Vasodilators through blocking Angiotensinll receptors (AT1).
 Charactized by “sartan” Suffix .
ARBs Drugs :-
 Losartan .
 Olmesartan .
 Valsartan .
 irbesartan.

20. Contraindications Side effects
Angioedema .
pregnancy.
Bilateral renal artery
stenosis .
Dry cough .
Angioedema.
Headache.
Fatigue.

21. Angiotensin – converting Enzyme
inhibitors (ACE)
Mechanism :- acts as Vasodilators through inhibition conversion Angiotensin l to
Angiotensin ll.
 Charactized by “Pril” Suffix .
ACE Drugs :-
 Lisinopril .
 Enalapril .
 Ramipril .
 Captopril .

22. Contraindications Side effects
Angioedema .
pregnancy.
Bilateral renal artery
stenosis .
Dry cough .
Angioedema.
Headache.
Fatigue.

23. Calcium channel blockers (CCBs)
Mechanism :- Blocks calcium channels (L-type calcium channels) in vascular and cardiac
muscles which lead to Vasodilation and reduce cardiac output then modify blood pressure.
Charactized by “pine” Suffix .
CCBs split to 2 main classes are :-
Dihydropyridine Non – Dihydropyridine
Work on vascular muscle
and acts as Vasodilators
such as :-
 Amlodipine .
 Felodipine .
 Nimodipine .
 Isradipine .
 Clevidipine
Work on both Cardiac muscle and vascular muscle
Benzothiazepines
 Diltiazem .
Phenylalkylamines
 Verapamil .

24. Contraindications Side effects
 Systolic heart failure.  Constipation.
 Headache.
 Ankle swelling.

25. Alpha blockers
Mechanism :- acts as Vasodilators through Blocking Alpha 1 Adrenergic receptors .
 Charactized by “Osin” Suffix .
Alpha blockers Drugs :-
 Doxazosin .
 Terazosin .
 Prazosin .

26. Contraindications Side effects
 Orthostatic hypotension  Nasal congestion.
 Dizziness.
 Fatigue.
 Headache.

27. Beta blockers
Mechanism :- acts as beta receptors blockers which found in heart and blood vessels and
kidney which lead to modify blood pressure .
 Charactized by “lol” Suffix .
Beta blockers split to 3 main classes are :-
 Non – selective beta blockers .
 Selective Beta - 1 blockers .
 Alpha beta blockers .

28. Non – selective beta blockers Selective Beta - 1 blockers Alpha beta blockers
Blocks beta 1 and beta2
receptors such as :-
 Nadolol .
Blocks beta 1 receptors
such as :-
 Atenolol .
Blocks alpha and beta receptors
such as :-
 Carvedilol .

29. Contraindications Side effects
 bradycardia.
 severe asthma .
 Chronic obstructive
pulmonary disease (COPD)
.
 mask symptoms of low blood
sugar.
 Cold hands and feet.
 Depression.
 Sexual dysfunction .

30. Direct Vasodilators
Mechanism :- acts as Vasodilators through relaxing Blood Vessels and lead to modify
hypertension .
Direct Vasodilators Drugs :-
 Hydralazine .
 Minoxidil .
 Sodium Nitroprusside .

31. Nitrates
Mechanism :- work through Decrease Cardiac work load through converts to Nitric oxide
(NO) Lead to increase (cGMP) Lead to relax veins in body and modify blood pressure .
Nitrates Drugs :-
 Nitroglycerin .
 Isosorbide Mononitrate.
 Isosorbide Dinitrate.

32. Central – Alpha 2 receptors Agonists
Mechanism :- Stimulates Alpha 2 receptors in brain which lead to
decrease sympathetic nervous system .
Central – Alpha 2 receptors Agonists Drugs :-
Clonidine .
Methyldopa .

33. Hypertension in Pregnancy
Definition :- refers to elevated blood pressure levels during (Gestation) effects on
mother and Fetus .
Risk factors of Hypertension in Pregnancy :-
 Family History .
 Age .
 Pre – existing Hypertension .
 Bad Life Style .
 Obesity .
 Diabetes
 Kidney Diseases .
 Endocrine Diseases .

34. Types of Hypertension in Pregnancy
Gestational Hypertension
(PIH)
Chronic
Hypertension
Pre – Eclampsia Pre – Eclampsia
Superimposed
Characterized by High
blood pressure without
proteinuria (protein in
urine) after 20 weeks of
pregnancy.
Characterized by
Pre-existing high
blood pressure
before pregnancy
or diagnosed
before 20 weeks
gestation.
Characterized by high
blood pressure and
damage to
organs(Kidney), often
including proteinuria.
Can develop after 20
weeks of pregnancy.
Women with chronic
hypertension may
develop worsening
symptoms of
preeclampsia during
pregnancy.

35. Treatment of Hypertension in Pregnancy
Life Style Medications
 Good Nutrition .
 Weight management .
 Methyldopa .
 Nifedipine .
 Labetalol .
Avoid (ACE - ARBs) drugs .

36. Thank You