Cardiovascular disease are agroup of disorders of the heart and blood vesssels.

1. Prepared By
Ms.Mokshada.R.Bhirud

2.  Introduction to hypertension:-
Hypertension is defiend as systolic blood pressure greater than 140 mmhg
and/or diastolic blood pressure greater than 90 mmhg.
Primary hypertension:- It has no definite cause and should be treated by general
approch & about 90%people suffer from this SBP 140-159
mmhg,DBP-90-99mmhg.
Secondary hypertension:-
It has some definite cause & about 10%people suffer
from this SBP more than 160mmhg DBP more than
100mmhg
Preganacy include hypertension:-
Beacause of increased production of harmones
and enzymes during pregnancy.

3. Classification of Hypertension
BP Grading *SBP(mm Hg) *DBP(mm Hg)
Normal 120-129 and/or 80-84
Prehypertension 130-139 and/or 85-89
Grade 1 Hypertension 140-159 and/or 90-99
Grade 2 Hypertension 160-179 and/or 100-109
Grade 3 Hypertension >180 and/or >110
Isolated Systolic Hypertension >140 and/or >90
Hypertensive urgency > 180and/or >110
Hypertension is defined as systolic blood pressure greater than 140 mmHg
and/or diastolic blood pressure greater than 90 mmHg.

4. Etiopathogenesis of hypertension:-
(Etiopathogenesis means the cause and development of the disease or
abnormal condition.)
1. Renal Disease e.g. chronic diffuse glomerulnrphritis,pyelonephritis,polycystic
kidney,etc.
2. Endocrine Disease e.g. cushing’s syndromes,pheochromocytoma,
primary hyperaldosteronism,
3. Vascular lesions e.g. renel artery disease,contraction of arorta,etc.
Hypertension is an asymptomatic condition. If untreated, it can lead to
target organ damage such as, coronary artery disease, left vrntricular
hypertrophy, strok, peripheral vascular diseases, renal disease, etc

5. Clinical manifestations of hypertension(Symptoms):-
 Often asymptomatic(silent killer).
 fatigue, headache, epistasis, vomiting, giddiness, breathlessness, and
palpitations.
 Strok, acute myocardial infraction due to vascular disease.
 Bruits over carotid.
 Spells of sweating, tachycardia indicates pheochromocytoma.
 Neck swelling indicates thyroid disorder.
 Chest pain.
 Tiredness.
 Vision changes.
Block in Artery
Muscle
Damage
Heart Attack

6.  Non-Pharmacological Manegement :-
1. Physical activity.
2. Dietary Sodium Restricton.
3. Weight Reduction.
4. Avoid Smoking.
5. Avoid alcohol consumption.
6. Stress Management.
7. Yoga.
8. DASH Diet(Dietary Approaches to Stop Hypertansion.

7.  Pharmacological Manegment :-
Pharmacological treatment means management of hypertension
with drugs.
1. Diuretics: (e.g. Hydrochlorothaizide,Furosemide).
2. β-blockers (e.g. Atenolol).
3. CCB-Calcium Channel blockers (e.g. Amlodipine).
4. α-blockers: (e.g.Prazosin).
5. ACE-Angiotensin converting enzyme inhibitor
(e.g.Captopril,Ramipril,Enalapril).

8. Angina Pectoris
Angina means pain and Pectis means chest
“It is a pain syndrome accurs due to adverse induction in oxygen supply and
oxygen demand(Iscemic Heart Disease).”
 Types of Angina Pectoris:-
There are three types of Angina Pectoris.
1. Stable Angina.
2. Unstable Angina.
3. Variant/Vsospastic Angina.

9. Stable angina generally
occurs with physical
exertion,but can be
improved after rest.
Ustable angina
Unstable angina
Unstable angina generally
accurs at rest.is a
dangerous condition
emergency treatment,and
is often a sing that a heart
attack could accur soon.
Variant angina
Variant angina is a rare
from that is caused by a
spam in a coronary artery.

10. Causes:-
Angina is the result of myocardial ischemia caused by n imbalance
between myocardial oxygen supply and oxygen demand.
O2 demand(Physical activity )
O2 Supply (blood flow obstruction)
 Symptoms:- 1. Chest pain.
2. Pain radiant to the neck ,jaw,teeth,back or epigastric
region.
3. Breathlessness.
4. Fatigue.
5. Reduced cardiac output.
6. Indigation.
7. Heartburn.
8. Sweating.
9. Nausea.
10. Shortness of breath.

11.  Diagnosis:-
• Physical examination.
• ECG examination.
1. Resting ECG.
2. Exercise ECG.
• Coronary angiography.
• Radionuclicde Imaging.
• Chest X-ray.
• MRI.
• Complete blood count.
• Lipid profie.
 Pharmacological Manegment:-
• Tab.Aspirin 75 mg once daily (antiplatet drug).
• Tab.Clopidogrel 75 mg per day (antiplatet drug).
• Tab. Atorvastatin 40 mg per day (antihyperlipidemic
drug.
• Nitrates-Sublingual Glyceryl trinitrate 300-500 mg
t.i.d
• Β-blockers:Tab Metoprolol 50-200 mg/day(orally in
divided dose).
• CC-blockers:Tab.Amlodipine 5-10 mg once a day.
Stable Angina

12. Unstable Angina
• Sublingually Nitroglycerin 300-600 mg stat
(immediately). It can be repeated after 5
min . Max 3 doses can be given.
• Aspirin initial dose of 325 mg followed by
150 mg /day life long.
• Clopidogrel initial dose of 300 mg followed
bt 75 mg/day for 2 years.
• Tab Atorvastatin 40 mg/day life long.
• Enoxaparin- Anticoagulant drugs.
 Non-Pharmacological Manegment:-
Stable Angina
• Daily Exercise.
• Stop smoking.
• Avoid alcohol.
• Dietry modification.
• Avoid any activity known to precipitate angina
attack.
• Weight reduction in obese patient

13. Unstable Angina
• Comlete bed rest.
• Coronary angiography.
• Regular medical check-up.
• Psychotherapy to relieve
nervousness.