This Will Give Detail Information On HYPERTENSION likes Types, Sign and Symptoms, Causes , Identification Test, Treatment, Drug Use for It . Plz Share and Give Suggestions for Improvement. THANK YOU 

1. • HYPERTENSION
Prepared By :- ROHITKUMAR
S. RATHI
Third year
B-pharmacy

2. Hypertension: Definition
Persistent elevation of
 Systolic blood pressure ≥140 mm Hg
or
 Diastolic blood pressure ≥90 mm Hg
Direct relationship between hypertension and
cardiovascular disease (CVD)

3. Prehypertension: Definition
• Systolic blood pressure:
120–139 mm Hg
or
• Diastolic blood pressure:
80–89 mm Hg

4. Epidemiology
• About 33% urban and 25% rural Indians are
hypertensive.
• Of these, 25% rural and 42% urban Indians are
aware of their hypertensive status.
• Only 25% rural and 38% of urban Indians are
being treated for hypertension.
• Risk of hypertension increases with age; if
you don’t have it by age 55 – 90% chance of
getting it later in life

5. Factors Influencing
Blood Pressure (BP)
Blood Pressure
= Cardiac Output × Systemic Vascular Resistance
• Cardiac output is total blood flow through
systemic or pulmonary circulation per min.

6. Factors Influencing BP
 Cardiac
•Heart rate
•Inotropic state
•Neural (pons and medulla)
•Humoral (hormones)
Cardiac Output
 Renal Fluid Volume Control
•Renin–angiotensin
•Aldosterone
•Atrial natriuretic factor

7. Sympathetic Nervous System
Baroreceptors
• Nerve cells in carotid artery & aortic arch
• Maintain BP during normal activities
• React to increases & decreases in BP
BP – impulse to brain to inhibit SNS; HR
& force of ctrx; vasodilation of arterioles
BP – activates SNS; vasoconstriction of
arterioles; HR & heart contractility

8. Increased BP send inhibitory impulse to
sympathetic vasomotor center in brainstem;
In long-standing hypertension, baroreceptors
adjust to elevated BP and reads it as normal;
doesn’t make adjustments; also becomes less
responsive in some older adults

9. Mechanism of Action of Aldosterone

10. Blood Pressure Classification

11. Etiology of Hypertension
Primary (essential or idiopathic) hypertension
----Elevated BP without an identified cause
----90% to 95% of all cases

12. Etiology of Hypertension
• Primary (essential or idiopathic) hypertension
I) Contributing factors
– • ↑ SNS activity
– • ↑ Sodium retaining hormones and
– vasoconstrictors
– • Diabetes mellitus
– • > Ideal body weight
– • ↑ Sodium intake
– • Excessive alcohol intake

13. Secondary Hypertension
• Elevated BP with a specific cause
---- 5% to 10% of adult cases.
– Contributing factors:
– • Coarctation of aorta name given to a congenital
condition whereby the aorta
– narrows in the area where the ductus arteriosus
(ligamentum arteriosum after regression) inserts.
– • Renal disease
– • Endocrine disorders
– • Neurologic disorders
– • Cirrhosis
– • Sleep apnea
• If someone under 20 or over 50 suddenly develops
hypertension, esp. severe then suspect secondary
cause

14. Hypertension:
Predisposing factors
• Advancing Age
• Sex (men and postmenopausal women)
• Family history of cardiovascular disease
• Sedentary life style & psycho-social stress
• Smoking ,High cholesterol diet, Low fruit
consumption
• Obesity & wt. gain
• Co-existing disorders such as diabetes,
and hyperlipidaemia
• High intake of alcohol

16. etiology of Systemic
Hypertension
Secondary HTN (05%)
A. Renal (80%) • AGN
• CGN,
• CPN,
• Polycyst. K.D
• Renal Artery stenosis
B. Endocrine • Adrenal • Primary aldosteronism
• Cushing’s syndrome
• Pheochromocytoma
• Acromegaly
• Exogenous hormone • Oral contraceptive
• Glucocorticoids
• Hypothyroidism &
• Hyperparathyroidism
Continue…

17. Others
– Coarctation of the aorta
– Pregnancy Induced HTN (Pre-eclampsia)
– Sleep Apnea Syndrome.

18. Diseases Attributable to
Hypertension
HYPERTENSION
Gangrene of the
Lower Extremities
Heart
Failure
Left Ventricular
Hypertrophy Myocardial
Infarction
Coronary Heart
Disease
Aortic
Aneurym
Blindness
Chronic
Kidney
Failure
Stroke Preeclampsia/E
clampsia
Cerebral
Hemorrhage
Hypertensive
encephalopathy

19. Clinical
manifestations
• No specific complains or manifestations other than
elevated systolic and/or diastolic BP (Silent Killer )
• Morning occipital headache
• Dizziness
• Fatigue
• In severe hypertension, epistaxis or blurred vision

20. Diagnostic Studies
History and physical examination
BP measurement in both arms
 Use arm with higher reading for subsequent
measurements
 BP highest in early morning, lowest at night

21. Laboratory Tests
 Routine Tests
• Electrocardiogram
• Urinalysis
• Blood glucose,
• Serum potassium, creatinine, or the corresponding estimated GFR,
and calcium
• Lipid profile, after 9- to 12-hour fast, that includes high-density and
low-density lipoprotein cholesterol, and triglycerides
 Optional tests
• Measurement of urinary albumin excretion or albumin/creatinine
ratio
 More extensive testing for identifiable causes is not generally
indicated unless BP control is not achieved

22. Treatment Overview
Goals of therapy
Lifestyle modification
Pharmacologic treatment
 Algorithm for treatment of hypertension
Follow up and monitoring

23. Goals of Therapy
Reduce Cardiac and renal morbidity and mortality.
Treat to BP <140/90 mmHg or BP <130/80 mmHg in
patients with diabetes or chronic kidney disease.

24. Non pharmacological
Treatment of hypertension
Avoid harmful habits ,smoking ,alcohal
Reduce salt and high fat diets
Loose weight , if obese
Regular exercise
DASH
diet

25. Life style modifications
• Lose weight, if overweight
• Increase physical activity
• Reduce salt intake
• Stop smoking
• Limit intake of foods rich in fats and
cholesterol
• increase consumption of fruits and
vegetables
• Limit alcohol intake

26. Drug therapy for
hypertension
Class of drug Example Initiating dose Usualmaintenance
dose
Diuretics Hydrochlorothiazide 12.5 mg o.d. 12.5-25 mg o.d.
-blockers Atenolol 25-50 mg o.d. 50-100 mg o.d.
Calcium Amlodipine 2.5-5 mg o.d. 5-10 mg o.d.
channel
blockers
-blockers prazosin 2.5 mg o.d 2.5-10mg o.d.
ACE- inhibitors ramipril 1.25-5 mg o.d. 5-20 mg o.d.
Angiotensin-II Losartan 25-50 mg o.d. 50-100 mg o.d.
receptor blockers

27. Diuretics
Example: Hydrochlorothiazide
• Act by decreasing blood volume and cardiac output
• Decrease peripheral resistance during chronic therapy
• Drugs of choice in elderly hypertensives
Side effects-
• Hypokalaemia
• Hyponatraemia
• Not safe in renal and hepatic insufficiency

28. Beta blockers
Example: Atenolol, Metoprolol, nebivolol,
• Block 1 receptors on the heart
• Block 2 receptors on kidney and inhibit release of renin
• Decrease rate and force of contraction and thus reduce
cardiac output
• Drugs of choice in patients with co-existent coronary
heart disease
Side effects-
• lethargy, impotency, bradycardia
• Not safe in patients with co-existing asthma and
diabetes

29. Calcium channel
blockers
Example: Amlodipine
• Block entry of calcium through calcium
channels
• Cause vasodilation and reduce peripheral
resistance
• Drugs of choice in elderly hypertensives and
those with co-existing asthma
• Neutral effect on glucose and lipid levels
Side effects
Flushing, headache, Pedal edema

30. ACE inhibitors
Example: Ramipril, Lisinopril, Enalapril
• Inhibit ACE and formation of
angiotensin II and block its effects
• Drugs of choice in co-existent diabetes
mellitus, Heart failure
Side effects-
dry cough, hypotension, angioedema

31. Angiotensin II
receptor blockers
Example: Losartan
• Block the angiotensin II receptor and
inhibit effects of angiotensin II
• Drugs of choice in patients with co-
existing diabetes mellitus
Side effects-
safer than ACEI, hypotension,

32. Alpha blockers
Example: prazosin
• Block -1 receptors and cause vasodilation
• Reduce peripheral resistance and venous
return
• Exert beneficial effects on lipids and insulin
sensitivity
Side effects-
Postural hypotension,

33. Thank
You
Date:17-4-2020