3. INTRODUCTION
Arterial hypertension is defined as borderline when it
reaches 140/95mmHg and hypertensive when its
165/95mmHg.
The elevation of systolic pressure alone (systolic
hypertension) or elevation of both systolic and diastolic
pressure (diastolic hypertension), both have an increased risk
of complication, but diastolic hypertension is more
dangerous.
4. CLASSIFICATION
Primary or essential hypertension in which the cause of
increase in blood pressure is unknown. This hypertension
constitutes about 90-95% patient with hypertension.
Secondary hypertension, remaining 5–10% of cases are
caused by other conditions that affect the kidneys, arteries,
heart, or endocrine system.
5. Essential arterial hypertension is arterial hypertension of
unknown origin and not associated with other diseases.
Symptomatical (secondary) arterial hypertension is symptom
disease of the kidneys, endocrine system, heart, nervous
system, exogenous(salt-,alcohol-,medicament drugs-,toxin
associated),pregnancy associated and other.
6. CAUSES
Unknown cause (idiopathic pulmonary arterial hypertension)
A genetic mutation passed down through families (heritable
pulmonary arterial hypertension)
Use of some prescription diet drugs or illegal drugs such as
methamphetamines — and other drugs
Heart problems present at birth (congenital heart disease)
Other conditions, such as connective tissue disorders
(scleroderma, lupus, others), HIV infection or chronic liver
disease (cirrhosis)
8. RISK FACTORS
A family history of the condition
Being overweight
Blood-clotting disorders or a family history of blood clots in
the lungs
Exposure to asbestos
Genetic disorders, including congenital heart disease
Living at a high altitude
Use of certain weight-loss drugs
Use of illegal drugs such as cocaine
9. COMPLICATION
Right-sided heart enlargement and heart failure (cor
pulmonale)
In cor pulmonale, your heart's right ventricle becomes
enlarged and has to pump harder than usual to move blood
through narrowed or blocked pulmonary arteries.
Blood clots
Having pulmonary hypertension makes it more likely you'll
develop clots in the small arteries in your lungs, which is
dangerous if you already have narrowed or blocked blood
vessels.
10. Arrhythmia
Pulmonary hypertension can cause irregular heartbeats
(arrhythmias), which can lead to a pounding heartbeat
(palpitations), dizziness or fainting. Certain arrhythmias can
be life-threatening.
Bleeding in the lungs
Pulmonary hypertension can lead to life-threatening bleeding
into the lungs and coughing up blood (hemoptysis).
Pregnancy complications
Pulmonary hypertension can be life-threatening for a woman
and her developing baby.
11. DIAGNOSIS
Blood tests
Include HIV, thyroid tests, autoimmune disease panels (test for
systemic lupus erythematosus, scleroderma, and rheumatoid
arthritis), liver tests and blood chemistry tests.
Electrocardiogram
Shows the electrical activity of the heart and may help detect
abnormalities. Doctors may also be able to detect signs of strain
on the right side of the heart.
Lung function tests (breathing tests)
Check for diseases like asthma or emphysema.
12. 6-Minute Walk Test
Objectively measures how far you can walk and to see if your
oxygen levels drop when you exert yourself.
Echocardiogram
Ultrasound of the heart to check the size and condition of the
chambers of the heart. It can also be used to estimate the blood
pressure in the pulmonary arteries.
Right Heart Catheterization
This test is invasive, so it is not usually performed unless other
tests cannot produce a firm diagnosis. It involves inserting a
catheter (small tube) into a large vein in either the neck, arm, or
groin, and threading it through the right side of the heart and
into the pulmonary artery.
13.
14. Sildenafil and tadalafil
o Sildenafil (Revatio, Viagra) and tadalafil (Adcirca, Cialis) are
commonly used to treat erectile dysfunction.
o Also open the blood vessels in the lungs and allow blood to
flow through more easily.
o Side effects can include an upset stomach, headache and vision
problems.
Guanylate cyclase (GSC) stimulators
o Riociguat (Adempas) increases nitric oxide in the body, which
relaxes the pulmonary arteries and lowers pressure within them.
o Side effects include nausea, dizziness and fainting. You should
not take GSC stimulators if you're pregnant.
15. ACE INHIBITORS
Captopril, 25-50 mg, 2-3 times per day
Enalapril, 10-20 mg, 1-2 times per day
Lisinopril, 10-20 mg, 1-2 times per day
Perindopril, 4-8 mg, 1 times per day
16. CALCIUM CHANNEL BLOCKERS
High-dose calcium channel blockers
o These drugs help relax the muscles in the walls of your blood vessels.
o They include amlodipine (Norvasc), diltiazem (Cardizem, Tiazac,
others) and nifedipine (Procardia, others).
o Although calcium channel blockers can be effective, only a small
number of people with pulmonary hypertension improve while taking
them
Digoxin
o Digoxin (Lanoxin) helps the heartbeat stronger and pump more blood.
It can help control the heart rate if you have arrhythmias.
17. Anticoagulant
Warfarin
o Doctors generally prescribe warfarin (Coumadin, Jantoven) to
help prevent blood clots in the lung's arteries. This medication
delays the clotting process and might put you at risk of
bleeding, especially if you're having surgery or an invasive
procedure.
o Blood tests while taking warfarin are suggested to check how
well it's working.
18. Diuretics
Diuretics
o Commonly known as water pills, these medications help
kidneys remove excess fluid from the body.
o This reduces the amount of work your heart has to do
o They may also be used to limit fluid buildup in your lungs, legs
and abdomen.
Oxygen therapy
o doctor might suggest to breathe pure oxygen to help treat
pulmonary hypertension, especially if you live at a high altitude
or have sleep apnea.
o Some people who have pulmonary hypertension eventually need
continuous oxygen therapy.