Hypertension, also known as high blood pressure, is a long-term medical condition in which the blood pressure in the arteries is persistently elevated. Blood pressure is expressed using two measurements - systolic and diastolic pressures. For most adults, normal blood pressure is within the range of 100-130 mmHg systolic and 60-80 mmHg diastolic. High blood pressure is present if the resting blood pressure is persistently at or above 130/80 or 140/90 mmHg. Treatment involves lifestyle modifications and medications such as diuretics, ACE inhibitors, ARBs, calcium channel blockers, and beta blockers. Uncontrolled high blood pressure can lead to damage of vital organs and increase risk of

2. What is Hypertension?
Hypertension (HTN or HT), also known as high
blood pressure (HBP), is a long-term medical
condition in which the blood pressure in
the arteries is persistently elevated.

3. Blood Pressure Measurement:
 Blood pressure is expressed by two measurements,
 the systolic and diastolic pressures, which are the
maximum and minimum pressures, respectively.
 For most adults, normal blood pressure at rest is within the
range of ;
100–130 mmHg systolic and 60–80 mmHg diastolic.
 For most adults, high blood pressure is present if the resting
blood pressure is persistently at or above 130/80 or 140/90
mmHg.

4. Stages of HTN:
Stage 1
140-159/90-
99 mmHg
Stage 2
>160/100 mmHg

5. PREHYPERTENSION
 Prehypertension is blood pressure readings with
a systolic pressure from 120 to 139 mm Hg or
a diastolic pressure from 80 to 89 mm Hg.
 Indivisuals who are pre hypertensive are not candidates for
drug therapy.
 Should be advised to practice lifestyle modification.
 Those with pre-htn, who also have diabetes or kidney
disease, drug therapy is indicated if a trial of lifestyle
modification fails to reduce their bp.

6. Isolated systolic blood pressure
 If the systolic blood pressure is elevated (>140) with
a normal (<90) diastolic blood pressure (DBP), it is
called "isolated systolic hypertension".
 Systolic bp should be primarily considered during
treatment and not just diastolic bp.
 Sbp is more imp risk factor after age 50
 Diastolic is more imp before age 50.

7. Hypertensive Crises:
 Severely elevated blood pressure (equal to or
greater than a systolic 180 or diastolic of 110) is
referred to as a hypertensive crisis.
 Hypertensive crisis is categorized as
either hypertensive urgency or hypertensive
emergency, according to the absence or presence
of end organ damage, respectively

8. HTN EMERGENCY HTN URGENCY
 Progressive end-organ
dysfunction.
 Severely elevated bp
>180/120mmHg
 Require emergent
lowering of bp.
 Examples include: Acute
Myocardial infarction or
unstable Angina.
 No progressive end-
organ dysfunction.
 Severe elevated bp in
the range of stage 2 htn.
 Examples : Highly
elevated bp without
severe headache,
shortness of breathe or
chest pain.

9. SYMPTOMS
A person with hypertension may not notice any symptoms, and
it is often called the “silent killer”.
If your blood pressure is extremely high, there may be certain
symptoms to look out for, including:
 Severe headache.
 Fatigue or confusion.
 Vision problems.
 Chest pain.
 Difficulty breathing.
 Irregular heartbeat.
 Blood in the urine.
.

11. ETIOLOGY OF HYPERTENSION
Primary Hypertension Secondary Hypertension
Primary Hypertension results
from a complex interaction of
genes and environmental
factors.
Such as:
High salt intake, lack of
exercise , obesity, aging,
Smoking etc.
Secondary hypertension
results from an identifiable
Cause.
such as ;
Kidney disease,
Hypothyroidism,
hyperthyroidism,
Cushing’s syndrome

12. One high reading does not mean you have high blood pressure. It is necessary to
measure the blood pressure at different times. To make the diagnosis of
hypertension at least three readings.

13. strategies

14. 1) Ambulatory B.P Measurement
 Ambulatory BP is
measure by a small BP
device usually attached
to a belt around the
body and connect to a
cuff around the upper
arm.
 It is standerstandard
for the diagnose of
hypertension and
pridector for CVD

15. Ranges of Ambulatory BP

16. 2) Home B.P measurements.
 Home B.P is define as the average of all remaining measure .
 Relatively inexpensive device my b use for home B.P
measurements these should include for morning and evening
both measurmeasuring b p in one week.
 It is important to acknowledge the measurements different
factors such as stress. Smoking or cardian variation.

17. 3) Office- based B.P measurement
 Despite there limitations
office based B.P
measurement continue to be
the primary technique used
world wide for the
detection and management
of hypertension.
 Multiple measurements of
different days may b
necessary such as patient
position , cuff size .

18. White coat hypertension
 Some people with normal
B.P find that it spike when
they visit to the doctor this
condition is called white
coat hypertension is also
called isolated or office
hypertension.
 The white coat may effect
persist for year it may
avoided by using ABPM or
home based B.P
monitoring.

19. Complications of
Hypertension

20. HYPERTENSION COMPLICATIONS
ORGANS DISEASES
 Heart
 Eyes
 The Kidneys
 Brain
 Heart attack, Heart failure.
 Retinopathy,vision loss
 Kidney Failure
 Stroke

22. HEART FAILURE:
The increased workload from high blood pressure
can cause the heart to enlarge and fail to supply
blood to the body and heart muscle doesn't pump
blood as well as it should.

23. KIDNEY FAILURE & DISEASE:
High blood pressure can
damage the arteries
around the kidneys and
interfere with their
ability to filter blood
effectively.

24. VISION PROBLEMS
High blood pressure can damage blood vessels
near eyes.

25. RETINOPATHY
 This may cause your blood vessels to become narrow ,which
then restricts blood from reaching the retina.
 In some cases retina become swollen.
 Over time high blood pressure can cause damage to the
retina’s blood vessels limit the retina function and causing
vision problems

26. Uninfected Retina Infected Retina

27. Diagnostic Tests
1. CBC
2. BLOOD GLUCOSE
3. LFT
4. RFT
5. ELECTROLYTES
6. CREATININE
7. ECG SCAN
8. PROTEIN, ALBUMIN (URINARY TEST)

28. Management Of
Hypertension

29. Non-pharmacological therapy
of hypertension

30. DASH DIET
(Dietry Approach To Stop Htn)

31. DIURETICS
Drugs that increase urine flow are called
diuretics.

32. Mechanism of Action
1. Increase renal excretion of Na and Water
2. Decrease plasma volume
3. Decrease peripheral resistance
(Desensitize smooth muscles to action of
catecholamine)

33. Adverse effects
Hypokalaemia – Muscle pain and fatigue
Hyperglycemia – Inhibition of insulin release due to
potassium depletion – Precipitation of diabetes.
Hyperlipidaemia – Rise in total LDL level
( Risk of stroke)
Hyperuricaemia
Sudden cardiac death

34. DRUG INTERACTION
NSAID
Reduce diuretic
efficacy
Corticosteroid
Enhance
hypokalaemia
Aminoglycoside
Enhance
nephrotoxicity

35. TYPES OF DIURETICS
THIAZIDES DIYRETICS
Hydrochlorothiazide and chlorothalidone
LOOP DIURETICS
Furosemide , torasemide
POTASSIUM-SPARING DIURETICS
Spironolactone , amiloride

36. Loop Diuretics
The loop diuretics inhibit chloride
reabsorption in the thick ascending loop of
henle.

37. INDICATIONS
 Hypertension
 Pulmonary edema with congestive heart failure
 Kidney problem
 Edema

38. Thiazide
diuretics
↓Na & water
retention
↓blood
volume
↓peripheral
resistance
Decrease in
blood pressure
↓cardicac
output
THIAZIDES DIURETIC MOA

39. Adverse Effects
 Hypokalemia
 Dehydration
 Hyperglycemia
 Hyperurecaemia

40. Potassium Sparing Diuretic
Not effective alone , so used in combination with other
diuretics to help maintain the potassium balance.
e.g Spironolactone, Amiloride, Uniretic
(HCT+Amiloride)
Adverse Effect:
 Hyperkalemia

42.  Inhibit generation of Angiotensin II
 Inhibit degradation of bradykinin
 Decrease aldosterone production indirectly
Eg: Captopril
DOSE 25 mg Sublingually onset : 5-15

43.  Benazepril (Lotensin)
 Captopril (Capoten)
 Enalapril (Vasotec)

44.  Hypertension with diabetes
 Hypertension: first line drug for all grades of hypertension but
specially indicated in
 Congestive cardiac failure
 Myocardial Infarction
 Diabetic Nephropathy

45.  Cough
 Angioedema (Life-threatening airway swelling and
obstruction; 0.1-0.2% of patients)
 Proteinuria
Who would not be given ACEI :
contraindicated in pregnancy.

46. Lack of postural hypotension
Safe in diabetes

47.  With potassium-sparing diuretics (e.g: Spirinolactone)
 NSAIDs may decrease ACE inhibitors the efficacy and increase
adverse renal effect
FOOD DRUG INTERACTION :
 Avoid taking food rich in potassium with captopril Or other ACEI
 Bananas and green leafy
 Because increase the amount of potassium in your body.
MANAGEMENT :
Should be taken 1hrs before meal because food reduce the
absorption 30%-40%.

49. • AT1:
– Vasoconstriction, aldosterone secretion, release NA
• AT2 receptor:
– Function is not known
• ARBs: competitively inhibit binding of angiotensin
II to AT1 receptor
• Has similar effects like ACE inhibitors
• Uses are similar to ACE inhibitors
• Mainly used in patients who cough with ACE
inhibitors
Eg : valsartan , (Losartan)

50. Advantage ARB’S of over ACE inhibitors
so less adverse effects like dry cough & angioedema
Drug Combination
Hydrochlorothiazide (12.5 mg+ Valsartan (60 or
80 mg)

51. Calcium channel blockers : (CCB's)
A calcium channel blocker is a chemical that disrupt the movement
of calcium (Ca+2) through calcium channels. They are also called
Calcium Antagonist.
OR
These are the important class of Cardiovascular drugs which act by
inhibiting L-type of voltage sensitive calcium channels in smooth
muscles and heart.

52. TYPES :
On the basis of chemical structure and activity there are three main
classes of CCB's:
1 - DIHYDROPYRIDINES : These works mostly on arteries.
2- BENZOTHIZEPINES : These works on the heart muscles and
arteries.
3- PHENYLALKLAMINES : These works mostly on the heart muscles.

53. INDICATIONS:
 In treating high blood pressure, angina
and abnormal heart rhythms.
 They may also be used after a heart attack.
 They are also used in the prevention of
migraines headaches
 In pulmonary hypertension.

54. SOME EXAMPLES INCLUDE :
 Amlodipine ( NORVESC)
 Clevidipine ( CLEVIPREX)
 Diltiazem (CARDIZEM)
 Felodipine (PLENDIL)
 Nifidipine (ADALAT,
PROCARDIA)
 Nicardipine ( CARDENE)
 Verapamil ( CALAN,
ISOPTIN) etc

55. SIDE EFFECTS :
 Constipation ( Verapamil)
 Headache
 Rash
 Dizziness
 Edema
 Drowsiness
OTHERTHINGSTOBE AWAREWHENTAKINGCCB's :
 If you are taking CCB's you should not drink grapefruit juice. this is because it
increases the amount of medicines that enters the blood stream. As a result BP
can drop suddenly which can be dangerous. Apart from diltiazem and
amlodipine, almost all CCB'S will be affected by grapefruit.
 If you have angina and stop taking CCB 'S, you could experienced chest pain.
WHOWOULDNOTBE GIVENCCB'S :
 Pregnant and breast feeding women
 Peoples with liver and kidney problems.

56. Natural CCB :
 Magnesium is an example of nutrient that acts as a
natural CCB. Research has shown that higher
levels of magnesium block the movement of
calcium. In animal studies, magnesium
supplementation seemed to be most effective in
young with elevated blood pressure before they
develop hypertension. It also seemed slow the
progeession to hypertension.

57. Beta blockers, also known as beta-
adrenergic blocking agents, are a class of
drugs to treat the high blood pressure that
works by blocking the
neurotransmitters norepinephrine
and epinephrine from binding to receptors

59. TYPES OF BETA RECEPTORS
 There are three known types of beta receptors,
known as beta1 (β1), beta2(β2) and beta3 (β3).
 β1-adrenergic receptors are located
commonly in the heart and kidneys.
 β2-adrenergic receptors are located mainly in
the lungs, Git , liver , uterus, vascular smooth
muscle, and skeletal muscle.
 β3- adrenergic receptors are located in fat cells.

60. EXAMPLES OF BETA BLOCKER
SELECTIVE BETA
BLOCKERS(B1):
Atenolol
Acebutolol
Bisoprolol
Betaxolol
Esmolol
Metoprolol
Nebivolol
NONSELECTIVE BETA
BLOCKER(B1 & B2):
Carvedilol
Propranolol
Carteolol
Timolol
Labetalol
Pindolol
Nadolol

61. INDICATIONS OF BETA BLOCKER
 Beta blockers are used to manage a variety of conditions.
They include, but are not limited to:
 Hypertension (In the management of HTN, it may be used
alone or concomitantly with other antihypertensive agents,
particularly thiazide diuretics.
 Cardiac arrhythmias
 Heart failure or post heart attack(myocardial infarction)
 Diabetes
 Angina pectoris due to coronary atherosclerosis and
 Also treat glaucoma, anxiety, migraine headaches and
hyperthyroidism

62. SIDE EFFECTS
Side
effects
Cold
hands
Upset
stomach
Trouble
sleeping
Shortness
of breath

63. CAUTIONS
 People should advise their doctor if they have a
history of the following before taking B blockers.
 Asthama
 Bronchospasm
 Severe peripheral arterial disease including raynauds
syndrome
 Slow heart rate
 Uncontrolled heart failure

64. INTERACTIONS
 Beta blockers could interact with a range of
medications. These include:
 NSAIDs
 Anti ulcer medications
 Anaesthetics
 Warfarin
 Hmg CoA reductase inhibitors