This slideshare is related to hypertension, its pathophysiology and diagnostic parameters of it.

1. DR. Chavan P. R.
Pharm D

3. Index
 Definition
 Terms
 Etiology
 Epidemiology
 Clinical presentations
 Pathophysiology
 Diagnosis

4. Terms :
 Hypertension is defined by persistent elevation of
arterial blood pressure (BP).
 Patients with diastolic blood pressure (DBP)
values <90 mm Hg and systolic blood pressure
(SBP) values ≥140 mm Hg have isolated systolic
hypertension.

6. Hypertensive crisis
 Hypertensive emergency
-extreme BP elevation with acute or progressing
target organ damage
 Hypertensive urgency
-severe BP elevation without acute or progressing
target organ injury).

7. Etiology
 primary or essential hypertension
 Secondary hypertension
chronic kidney disease or renovascular disease.
Other conditions
 pheochromocytoma,
 Cushing’s syndrome,
 hyperthyroidism,
 hyperparathyroidism,
 primary aldosteronism,
 pregnancy,
 obstructive sleep apnea, and
 coarctation of the aorta.

8.  Some drugs to cause HTN
• corticosteroids,
• estrogens,
• nonsteroidal antiinflammatory drugs (NSAIDs),
• amphetamines,
• sibutramine,
• cyclosporine,
• tacrolimus,
• erythropoietin, and
• venlafaxine.

9. Clinical presentation
 Primary hypertension -asymptomatic initially.
 Patients with secondary hypertension may
complain of symptoms suggestive of the
underlying disorder.

10.  Patients with pheochromocytoma may have a history
of paroxysmal headaches, sweating, tachycardia,
palpitations, and orthostatic hypotension.
 In primary aldosteronism, hypokalemic symptoms of
muscle cramps and weakness may be present.
 Patients with hypertension secondary to Cushing’s
syndrome may complain of weight gain, polyuria,
edema, menstrual irregularities, recurrent acne, or
muscular weakness.

11. Epidemiology
 Approximately 31% of Americans (74.5 million people) have elevated
BP, defined as greater than or equal to 140/90 mm Hg.
 The overall incidence is similar between men and women, but varies
depending on age.
 The percentage of men with high BP is higher than for women before
the age of 45 and is similar to that of women between the ages 45 and
64.
 However, after the age of 64, a much higher percentage of women have
high BP than men.
 Prevalence rates are highest in non-Hispanic blacks (45% in women,
44% in men), followed by non-Hispanic whites (31% in women, 34% in
men), Mexican Americans (32% in women, 26% in men), American
Indians/Alaska Natives (25% in women and men), and Asians (21% in
women and men).
 B P values increase with age, and hypertension (persistently elevated
BP values) is very common in the elderly.
 The lifetime risk of developing hypertension among those 55 years of
age and older who are normotensive is 90%.
 Most patients have prehypertension before they are diagnosed with
hypertension, with most diagnoses occurring between the third and fifth
decades of life.

12. Pathophysiology
 Multiple factors may contribute to the development of
primary hypertension, including:
 Humoral abnormalities involving the renin-
angiotensin-aldosterone system, natriuretic hormone,
or hyperinsulinemia;

13.  Abnormalities in either the renal or tissue
autoregulatory processes for sodium excretion,
plasma volume, and arteriolar constriction;
 A pathologic disturbance in the CNS, autonomic
nerve fibers, adrenergic receptors, or
baroreceptors;

14.  A deficiency in the local synthesis of vasodilating
substances in the vascular endothelium, such as
prostacyclin, bradykinin, and nitric oxide, or an
increase in production of vasoconstricting
substances such as angiotensin II and endothelin
I;

15.  A high sodium intake and increased circulating
natriuretic hormone inhibition of intracellular
sodium transport, resulting in increased vascular
reactivity and a rise in BP;
 Increased intracellular concentration of calcium,
leading to altered vascular smooth muscle
function and increased peripheral vascular
resistance

16.  The main causes of death in hypertensive
subjects are cerebrovascular accidents,
cardiovascular (CV) events, and renal failure. The
probability of premature death correlates with the
severity of BP elevation.

17. Diagnosis
 Physical examination by average of readings

18.  pathologic changes in the eye, brain, heart, kidneys,
and peripheral blood vessels due to end organ
damage

19. funduscopic examination

20.  arteriolar narrowing, focal arteriolar narrowing,
arteriovenous nicking, and retinal hemorrhages,
exudates, and infarcts. The presence of
papilledema indicates hypertensive emergency
requiring rapid treatment.

21.  Cardiopulmonary examination may reveal an
abnormal heart rate or rhythm, left ventricular (LV)
hypertrophy, precordial heave, third and fourth
heart sounds, and rales.

22.  Peripheral vascular examination can detect
evidence of atherosclerosis, which may present
as aortic or abdominal bruits, distended veins,
diminished or absent peripheral pulses, or lower
extremity edema.

23.  Patients with renal artery stenosis may have an
abdominal systolic-diastolic bruit

24.  Patients with Cushing’s syndrome may have the
classic physical features of moon face, buffalo
hump, hirsutism, and abdominal striae.
 Baseline hypokalemia may suggest
mineralocorticoid-induced hypertension. The
presence of protein, blood cells, and casts in the
urine may indicate renovascular disease.

25. Laboratory tests
 urinalysis,
 complete blood cell count,
 serum chemistries (sodium, potassium,
creatinine,
 fasting glucose, fasting lipid panel),
 12-lead electrocardiogram (ECG).

26.  laboratory tests for secondary hypertension.
 plasma norepinephrine and urinary metanephrine
levels for pheochromocytoma,
 plasma and urinary aldosterone levels for primary
aldosteronism,
 plasma renin activity,
 captopril stimulation test,
 renal vein renins, and renal artery angiography
for renovascular disease.