This document discusses hypertension (high blood pressure). It defines hypertension as persistently raised blood pressure and notes its symptoms can include headaches, vision problems, and chest pain. The pathophysiology of hypertension is complex and involves multiple factors affecting cardiac and vascular systems. Essential (primary) hypertension accounts for 95% of cases and has no identifiable secondary cause, while secondary hypertension is caused by conditions like chronic kidney disease or adrenal gland tumors. New guidelines recommend treating high blood pressure earlier and at lower thresholds to prevent cardiovascular events. Risk factors include diet, physical inactivity, obesity, alcohol, genetics and lifestyle factors. Treatment involves lifestyle changes like following the DASH diet and medication classes like diuretics, ACE inhibitors, and calcium

1. HYPERTENSION
PRESENTED BY:
DR. CAUVERI GURAV

2. WHO DEFINITION
 Hypertension, also known as high or raised blood
pressure, is a condition in which the blood vessels
have persistently raised pressure.
 Blood pressure is created by the force of blood
pushing against the walls of blood vessels (arteries)
as it is pumped by the heart. The higher the
pressure, the harder the heart has to pump.

3. SYMPTOMS OF HIGH BLOOD PRESSURE
 Severe headache
 Fatigue or confusion
 Vision problems
 Chest pain
 Difficulty breathing
 Irregular heartbeat
 Blood in the urine
 Pounding in chest, neck or ears

4. PATHOPHYSIOLOGY
 Maintenance of a normal BP is dependent on the
balance between the cardiac output and peripheral
vascular resistance. It follows that patients with arterial
hypertension may have an increase in cardiac output,
an increase in systemic vascular resistance, or both.
 While this conceptual framework is used to understand
the final physiological alterations leading to elevated BP,
it is now well established that multiple renal, neural,
endocrine, and CV control systems can affect cardiac
and vascular homeostasis, making the pathophysiology
of hypertension extremely complex.
 The contribution of each of these factors to elevated BP
values is defined by gene–environment interactions and
varies among different individuals

6.  Essential hypertension
 Essential, primary, or idiopathic hypertension is defined
as high BP in which secondary causes such as
renovascular disease, renal failure, pheochromocytoma,
aldosteronism, or other causes of secondary
hypertension or mendelian forms (monogenic) are not
present.
 Essential hypertension accounts for 95% of all cases of
hypertension.

7.  Secondary hypertension
 In about 10% of people, high blood pressure is caused by
another disease. If that is the case, it is called
secondary hypertension.
 In such cases, when the root cause is treated, blood
pressure usually returns to normal or is significantly lowered.
These causes include the following conditions:
 Chronic kidney disease
 Sleep apnea
 Tumors or other diseases of the adrenal gland
 Coarctation of the aorta -- A narrowing of the aorta that you
are born with that can cause high blood pressure in the arms
 Pregnancy
 Use of birth control pills
 Alcohol addiction
 Thyroid dysfunction

8. NEW GUIDELINES
 High blood pressure should be treated earlier with lifestyle changes
and in some patients with medication – at 130/80 mm Hg rather than
140/90 – based on new American Heart Association (AHA)
guidelines for the detection, prevention, management and treatment
of high blood pressure.
 Blood pressure categories in the new guideline are:
 Normal: Less than 120/80 mm Hg;
 Elevated: Systolic between 120-129 and diastolic less than 80;
 Stage 1: Systolic between 130-139 or diastolic between 80-89;
 Stage 2: Systolic at least 140 or diastolic at least 90 mm Hg;
 Hypertensive crisis: Systolic over 180 and/or diastolic over 120,
with patients needing prompt changes in medication if there are no
other indications of problems, or immediate hospitalization if there
are signs of organ damage.
 The guidelines eliminate the category of pre-hypertension.

9.  In addition, the guidelines stresses the importance of using proper
technique to measure blood pressure; recommend use of home
blood pressure monitoring using validated devices; and highlight the
value of appropriate training of health care providers to reveal "white-
coat hypertension." Other changes include:
 Only prescribing medication for Stage I hypertension if a patient has
already had a cardiovascular event such as a heart attack or stroke,
or is at high risk of heart attack or stroke based on age, the presence
of diabetes mellitus, chronic kidney disease or calculation of
atherosclerotic risk (ASCVD).
 Recognizing that many people will need two or more types of
medications to control their blood pressure, and that people may take
their pills more consistently if multiple medications are combined into
a single pill.
 Identifying socioeconomic status and psychosocial stress as risk
factors for high blood pressure that should be considered in a
patient's plan of care.
 https://www.acc.org/latest-in-
cardiology/articles/2017/11/08/11/47/mon-5pm-bp-guideline-aha-
2017

10. RISK FACTORS
 Unhealthy Diet
 Physical Inactivity
 Obesity
 Too Much Alcohol
 Tobacco Use
 Genetics and Family History
 Age
 Sex (W>M)
 Race or ethnicity: Black people develop high blood
pressure more often than white people.

11. SCREENING OF HYPERTENSION
 The USPSTF recommends annual screening for
adults aged 40 years or older and for those who are
at increased risk for high blood pressure. Persons
at increased risk include those who have high-
normal blood pressure (130 to 139/85 to 89 mm
Hg), those who are overweight or obese, and
African Americans.
 Adults aged 18 to 39 years with normal blood
pressure (< 130/85 mm Hg) who do not have other
risk factors should be rescreened every 3 to 5
years.

12. NONPHARMACOLOGIC MANAGEMENT
 DASH diet
 Diet including vegetables, fruits, and whole grains
 Reducing salt intake
 150 minutes of physical activity per week
 Monitoring blood pressure regularly
 Quit smoking
 Cut back on caffeine
 Dietary supplements such as garlic, cocoa, vitamin C,
coenzyme Q10, omega-3 fatty acids, and magnesium
have been suggested for lowering blood pressure, but
evidence is lacking
 Stress management

13. MEDICATIONS
 Diuretics
 Beta-blockers
 ACE inhibitors
 ARBs
 Calcium channel blockers
 Alpha-blockers
 Alpha-2 receptor agonist
 Alpha beta-blockers
 Central agonists
 Peripheral Adrenergic Inhibitors
 Vasodilators
 Renin inhibitor

14.  Management of diabetes and obstructive sleep
apnea

15. THANK YOU!!