Hypertension is defined as a systolic blood pressure of 140 mmHg or higher and/or a diastolic blood pressure of 90 mmHg or higher. The main types are primary (essential) hypertension, which has no identifiable cause, and secondary hypertension, which has an underlying medical cause. Risk factors include modifiable factors like obesity, diabetes, and lifestyle habits as well as non-modifiable factors like age, sex, and genetics. Treatment involves lifestyle modifications, medication like ACE inhibitors, calcium channel blockers, and thiazide diuretics, and controlling blood pressure to a target goal to prevent hypertension-related organ damage.

1. Hypertension

2. Definition
● Systolic Blood Pressure ≥ 140 mmHg and/or
● Diastolic Blood Pressure ≥ 90 mm Hg

3. ●Primary Hypertension
●Also known as essential
hypertension
●Idiopathic
●Includes 90-95%
●Secondary Hypertension
●Hypertension with underlying
causes

4. Risk Factors
●Modifiable
●Obesity or Overweight
●Diabetes Mellitus
●Sedentary Lifestyle
●Alcohol consumption
●Tobacco Use
●Stress
●Increased Salt Intake
●Socioeconomic State
●Non- Modifiable
●Age
●Gender – Male > Female
●Genetic Predisposition
●Early Menopause

5. Secondary Hypertension
● Renal parenchymal disease – CKD, PCKD, Obstructive Uropathy
● Renovascular disease – Atherosclerotic renal artery stenosis,
Fibromuscular dysplasia
● Hemodynamic Causes – Coarctation of Aorta, Takayasu Disease,
Aortic Regurgitation
● Obstructive Sleep Apnoea (Metabolic Syndrome)
● Endocrine Causes – Primary Aldosteronism, Pheochromocytoma,
Cushing Syndrome, Thyroid Disease( Hyper and Hypo ) and
Thyrotoxicosis, Hyperparathyroidism , Acromegaly
● Drug Induces – NSAIDs, OCPs, Corticosteroids
● Neurogenic – Spinal cord transaction, Raised ICP
● Mendelian Cause – Gordon Syndrome , Liddle Syndrome

6. Pathophysiology of Hypertension

8. Grades of Hypertension

9. Stage and risk

11. Clinical Features of Hypertension
●Mostly asymptomatic
●Some symptoms may show up –
○ Headache
○ Asphyxia
○ Nausea
○ Epistaxis
○ Fatigue
○ Chest pain
○ Palpitation
○ Vison Problems

12. Hypertension Mediated Organ Damage

14. Diagnosis
● Medical History –
○ BP (Previous & Current)
○ History of current or past anti-hypertensive medications
○ History other medications, menopause history
○ History of other r diseases( CVD, Renal, CNS)
○ Evaluation of Risk Factors and Lifestyle
○ Family history of HTN, CVD, Stroke or Renal Diseases
○ Assessment of overall CV risk
● Physical Examination –
○ BP measurement, (equal and symmetric BP bilaterally)
○ Pulse rate, rhythm and JVP
○ Edema
○ BMI
○ Auscultation of heart and carotid artery- apex beat, extra heart sound, basal crackles
○ Other organs/system- enlarged kidneys, enlarged thyroid, fatty deposits and coloured striae
abdominal masses and bruits
○ Skin examination
○ Any signs of Cushing disease, acromegaly
○ Neurolgical examination (seizures, papilledema, hemorrhage)

15. ● ROUTINE LAB TESTS –
○ CBC: cardiac markers, infection, anemia
○ Urine Analysis: microscopic examination, urinary protein by dip stick testor,AER, albumin:
creatinine ratio
○ Fasting blood glucose: increase
○ Lipid profile: total cholesterol increase, LDL increase , HDL
○ Blood triglycerides: increase
○ Blood uric acid: increase
○ Blood creatinine and GFR
○ Blood potassium and sodium
○ KFT: Uric acid, BUN, Creatinine
○ TSH: endocrine diseases
● Instrumental:
○ ECG: Afib, signs of LVH, ischemic heart disease, arrhythmia, HR, cardiac rhythm
○ Echo: coarctation of aorta, LVH, aortic root dimensions
○ USD : Renal size and structure,
○ Fundoscopy: retinal changes
○ CT , MRI: Hemorrhagic brain injury

16. TREATMENT AND MANAGEMENT
● LIFE STYLE MODIFICATION:
○ Waist circumference (F< 80cm , M<94cm)
○ Smoking Cessation
○ Alcohol cessation
● D.A.S.H
○ Na (decrease) , K (increase,)
○ Salt restriction: <5gm/day
○ Stop saturated fats
○ Deacrese carbohydrates
○ Vegetables
○ Nuts
○ Fruits
○ Low red meat
● Physical activity- (weight loss, BMI (20-25kg/m²)
○ 30mins for 4-5 days a week

18. UNCOMPLICATED
● If patient <55 yr
○ Begin with ACEI (Ramipril 2.5-20mg)
If not effective add ACEI+CCB(Amilodipine 2.5-10mg)
If not effective add ACEI+CCB+THIAZIDE DIURETICS(
spirinolactone 20-50mg)
● If patient >55 yr
○ Begin with CCB(Amilodipine 2.5-10mg)
If not effective add CCB+ACEI(Ramipril 2.5-20mg)
If not effective add CCB+ACEI+THIAZIDE
DIURETICS(spirinolactone 20-50mg)
● Resistant HTN
○ Uncontrolled BP inspite of 3 classes of anti hypertensive drugs
including thiazide diuretics (+beta blocker or +alpha blocker)

20. COMPLICATED
● ACEI –
○ acs – post mi
diabetic nephropathy
HF with ↓↓ EF
○ Ischemic neuropathy
● Beta blockers –
○ CHF due to systolic dysfunction
○ chronic stable angina
● Alpha blockers –
○ Htn + BPH
○ Htn + pheochromocytoma
● Aldosterone antagonist –
○ pt with HFpEF

21. Antihypertensive Drugs
● ACE INHIBITOR :
○ ENALAPRIL (10-20mg/B.I.D)
RAMIPRIL (2.5-20mg ) , S/E: Hyperkalemia,dry cough CI: Pregnancy
● THIAZIDE DIURETICS:
○ HYDROCHLOROTHIAZIDE 12.5- 50mg PO once daily
INDAPAMIDE 1.25mg P.O
CHLORTHALIDONE 12.5 – 25mg
S/E: Hypercalcemia, Hypokalemia, Gout hyperglycemia, CI: Hypotension
● CCB:
○ DIHYDROPYRIDINE :AMLODIPINE (2.5-10 mg once a day)
NONDIHYDROPYRIDINE: VERAPAMIL (80mg)
S/E : Edema and flushing, constipation
● ARB:
○ LOSARTAN (25-100mg / day) , S/E: Hyperkalemia
● B-BLOCKER:
○ LABETALOL (50mg/ once a day)
○ METOPROLOL (100-200mg)

22. ●HTN in pregnancy: Methyldopa- 250mg
●HTN emergency in pregnancy- Hydralazine
●HTN emergency: Nitroprusside
●RESISTANT HTN: >3CLASSES of antihypertensive
medication use, Uncontrolled HTN MUST INCLUDE
: THIAZIDE, If Still not control Add : Alpha Blocker
(phenoxybenzamine 10mg)
●< 55yr : ACE INH. / ARB
● >55yr: CCB
●30yr : ACEI->CCB->THIAZIDES

23. Hypertensive crisis
● HYPERTENSIVE URGENCY :
○ BP >220/125mmHg – without Target Organ Damage
● HYPERTENSIVE EMERGENCY / CRISIS:
○ >220/125mmHg – with Tareget Organ Damage
Eg : Malignant htn – fibrinoid necrosis of blood vessels of – retina,
brain, heart, kidney, blood vessels
Malignant htn – mortality ↑ 50% ( 6-12 months )
Rx – Several hours, MAP – 20-25%
Lebetalol
. Nicardioine
SNP
ACEI ( intravenously)
Sodium Nitroprusside
Hypertensive encepalopathy : Labetalol, Nicardipine , Sodium
Nitroprusside.

24. Target BP goal
●<65 yrs old <130/80 mmHg
●>65 yrs old <130-139 / <80 mmHg
○ Both SBP & DBP Should be corrected
● Malignant htn – on admission 160/110 mmHg
MAP ↓ 25% over 2 hours

25. PREVENTION
●Healthy lifestyle
○ Regular exercise ( weight loss)
○ Healthy diet
○ Limit alcohol
○ Stop smoking
○ Managee stress
●Goal: <140/90 mmHg in all patients & regular health care
visits

26. Thank You…