This document discusses hypertension (high blood pressure). It covers the history of hypertension diagnosis and treatment. It defines hypertension as a systolic blood pressure over 140 mm Hg or diastolic over 90 mm Hg. The document classifies hypertension and discusses risk factors, pathogenesis, symptoms, investigations, management guidelines, hypertensive emergencies/urgencies, complications like left ventricular hypertrophy, and drug treatments.
2. History of Hypertension
• Historical records as far back as 2600 B.C. hold
mention of “hard pulse disease”
•First treatments: Leeching/phlebotomy,
acupuncture
•Hippocrates recommended phlebotomy
3. Lithograph showing the leeching of a
patient, date unknown.
National Library of Medicine, Bethesda,
Maryland
4. • 1733 –Reverend Stephen Hales measured the
intra-arterial BP of a horse.
• 1905 –N.C. Korotkoff reported on the method
of auscultation of brachial artery, the method
which is widely used today.
5. • Blood pressure is defined as pressure exerted
by blood against the walls of the blood
vessels,especially the arteries.
• Blood pressure =cardiac output * systemic
vascular resistance.
7. Hypertension Definition
Hypertension is sustained elevation of BP
-Systolic blood pressure >/=140 mm Hg
-Diastolic blood pressure >/=90 mm Hg
-Any level of BP in patients taking
antihypertensive medication.
8. Classification of hypertension for
adults aged >18yrs according JNC
Category Systolic (mm Hg) Diastolic (mm Hg)
Normal 90-119 60-79
Prehypertension 120-139 80-89
stage 1 Hypertension 140-159 90-99
Stage 2 Hypertension >160 >100
Isolated systolic
Hypertension
>/=140 <90
9. Classification of Hypertension
• Primary Hypertension
Elevated BP with unknown cause
-90% to 95% of all cases.
• Secondary Hypertension
Elevated BP with a specific cause
Coarctation of aorta
Renal disease-diabetes, interstital tubular disease, glomerular
disease, polycystic kidney disease, analgesic nephropaty, renal
artery stenosis.
Endocrine disorders- Phaeochromacytoma, primary aldosteronism,
cushings disease, pituitary disorder, thyroid disorders.
Others –sleep apnoea, oral contraceptives, cerebral hemorrhage.
10.
11. Risk factors for hypertension
• Role of genetics: 20% to 60% of essential
hypertension is inherited.
• Age and Sex : BP raises with age in both men
and women. In adult women, BP is lower than
in men of comparable age, but the rise is more
steep thereafter and around middle age BP is
about the same, in later life it is higher in
women.
12. • Weight gain : approximately 1mm Hg rise of
SBP for every 1.25kg of weight gain. 70%of
hypertensive in men and 60% in women could
be attributed to abdominal obesity.
• Salt intake: intake of sodium chloride <3g or
less per day have low average BP.
• Physical activity: sedentary individual have a
20% to 50% increased risk of developing
hypertension.
13. • Alcohol intake: excess alcohol consumption
accounts for 5% to 30% of all hypertension.
• Smoking: tobacco smoking reported to cause
acute rise of BP.
• Stress
14. Pathogenesis of hypertension
• Hypertension caused by increased cardiac
output and or increased peripheral
resistance.
• Factors involved in increased cardiac output-
1. Increased circulating fluid volume-excess
sodium intake causes HTN by
increasing fluid volume and preload thus
increasing cardiac output and contractility.
16. 3. Renal sodium retention.
4. Sympathetic nervous system over activity-augments
release of renin, vascular
constriction, increases the heart rate.
5. Resetting of pressure natriuresis
17. Symptoms
• Frequently asymptomatic until severe and
target organ disease has occurred
–Fatigue, reduced activity tolerance
–Dizziness
–Palpitations, angina
–Dyspnea
18. Investigation
• Urine examination- protein, glucose,
microscopic(red blood cells, other sediments)
• Hemoglobin
• RFT and serum potassium
• Fasting blood glucose
• Electrocardiogram
• Lipid profile
• Uric acid
• Chest radiography
• Other tests to rule out secondary hypertension.
19. Management
• The primary goal of therapy of hypertension is
effective control of BP to prevent, reverse or
delay the progression of complication and thus
reduce the overall risk of an individual without
affecting the quality of life.
• BP < 140/90
• In patients with diabetes or renal disease, goal is
< 130/80
20.
21.
22. Guidelines for selecting the most
appropriate antihypertensive drugs
Class of drugs Indication Contraindication
Diuretics Heart failure
Elderly patients
Systolic hypertension
Gout
Beta blockers Angina
Post MI
Tachyarrhythmia
Heart failure
Asthma
COPD
Heart blocks
Calcium channel blockers Angina
Diabetes
CVA
Heart blocks
ACE inhibitors Heart failure
Left ventricular dysfunction
Significant proteinuria
Pregnancy
Lactation
Bilateral renal artery
stenosis
Hyperkalaemia
24. Hypertensive emergencies
• Severe elevation in BP often higher than
220/140 mmHg, complicated by clinical
evidence of progressive target organ
dysfunction.
• Hypertensive encephalopathy, intracranial
hemorrhage, acute myocardial infraction,
acute left ventricular failure with pulmonary
edema, dissecting aneurysm of aorta, acute
renal failure, eclampsia of pregnancy.
26. Hypertensive urgencies
• Marked elevation of BP higher than
180/110mmHg
• Evidence of end organ damage may be
present, but non progressive
• Symptoms-headache, shortness of breath,
pedal edema and epitasis.
• Drug of choice- amlodipine, labetalol,
clonidine, captopril.
27. Hypertension complication
• Complications are primarily
related to development of
atherosclerosis (“hardening
of arteries”), or fatty
deposits that harden
with age.