This document discusses hypertension, including its causes, mechanisms, clinical features, investigations, and treatment. It defines hypertension as a persistent blood pressure above 140/90 mm Hg. The causes are primarily essential (80-90%) or secondary (10-20%), which can be renal, endocrine, metabolic, drug-related, congenital, or psychogenic. Hypertension occurs via increased cardiac output or peripheral resistance. Clinical features involve the cerebral, cardiac, vascular, ocular, and renal systems. Investigations include urine tests, imaging, and blood tests. Treatment involves lifestyle changes and medications like diuretics, adrenergic blockers, or vasodilators. Treatment duration is typically lifelong.

1. HYPERTENSION
In any person persistent rise of blood pressure above the
arbitrary level of 140/90 mm of Hg is known as hypertension .

2. CAUSES OF HYPERTENSION
A. Primary or essential hypertension or idiopathic (80-90 %) ;
B. Secondary (10-20%)
1. Renal cause—
i. Acute glomerulonephritis
ii. Chronic glomerulonephritis
iii.Chronic pyelonephritis
iv. Polycystic diseases of the kidney
v. Renal artery stenosis
vi. Hydronephrosis

3. CAUSES OF HYPERTENSION CONT.--
VII. Any other diseases which affect the kidney e.g.,S.L.E.
2.Endocrine causes-
i. Cushing syndrome
ii. Primary aldosteronism (Conn’s syndrome)
iii. Phaeochromocytoma
iv. Thyrotoxicosis
v. Myxoedema
3. Metabolic causes—
i. Diabetes mellitus

4. CAUSES OF HYPERTENSION CONTND.---
ii. Toxaemia of pregnency
iii. Chronic gout
iv. Atherosclerosis
4. Drugs—
i. Contraceptive pill
ii. Steroid
5.Congenital –coarctation of aorta
6. Blood diseases like polycythaemia rubra vera
7. Psychogenic

5. MECHANISM OF HYPERTENSION
Blood pressure= Cardiac output × peripheral resistance. Four
factors control blood pressure by the above formula :
1. Baro-reflex
2. Blood volume
3. Renin angiotensis mechanism
4. Vascular autoregulation

6. CLINICAL FEATURES OF HYPERTENSION
Symptoms:
A. Cerebral—
i. Headache at the occipital region particularly in the
morning.
ii. Dizziness
iii. Insomnia
iv. Irritability
v. vomiting
vi. Fatiguability
vii. Personality change and lack of concentration

7. CLINICAL FEATURES OF HYPERTENSION
B. cardiac-----------
i. Angina pectoris or chest pain
ii. Shortness of breathing
iii. Symptoms of right and left ventricular failure (tachycardia,
facial oedema)
C. Vascular-
i. Bleeding from unexpected site
ii. Cerebro vascular attack
D. Ocular- i. Blurring of vision ii. Scotoma

8. CLINICAL FEATURES OF HYPERTENSION
E. Renal-
i. Increased nocturnal frequency of urine
ii.Diuresis
iii. Symptoms of renal failure (leg oedema)
iv. Uraemia
SIGN:
1. Pulse: Rate may be slow
2. Blood pressure above 140/90 in adult
3. Enlargement of the heart
4. Flame shaped hemorrhage and papilloedema in the eye
(fundoscopic examination)

9. INVESTIGATION OF HYPERTENSION
1. Urine: Routine examination for album,in, RBC and
pus cell may present.
2.Xray chest
3. Blood urea, serum creatinine, serum electrolyte and
serum cholesterol
4. E.C.G
5. E.T.T.
6. Angiogram
7.Echocardiogram

10. TREATMENT OF HYPERTENSION
1. General treatment;
i. If obese reduction of weight
ii. Restricted salt intake
iii. Stop smoking
iv. Moderate exercise daily
v. Avoid anxiety and tension
vi. If diabetic control the diseases
v. Disciplined life

11. TREATMENT OF HYPERTENSION
2. Treatment by drugs ;
Three types of drugs are used in treating which
hypertension which are as follows-
i. Diuretics (thiazide, frusemide)
ii. Adrenergic blocking drugs (methyldopa, propanolol)
iii. Vasidilators (hydrazine, prozocin)
Malignant Hypertension: 1. Hypertensive
encephalopathy 2. Brain haemmorhage.
Duration of treatment: Life long.