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HYPERTENSION
- 1. A Presentation On Hypertension Dr. Alim Al Razy Intern, North East Medical College Medicine unit 1 under prof Dr. GAUTAM KUMAR ROY
- 2. BLOOD PRESSURE Arterial blood pressure is defined as the lateral pressure exerted by the column of blood on wall of arteries.
- 3. TYPES OF BLOOD PRESSURE Arterial blood pressure is expressed in four different terms: • 1. Systolic blood pressure • 2. Diastolic blood pressure • 3. Pulse pressure • 4. Mean arterial blood pressure.
- 4. REGULATION OF BLOOD PRESSURE
- 5. HYPERTENSION Hypertension is defined as the persistent high blood pressure.
- 6. Types Hypertension 1. Primary or Essential hypertension 2. Secondary Hypertension
- 7. Primary Hypertension • Exact cause of primary HTN is still unknown. • It is suspected that multiple factors are responsible for Essential HTN like: - Genetic predosposition - Diet - Life style - Obesity ETC • Recently there are data available to support the view that neurovascular compression of the RVLM is associated with essential hypertension in some subjects.
- 8. In the 1970s, Dr. Peter Jannetta, a neurosurgeon developed a technique for “microvascular decompression” of the medulla to treat trigeminal neuralgia and hemifacial spasm, which he attributed to pulsatile compression of the vertebral and posterior inferior cerebellar arteries impinging on the fifth and seventh cranial nerves. Moving the arteries away from the nerves led to reversal of the neurologic symptoms in many cases. Some of these patients were also hypertensive, and they showed reductions in blood pressure postoperatively. Later, a few human studies claimed that surgical decompression of the RVLM could sometimes relieve hypertension.
- 9. Causes of secondary HTN • Alcohol • Obesity • Pregnancy (pre- eclampsia) • Coarctation of the aorta • Endocrine disease • Phaeochromocytoma • Cushing’ssyndrome • Primaryhyperaldosteronism (Conn’ssyndrome) • Glucocorticoid- suppressiblehyperaldosteronism • Hyperparathyroidism • Acromegaly • Renal disease • Parenchymal renal disease particularly glomerulonephritis • Renalvascular disease • Polycystickidneydisease • Drugs Oral contraceptives containing oestrogens anabolic steroids corticosteroids NSAIDs sympathomimetic agents
- 12. At first we have to take decision about - • Weather it is HTN or not. • Is it primary HTN or Secondary?. • If secondary what is/are the cause/s? • If primary – What will be our next approach? • Do we really need Drugs or Lifestyle modification and follow-up is enough? • If necessary what will be the drug? • Is there any special situation like pregnancy DM etc • Is there any other disease?
- 13. The next flow-chart will help us to reach in decision -
- 16. Routine Examination of a Hypertensive patient • Routine Examination of urine • Fasting blood for lipid and glucose • Serum Urea, Creatinin and Electrolyte • ECG
- 17. LIFESTYLE MODIFICATION • Body weight Maintain normal body weight (BMI 20–25 kg/m2) • Aerobic exercise Perform >/= 30 min brisk walk most days of the week • Diet Reduce intake of fat and saturated fat. Reduce salt intake <100 mmol/day (<6 g NaCl or <2.4 g Na/day) Limit alcohol to </=3 units/day men and </=2 units/day women Consume >/=5 portions of fresh fruit and vegetables/day • Cardiovascular risk reduction Avoid cigarette smoking and increase oily fish intake
- 19. DIURETICS • Thiazides and related diuretics Hydrochlorothiazide Chlorthalidone Metolazone • Loop diuretics Furosemide Ethacrynic acid • Aldosterone receptor blockers Spironolactone
- 20. Beta-adrenergic blocking agents • Acebutolol • Atenolol • Betaxolol • Carvedilol • Labetalo • Metoprolol
- 21. Alpha-Blocker and central Sympatholytic • Alpha-blocker Doxazosin Prazosin Terazosin • Central sympatholytics Methyldopa Clonidine
- 22. Renin and ACE inhibitors and angiotensin II receptor blockers • Renin inhibitors Aliskiren • ACE inhibitors Benazepril Captopril Enalapril Perindopril Ramipril • Angiotensin II receptor blockers Losartan Valsartan
- 23. Calcium channel blocking agents • Diltiazem • Verapamil • Amlodipine • Nifedipine
- 24. Direct vasodilators • Hydralazine • Minoxidil
- 25. CHOICE OF ANTI- HYPERTENSIVE DRUG
- 27. The influence of comorbidity on the choice of antihypertensive drug therapy • Alpha-blockers Benign prostatic hypertrophy • ACE inhibitors Heartfailure Leftventricular dysfunction, post-MI or established coronary artery disease Type1 diabetic nephropathy Secondary stroke prevention • Angiotensin II receptor blockers ACE inhibitor intolerance Type2 diabetic nephropathy Hypertension with left ventricular hypertrophy Heartfailure in ACE-intolerant patients, after MI • ß-blockers MI, angina Heart failure • Calcium channel blockers Older patients isolatedsystolic hypertension • Thiazides or thiazide-like diuretics Olderpatients,isolatedsystolic hypertension heartfailure secondary stroke prevention
- 28. Complications of HTN • Blood vessels Widespread atheroma aortic aneurysm aortic dissection • Central nervous system Stroke TIA Hypertensive encephalopathy • Retina Hypertensive retinopathy • Heart Coronary artery disease Left ventricularhypertrophy Atrial fibrillation left ventricular failure • Kidneys renal failure
- 29. THANK YOU