ITS ABOUT HYPERTENSION AND ITS COMPLICATIONS

1. BY
BRAHAMDEV MANDAL
RAAHAT SHAIKH
KUNJAN KANTHARIA
JINAL CHAUDHARI
HYPERTENSION

2. OBJECTIVE:
1. Definition
2.Risk factors
3.General Approach to the patient
4.History
5.Investigations
6.Measurement of Blood Pressure
7.Secondary Hypertension
8.Complications

3. HYPERTENSION :
 Also known as high blood pressure (HBP)
 Is a long term medical condition in which the blood
pressure in the arteries is persistently elevated.
 Arbitrarily defined as systolic blood pressure above
140mm Hg or a diastolic blood pressure above
90mmHg
 High blood pressure usually does not cause
symptoms.
 Long terms high blood pressure, however ,is a
major risk factor for coronary artery disease, stroke
,heart failure, peripheral vascular disease, vision loss
,and chronic kidney disease.

5. CLASSIFICATION:
 1 Primary(essential) Hypertension
 2 Secondary hypertension
PRIMARY HYPERTENSION:
 Defined as high blood pressure due to
nonspecific lifestyle and genetic factors .
SECONDARY HYPERTENSION:
 Defined as High blood pressure due to an
identifiable cause ,such as chronic kidney
disease, narrowing of the kidney arteries, an
endocrine disorder, or the use of birth control
pills.

7. RISK FACTORS:
 Excess body weight
 smoking
 Alcohol
 Age gender(male>female)
 Ethnic origin(black>white)
 Diet
 Diabetes mellitus
 Family history
 Pre existing vascular disease

9. PRACTICAL DEFINITION OF
HYPER TENSION:
 The level of blood pressure at which the benefits
of treatment outweigh its costs and hazards of
treatment.

10. GENERAL APPROACH TO THE
PATIENT:
 Confirm that the patient’s blood pressure (BP) has accurately
Measure using
 Correct positioning with an appropriately sized cuff.
 If white coat hypertension suspected :
 Ambulatory BP monitoring can be useful to rule out.
IMPORTANT TO REVIEW:
 The patient ‘s diet and medication use for potential cause of
Hypertension.
EXCESSIVE CONSUSMPTION OF -
• Sodium
• Licorice(Hindi: jethimadh ,Mulhathi)
• Alcohol is also known to increase blood pressure

11. HISTOR
Y
 Proper history should be taken.
 Following history should be recorded:
 Family history
 Lifestyle(exercise , diet, smoking habits)
 Patients with drugs-or alcohol induced hypertension
and may elicit symptoms of other causes of
secondary hypertension such as:
paroxysmal headache
palpitation
sweating in phaeochromocytoma
Most hypertension patients symptoms are due to
complications such as :
Coronary artery disease (e.g. angina
,breathlessness)

13. INVESTIGATIONS:
Chest radiography
 To detect cardiomegaly, heart failure
Renal Ultrasound
 To detect possible renal disease.
Renal angiography
 To detect or confirm presence of renal artery.
Echocardiogram
 To detect or confirm presence of renal artery
stenosis

14. Cushing’s syndrome:
Plasma renin activity and aldosterone :
 To detect possible primary aldosternnism
Ambulatory Blood pressure recording:
 To assess borderline or “white coat” hypertension

15. EXAMINATION OF
HYPERTENSION PATIENTS:
 A physical examination for high blood pressure also
includes medical history.
 The extent of the physical examination and the level
of detail in your Doctor’s questions depend on how
high your Blood pressure is and whether you have
other risk factors for heart disease. People who have
many risk factors may have a more detailed
evaluation.
 The physical examination and medical history
includes:
 Your medical history, to evaluate risk factors such as
smoking or family history of high blood pressure.
 Two or more blood pressure measurements.

16.  Measurement of yours weight,height,and waist.
 An examination of Retina, the light –sensitive lining at
the back of the eye.
 An examination of our legs for fluid buildup (edema)
,and the pulse in several areas, including the neck.
 A heart examination.
 An examination of our abdomen using a stethoscope
.A doctor will listen to the blood vessels in the
abdomen for abnormal sounds . These sounds may be
caused by blood flow through a narrowed artery in the
abdomen (abdominal bruits).
 An examination of our neck for an enlarged thyroid ,
distended neck veins ,and bruits in the cortical arteries.

17. WHY PHYSICAL EXAMINATION
AND MEDICAL HISTORY IS DONE?
 Confirm that you have high blood pressure.
 Check for effects of high blood pressure on
organ such as the kidney and heart.
 Determine whether you have risk factors for heart
disease or stroke .
 Rule out other causes of high blood pressure
(secondary high blood pressure) ,such as
medicines or other medical conditions.

18. Blood pressure measurement:
 Before a diagnosis of hypertension can be confirmed, it is
essential that the blood pressure is checked correctly.
 The patient should sit quietly for at least 5 minutes with the
arm exposed and supported at the level of the heart, and the
back resting against a chair.
 The width of the cuff should be equal to 80% of the arm
circumference and cover two-thirds of the length of the arm (a
small bladder can cause falsely elevated readings).
 The bell of the stethoscope should be used, and two readings
should be taken 5 minutes apart.
 Elevated readings should be confirmed by 3 sets of readings
at weekly intervals.
 It is recommended that ambulatory 24-hour blood pressure
monitoring or regular home monitoring be first used to
document true hypertension outside the clinic setting, before
therapy is initiated.

19. Patient Evaluation Objectives:
 (1) To assess lifestyle and identify other
cardiovascular risk factors or concomitant
disorders that may affect prognosis and guide
treatment
 (2) To reveal identifiable causes of high BP
 (3) To assess the presence or absence of
target organ damage and CVD

20. SECONDARY
HYPERTENSION:
 Secondary hypertension (or, less
commonly, inessential hypertension) :
 Is a type of hypertension which by definition is
caused by an identifiable underlying secondary
cause.
 It is much less common than the other type,
called essential hypertension, affecting only 5% of
hypertensive patients. It has many different
causes including endocrine diseases, kidney
diseases, and tumors.
 It also can be a side effect of many medications.

21. Causes:
 A number of conditions can cause secondary
hypertension. These include:
Diabetes complications (diabetic nephropathy).
 Diabetes can damage your kidneys' filtering system,
which can lead to high blood pressure.
Polycystic kidney disease:
 In this inherited condition, cysts in your kidneys prevent
the kidneys from working normally and can raise blood
pressure.
Glomerular disease:
 Your kidneys filter waste and sodium using
microscopic-sized filters called glomeruli that can
sometimes become swollen.
 If the swollen glomeruli can't work normally, you may

22. Risk factors:
 The greatest risk factor for having
secondary hypertension is having a
medical condition that can cause high
blood pressure, such as kidney, artery,
heart or endocrine system problems.

23. COMPLICATION:
HEART COMPLICATION: High blood pressure is a
major risk factor for hypertensive heart disease, the
leading cause of illness and death from high blood
pressure. Hypertensive heart disease is a group of
complications that include:
Coronary Artery Disease:
High blood pressure contributes to the thickening of the
blood vessel walls, which can cause or worsen
atherosclerosis (accumulated deposits of cholesterol in
the blood vessels).
The end result is coronary artery disease (CAD),also
called ischemic heart disease ,which increase the risk for
angina(chest pain),heart attack ,stroke and death.
High blood pressure is the most common risk factor for

24. Heart Failure:
 High blood pressure increases the heart’s workload.
 Overtime, this can cause the heart pumps against elevated
pressure in the blood vessel ,the left ventricle becomes
enlarged and the amount of blood pumped by the heart each
minute(cardiac output) goes down,
a condition called left ventricle hypertrophy(LVH)without
treatment, this can lead to heart failure.
• Cardiac arrhythmias: disturbances and irregularities in
heartbeats.
STROKE:
Hypertension is also an important cause of stroke so-called
silent cerebral infarcts, or blockages, in the blood vessels in the

25. Retina:
Hypertensive retinopathy:
 Funds changes occurring in patients suffering from
systemic hypertension.
Pathogenesis :
Vasoconstriction ,arteriosclerotic change, increased
vascular permeability.
Grading of hypertensive retinopathy:
Grade 1(fig. A)
 It consists of mild generalized arteriolar attenuation,
particular of small branches, with broadening of the
arteriolar light reflex and veins concealment

26. Grade 2(fig .B)
It comprises mark generalized narrowing and focal
attenuation of arterioles associated with deflection of veins
at arteriovenous crossing(Salus’s sign)
Grade 3(fig.C)
This consists of grade 2 changes plus copper-wiring of
arterioles ,banking of veins distal to arteriovenous
crossings (Bonnet sign),
flame –shaped haemorrhages,cotton –wool spots and
hard exudates are also present.
Grade 4(fig. D)
Consist of all changes of Grade 3 plus silver –wiring of

28.  DIABETES AND KIDNEY DISEASE:-
 Diabetes:
 High blood pressure, and some of the medications used
to treat it, can increase the risk for developing diabetes.
There are strong biologic links between insulin resistance
(with or without diabetes) and hypertension.
 People with diabetes or chronic kidney disease need to
reduce their blood pressure to 130/80 mm Hg or lower to
protect the heart and help prevent other complications
common to both diseases.
 End-Stage Kidney Disease.
 High blood pressure causes 30% of all cases of end-
stage kidney disease (medically referred to as end-stage
renal disease, or ESRD).
 Only diabetes leads to more cases of kidney failure.
Patients with diabetes and hypertension need to be
monitored very closely for the development of kidney

29. SEXUAL DYSFUNCTION:
 Sexual dysfunction is more common and more severe in
men with hypertension and in smokers than it is in the
general population.
 Although older drugs used to treat hypertension caused
erectile dysfunction as a side effect….,
PREGNANCY AND HIGH BLOOD PRESSURE
 Severe, sudden high blood pressure in pregnant women is
one component of a condition called toxemia.
 Other symptoms and signs of include protein in the urine,
severe headaches, and swollen ankles.
 The reduced supply of blood to the placenta can cause low
birth weight and eye or brain damage in the fetus.
 Severe cases, can cause kidney damage, convulsion, and
coma in the mother and can be lethal to both mother and

30. Hyperparathyroidism:
 The parathyroid glands regulate levels of calcium and
phosphorus in your body. If the glands secrete too
much parathyroid hormone, the amount of calcium in
your blood rises — which triggers a rise in blood
pressure.

31.  Renovascular hypertension.
 This type of hypertension is caused by narrowing
(stenosis) of one or both arteries leading to your
kidneys.
 It's often caused by the same type of fatty
plaques that can damage your coronary arteries
(atherosclerosis) or a separate condition in which
the muscle and fibrous tissues of the renal artery
wall thicken and harden into rings (fibromuscular -
dysplasia).
 Renovascular hypertension can cause irreversible
kidney damage.

32.  Coarctation of the aorta.
 With this defect you're born with, the body's main artery
(aorta) is narrowed (coarctation).
 This forces the heart to pump harder to get blood through
the aorta and to the rest of your body.
 This, in turn, raises blood pressure — particularly in your
arms.
 Sleep apnea
 . In this condition, often marked by severe snoring,
breathing repeatedly stops and starts during sleep, causing
you to not get enough oxygen.
 Not getting enough oxygen may damage the lining of the
blood vessel walls, which may make your blood vessels
less effective in regulating your blood pressure.
 In addition, sleep apnea causes part of the nervous system
to be overactive and release certain chemicals that

34. DIAGNOSIS:
 A blood test:
 Your doctor may want to check your potassium, sodium,
creatinine, fasting blood glucose, total cholesterol and
triglycerides, and other chemicals in your blood to help make
a diagnosis.
 Urinalysis:
 Your doctor may want to check your urine for markers that
could show your high blood pressure is caused by another
medical condition.
 Ultrasound of your kidneys:
 Since many kidney conditions are linked to secondary
hypertension, your doctor may order an ultrasound of your
kidneys and blood vessels.
 In this noninvasive test, a technician will run an instrument
called a transducer over your skin.
 The transducer, which produces sound waves, measures

35. Electrocardiogram (ECG) :
 If your doctor thinks your secondary hypertension may be
caused by a heart problem, he or she may order an
electrocardiogram.
 In this noninvasive test, sensors (electrodes) that can
detect the electrical activity of your heart are attached to
your chest and sometimes to your limbs. An ECG
measures the timing and duration of each electrical phase
in your heartbeat.

37. Reference:
A.K Khurana
www.goggle.com