Hypertension: Definition, Risk factors, Classification, Clinical Manifestations, complication, and Treatment overview.

1. Presented by : Rozan Mansour Alanzi

2.  is high blood pressure Blood pressure is the
force of blood pushing against the walls
Of arteries as it flows through them.
 Systolic blood pressure  140 mm Hg
Diastolic blood pressure  90 mm Hg

3.  Age : high blood pressure is more common in
men. Women are more likely to develop high
blood pressure after age 65.
 Family history.
 Being overweight or obese.
 Not being physically active.
 Too much salt (sodium) in your diet.
 Too little potassium in your diet or vitamin
D.
 Stress.

4. DBP mmHgSBP mmHgBP Classification
< 80< 120 andNormal
80-89120-139 orPre-
hypertension*
90-99140-159 orStage 1
Hypertension
> 100> 160 orStage 2
Hypertension

5.  NOT a DISEASE category
◦ Should encourage Lifestyle modification as this
group has an increased risk of becoming
hypertensive
 NOT candidates for drug therapy.

6. Primary (Essential) Hypertension
- Elevated BP with unknown cause
- 90% to 95% of all cases
- Contributing factors:
•  SNS * activity
• Diabetes mellitus (DM )
•  Sodium intake
• Excessive alcohol intake
*sympathetic nervous system

7.  Secondary Hypertension
- Elevated BP with a specific cause
- 5% to 10% in adults
- Contributing factors:
• Renal disease
• Endocrine disorders
• Neurologic disorders
- Rx: Treat underlying cause

8. Frequently asymptomatic until severe and
target organ disease has occurred :
◦ Fatigue, reduced activity tolerance
◦ Dizziness
◦ Palpitations, angina
◦ Dyspnea

9.  Complications are primarily related
to development of atherosclerosis
(“hardening of arteries”), or fatty
deposits that harden with age.
 The common complications are
target organ diseases occurring in
the :
 Heart
 Brain
 Kidney
 Eyes

10.  Diagnosis requires several elevated readings
over several weeks.
 BP measurement in both arms

11.  Goal is to reduce overall cardiovascular risk
factors and control BP by the least intrusive
means possible
◦ BP < 140/90
◦ In patients with diabetes or renal
disease, goal is < 130/80

14. • Drug Therapy
1. Diuretics
2. Adrenergic inhibitors
3. β - Adrenergic blockers
4. ACE Inhibitors
5. Calcium channel blockers
Thiazide-type Diuretics
Inhibit NaCl reabsorption
Side effects:
Electrolyte imbalances: ↓ Na, ↓ Cl, ↓ K** (advise K
rich foods)
Fluid volume depletion (monitor for orthostatic
hypotension)
Impotence, decreased libido

15. Adrenergic Inhibitors
Reduce sympathetic effects that cause HTN by:
Reducing sympathetic outflow
Blocking effects of sympathetic activity on vessels
Side effects
Hypotension
 Varied, depending on specific drug
β – adrenergic blockers (suffix “olol”)
(metoprolol, propranolol)
Block β – adrenergic receptors
↓ HR, ↓ inotropy, reduces sympathetic vasoconstriction)
Side effects
Bradycardia, hypotension, heart failure, impotence

16. ACE Inhibitors (suffix “pril)
Enalapril, captopril
Prevents conversion of angiotensin I to
angiotensin II, thereby preventing the
vasoconstriction associate with A II.
Side effects
Hypotension, cough
Calcium Channel Blockers
Block movement of calcium into cells, causing
vasodilation
Side effects
Brdaycardia, heart block

17.  Stage 1 – Thiazide 1st unless compelling
indication
 Stage 2 – Two drugs (one of the two should
be a diuretic or ACE/ARB)
 Compelling Indications for certain disease
modifying meds should be considered

21.  www.mayoclinic.org
 Hamilton cardiology associates :
1. https://www.hcahamilton.com/hypertension
2. https://www.hcahamilton.com/wp-
content/uploads/High-Blood-Pressure.pdf
 American Heart Association .