Hypertension

1. HYPERTENSION
DR OSARENKHOE O. J.
IUO/IUTH

2. CONTENT
• INTRODUCTION
• AETIOLOGY
• CLINICAL FEATURES
• DIAGNOSIS
• INVESTIGATIONS
• TREATMENT

3. INTRODUCTION
• DEFINE
• TYPES
• EPIDERMIOLOGY

4. DEFINE
• SUSTAINED ELEVATED BLOOD PRESSURE
ABOVE 140 MMHG SYSTOLIC AND/OR ABOVE
90 MMHG DIASTOLIC
• REASONABLY REQUIRE 2 OR MORE VISITS
BLOOD PRESSURE READINGS

5. TYPES
• PRIMARY OR IDIOPATHIC
• ACCOUNTS FOR 90-95% OF CASES
• SECONDARY
• ACCOUNTS FOR 5-10% OF CASES

6. EPIDERMIOLOGY
• ABOUT 30% OF NIGERIANS ABOVE 18 YEARS
• MORE IN URBAN THAN RURAL
• MOST COMMON MORDIFIABLE RISK FACTOR
FOR STROKE,CORONARY ARTERY DISEASE AND
END STAGE RENAL DISEASE
• MORE IN BLACKS THAN WHITES
• NOT RESTRICTED TO ANY AGE
• MORE IN MALES EXCEPT POST MENOPAUSAL

7. AETIOLOGY
• PRIMARY, ESSENTIAL OR IDIOPATHIC
• UNKNOWN AETIOLOGY
• USUALLY GENETIC PREDISPOSITION
• FAMILIAL
• INTERRACTION BETWEEN GENETIC AND
ENVIROMENT FACTORS

8. SECONDARY
• RENAL DISEASE LIKE POLYCYSTIC KIDNEY
DISEASE,CHRONIC GLOMERULONEPHRITIS,RENAL
ARTERY STENOSIS
• TUMOURS LIKE WILMS , RENAL CELL
CARCINOMA,PHAECHROMOCYTOMA
• ENDOCRINE DISEASE LIKE CONN SYNDROME,
CUSHINGS SYNDROME,DM
• DRUGS LIKE NSAIDS,HEAVY ALCOHOL
ABUSE,STERIODS,NICOTINE ABUSE

9. • CONGENITAL LIKE AORTIC COARCTATION,
• GESTATIONAL OR PREGNANCY RELATED
• SLEEP DISORDERS

10. PATHOPHYSIOLOGY
BLOOD PRESSURE
↑
CARDIAC OUTPUT X PERIPHERAL RESISTANCE
↑ ↑
SV X HR VAS TONE X VAS STRUCTURE

11. RISK FACTORS
• OBESITY
• INSULIN RESISTANCE
• HIGH SALT INTAKE
• AGING
• SEDENTARY LIFE STYLE
• STRESS
• LOW POTASSIUM INTAKE
• USUALLY ADDITIVE/HYPERTENSINOGENIC

12. SPECIAL BLOOD PRESSURE STATUS
• WHITE COAT HYPERTENSION INDICATED BY
BLOOD PRESSURE BEING HIGH IN THE OFFICE
BUT NORMAL AT HOME
• MASKED HYPERTENSION INDICATED BY
BLOOD PRESSURE BEING NORMAL IN THE
OFFICE BUT HIGH AT HOME

13. CLINICAL FEATURES
• LARGELY ASSYMPTOMATIC BUT MAY HAVE
• HEADACHE
• ANXIOUS
• INSOMNIA
• SYNCOPAL ATTACKS
• EPISTAXIS
• FEATURES OF COMPLICATIONS

14. DIAGNOSIS
• MADE BY BLOOD PRESSURE MEASUREMENT

15. JNC V11 CLASSIFICATION
• CLASS SBP DBP
• NORMAL <120 <80 MMHG
• PRE HTN 120-139 80-89
• STAGE 1 140-159 90-99
• STAGE 2 ≥160 ≥100
• SBP SYSTOLIC BLOOD PRESSURE
• DBP DIASTOLIC BLOOD PRESSURE

16. WHO CLASSIFICATION
• CLASS SBP DBP
• OPTIMAL <120 <80
• NORMAL 120-129 80-84
• HIGH NORMAL 130-139 85-89
• GRADE 1 MILD 140-159 90-99
• GRADE 2 MODERATE 160-179 100-109
• GRADE 3 SEVERE ≥180 >110
• ISOLATED SYSTOLIC ≥140 <90
HYPERTENSION

17. INVESTIGATIONS
• 12 LEADS ECG
• MAY INDICATE LVH,MI OR DYSRHYTHMIA
• ECHOCARDIOGRAPHY
• MAY REVEAL HYPERTROPHY, CARDIOMEGALY,
COARCTATION, STENOSIS
• CHEST X RAY
• MAY SHOW CARDIOMEGALY, UPPER LOBE
DIVERSION

18. INVESTIGATIONS
• SCAN
• RENAL SCAN
• MAY REVEAL SMALL KIDNEYS,LOSS OF
CORTICOMEDULARY DIFFERENTIATION
• DOPPLER
• WHEN INDICATED MAY SHOW REDUCED OR
ABSENT BLOOD FLOW, PLAQUES ESPECIALLY
IN THE LIMBS

19. INVESTIGATIONS
• URINE ANALYSIS
• MAY SHOW MICRO ALBUMINURIA OR
PROTEINURIA
• BLOOD ANALYSIS
• E/U Cr
• MAY SHOW HYPER OR HYPO KALAEMIA,
NORMAL OR ELEVATED UREA AND/OR
CREATININE

20. INVESTIGATIONS
• FBC/ESR
• MAY REVEAL ANAEMIA, NORMAL OR
ELEVATED SER
• LIPIDS
• MAY BE NORMAL OR ELEVATED, NOTE
ATHEROGENIC INDEX
• BLOOD SUGAR
• FBS OR RBS MAY BE NORMAL OR ELEVATED

21. TREATMENT
• PRIMARY MANAGEMENT
• THIS ENTAILS PREVENTION
• INCLUDES
• REGULAR EXCECISE OF ABOUT 30 MINUTES 3
TIMES WEEKLY OR MORE
• DASH DIET
• HIGH IN FRUITS AND VEGETABLES
• LOW SALT
• LOW FAT ESPERCIALLY SATURATED FATS

22. TREATMENT
• SECONDARY TREATMENT
• ENTAILS MANAGING INDEX PATIENT
• MAY USE
• CALCIUM CHANNEL BLOCKS LIKE AMLODIPINE
5 – 10 MG DAILY, NIFEDIPINE 20 – 40 MG OD
OR BID
• ACE I LIKE LISINOPRIL 5 – 20 MG OD, RMIPRIL
2.5 – 10 MG OD, PERINDOPRIL 5 – 10 MG OD

23. TREATMENT
• ARB LIKE TELMISARTAN 40-80 MG
OD,LOSARTAN 25 – 100 MG OD,
• THIAZIDE DIURETICS LIKE
HYDROCHLOROTHIAZIDE 25 – 50 MG OD
• THIAZIDE LIKE DIURETICS LIKE INDAPAMIDE
1.5 – 3 MG OD
• B BLOCKERS LIKE ATENOLOL 25 – 100 MG OD

24. TREATMENT
• ALPHA MEHTYL DOPA
• USEFUL IN PREGNANCY AT 250 – 500 MG TDS

25. TREATMENT
• TERTIARY MANAGEMENT
• ENTAILS MANAGING THE COMPLICATIONS
• LIKE CVA, MI, ACUTE LEFT VENTRICULAR
FAILURE

26. TREATMENT
• ENCOURAGE CLINIC FOLLOW UP VISITS
• ADVICE GOOD ADHERENCE NOT JUST GOOD
COMPLIANCE

27. CONCLUSION