Hypertension In Medicine POV

1. HYPERTENSION
MEDICINE

2. LEARNING OBJECTIVES
 What is hypertension?
 What is normal BP?
 Prevalence of hypertension.
 Causes of hypertension.
 Risk factors.
 Regulation of BP.
 Measurement of BP.
 Treatment of hypertension.

3. DEFINITION
 High blood pressure (hypertension) is a common condition in which the
long-term force of the blood against your artery walls is high enough that
it may eventually cause health problems, such as heart disease.

4. NORMAL BP
 Normal blood pressure for most adults is defined as a systolic pressure of
less than 120 and a diastolic pressure of less than 80.

5. HYPERTENSIVE BP
 Hypertension is diagnosed when systolic BP is 140 mm Hg or diastolic BP
is greater than 90 mm Hg on repeated examination.
 Systolic BP is important and is basis for diagnosis in most patients.
 For those age greater than 80 systolic BP is up to 150 mm Hg is now
regarded acceptable.

6. A WORLD EPIDEMIC
 Nearly 1 billion hypertensive in world.
 Hypertension is poorly cvontrolled with less than 25% controlled in
developed countries and less 10% in developing countries.
 Hypertension is responsible for 3 million annual deaths.
 May 14th is world hypertension day.

7. PREVALENCE OF HYPERTENSION

8. RISK FACTOR
Family history of cardiovascular
disease.
Psycho-social stress.
Smoking,high cholestrol diet,low
fruit consumption.
High intake of alcohol.
Co-existing disorders such as
diabetes and hyperlipidaemia.
Obesity and weight gain.

9. TYPES OF HYPERTENSION
ESSENTIAL HYPERTENSION
-95%
-No underlying cause
SECONDARY HYPERTENSION
-Underlying cause

10. CAUSES OF HYPERTENSION
 Renal
 Endocrine
 Miscellaneous
 Unknown
CLINICAL MANIFESTATIONS
 Asymptomatic in majority of patients can remain undetected for many
years.
 Headache may occur when SBP rise above 200 mm Hg or when BP is
rapidly elevated.

11. CLASSIFICATION

12. COMPLICATIONS OF
HYPERTENSION
Hypertension itself isn’t life threatening but it can lead to
certain complications which can be life threatening.
Uncontrolled high blood pressure can lead to complications
including:
Heart attack or stroke
Aneurysm
Heart failure
Weakened and narrowed blood vessels in your kidneys
Thickened, narrowed or torn blood vessels in the eyes
Metabolic syndrome
Trouble with memory or understanding
Dementia

13. REGULATION OF BP
BP = CO X TPR

14. HAEMODYNAMIC PATTERN IN
HYPERTENSION
 YOUNG = BP : ↑ CO X TPR
 MIDDLE AGED = BP : CO X TPR
 OLD = BP : ↓ CO X ↑↑ TPR

15. SYMPTOMS OF
HYPERTENSION
Dizziness
Blury vision
Nose bleeds
Palpitations
Vomiting
Short breath

16. SELF MEASUREMENT OF BP
 Provides information on:
1. Response to antihypertensive therapy
2. Improving adherence with therapy
3. Evaluating white-coat HTN
 Home measurement of >135/85 mmHg is generally considered to be
hypertensive.
 Home measurement devices should be checked regularly.

17. MEASURING OF BP
 There are three types of blood pressure measuring devices:
1. Mercury sphygmanometer
2. Aneroid sphygmanometer
3. Digital sphygmanometer

18. 1 . MERCURY SPYGMANOMETER

19. 2 . ANEROID SPYGMANOMETER

20. 3 . DIGITAL SPYGMANOMETER

21. MEASURING OF BP
 Patient seated quietly for at least 5minutes in a chair, with feet on the floor
and arm supported at heart level.
 An appropriate-sized cuff (cuff bladder encircling at least 80% of the arm).
 At least two measurement.

22. MEASURING OF BP
 Systolic Blood Pressure is the point at which the first of 2 or more sounds
is heard
 Diastolic Blood Pressure is the point of disappearance of the sounds

23. MEASURING OF BP
 Ambulatory BP Monitoring - information about BP during daily activities
and sleep.
 Correlates better than office measurements with target-organ injury.

24. LABORATORY TESTS
 Routine Tests
 Electrocardiogram
 Urinalysis
 Blood glucose,
 Serum potassium, creatinine, or the corresponding
estimated GFR, and calcium
 Lipid profile, after 9- to 12-hour fast, that includes high-
density and low-density lipoprotein cholesterol, and
triglycerides
 Optional tests
 Measurement of urinary albumin excretion or
albumin/creatinine ratio
 More extensive testing for identifiable causes is not
generally indicated unless BP control is not achieved

25. MONITORING OF BP
 Is of two types
1. Out of office Blood Pressure Monitoring
2. Office Blood Pressure Monitoring

26. OFFICE BLOOD PRESSURE
MONITORING
DEFINITION
Those BP which are measured by a healthcare professional at a
clinic.

27. OUT OF OFFICE BP MONITORING
DEFINITION
Those BP which are measured at home(with or without an associated
antepartum home care program).

28. COMPARISON

29. AMBULATORY BP
MONITORING
Ambulatory blood pressure
monitoring allows your blood
pressure (BP) readings to be
recorded over a 24-hour period,
whether you're awake or asleep.

30. HYPERTENSION EVEN TODAY IS A
TRIPLE PARADOX WHICH IS:
 Easy to diagnose OFTEN remains undetected.
 Simple to treat OFTEN remain untreated.
 Despite availability of potent drugs, treatment all to OFTEN is undetected.

31. TREATMENT

32. OVERVIEW OF TREATMENT
 Goals of therapy
 Lifestyle modification
 Pharmacologic treatment
 Algorithm for treatment of hypertension
 Follow up and monitoring

33. GOALS OF THERAPY
 Reduce Cardiac and renal morbidity and mortality.
 Primary focus should be on achieving of primary systolic BP.
 Treat to BP <140/90 mmHg or BP <130/80 mmHg in patients with
diabetes or chronic kidney disease

34. LIFESTYLE MODIFICATIONS 1
 Losing weight if you are overweight or obese
 Quitting smoking. Tobacco damages the walls of your blood vessels and
hardens your arteries. Both need to be in good shape while you control
your blood pressure.
 Following the DASH eating plan, which stands for Dietary Approaches to
Stop Hypertension. It focuses on vegetables, fruits, whole grains fish,
poultry, nuts, and beans. High-potassium foods, like avocados, bananas,
dried fruits, tomatoes, and black beans, get a big thumbs-up. This plan
keeps sugary drinks, sweets, and high-fat meats and dairy products at a
minimum.

35. LIFESTYLE MODIFICATIONS 2
 Reducing the amount of sodium in your diet to less than 1,500 milligrams
a day if you have high blood pressure; healthy adults should try to limit
their sodium intake to no more than 2,300 milligrams a day (about 1
teaspoon of salt). Many processed foods have a lot of salt in them. For
instance, soups, condiments, and tomato sauce can have as much as 75%
of the total amount of salt you need each day. Read food labels carefully
(salt is listed as sodium), and don't sprinkle more on when you cook or
before you eat. Instead, use spices and herbs to flavor your food.

36. LIFESTYLE MODIFICATIONS 3
 Keeping a healthy weight for your age and height is key. If you're
overweight or have obesity, you can lower your blood pressure by losing
just 5 pounds.
 Limiting alcohol to two drinks a day for men, one drink a day for women.
One drink is an ounce of alcohol, 5 ounces of wine, or 12 ounces of beer.
 Reducing stress. Think about stressful areas of your life and take steps to
change them. Consider talking to a counselor, learning meditation or
anger-control techniques, or getting regular massages.

37. NON PHARMACUTICAL TREATMENT
OF HYPERTENSION

38. LIFESTYLE MODIFICATION
MODIFICATION APPROXIMATE SBP
Weight reduction 5–20 mmHg / 10 kg weight loss
Adopt DASH eating plan 8–14 mmHg
Dietary sodium Reduction 2–8 mmHg
Physical activity 4–9 mmHg
Moderation of alcohol consumption 2–4 mmHg

39. PHARMAC LOGICAL TREATMENT
 It can be treated pharmacologically by using anti-hypertensive drugs.

40. CLASSIFICATION

41. TABLE

42. Algorithm for treatment of
hypertension

43. RESISTANT HYPERTENSION
DEFINITION
Resistant hypertension is a condition where your blood pressure
remains high or uncontrolled despite the medications you take to lower it.

44. CAUSES OF RESISTANT
HYPERTENSION
 Improper BP measurement
 Excess sodium intake
 Inadequate diuretic therapy
 Medication
 Inadequate doses
 Drug actions and interactions (e.g., (NSAIDs), illicit drugs, sympathomimetics, OCP)
 Over-the-counter drugs and some herbal supplements
 Excess alcohol intake
 Identifiable causes of HTN

45. TRATMENT OF RESISTANT
HYPERTENSION
 Limiting salt and alcohol.
 Limiting use of NSAIDs for pain relief (acetaminophen can be used
instead).
 Doing at least 30 minutes a day of aerobic activity several days a week.
 Treating sleep apnea with continuous positive airway pressure.

46. CONCLUSION
 Hypertension is a major cause of morbidity and mortality, and needs to be treated
 It is an extremely common condition; however it is still under-diagnosed and
undertreated
 Hypertension is easy to diagnose and easy to treat
 Aim of the management is to save the target organ from the deleterious effect
 Besides pharmacology we have other choices and one has to be acquainted with
that choice
 Life style modification should always be encouraged in all Hypertensive patients

47. THANKYOU