Hypertension/Symptoms of HTN/Complications of HTN

Persistent rise of Blood Pressure above the upper limit of normal level, according to the age & sex of the patient is called Hypertension.

Normal limit of BP:

Systolic: 100 – 140 mm of Hg (120 + 20)

Diastolic: 60 – 90 mm of Hg (75+15)

Aetiology of Hypertension/ Types:

Primary/ Essential hypertension:

Idiopathic > 95%

Factors influencing the development of essential hypertension are

Genetic & families (40-60%)
Socio – economic factors.
Dietary factors; obesity, high, salt intake, caffeine.
Lake of exercise.
Hormonal factors: High renin.
Neurotransmitters – Accetylcholine, noradrenaline
Secondary hypertension (5% case only)
Vascular: Coarctation of aorta.
Renal disease:

Acute glomerulo-nephritis.
Chronic (GN).
Chronic pyelonephritis.
Renal artery disease

Endocrine disease:

Chusing-Syndrome.
Acro-megally.

Drugs:

Oral contraceptive containing destrogen.
Corticosteroids

Alcohol.
Obesity.
Gestational: pregnancy with pre- eclampsia.

Mechanisms of Hypertension

Clinical features of Hypertension

Symptoms of HTN :

Asymptomatic: Most of the case symptoms appear after delection of HTN.
Symptoms due to complication:

Anxinal pain
Breathlessness due to left ventricular failure.
Blurring of vision
Hemiplegia due to cardio vascular disease.

Symptoms of etiological factors:

Headache
Vertigo
Palpitation
Dizziness

Family history of hypertension.
Patient history of renal disease.
Patients gives history of smoking.

Sign of HTN:

Physical examination of

To identify any underlying causes.
To defects complications already present:

Pulse:Usually normal but may have high volume.
BP raised.

Complications of HTN :

Central nervous systems:

Stroke
Hypertensive encephalopathy
Subarachnoid haemorrhage
Carotid atheroma

Retina: Hypertensive retinopathy.
Heart:

Left ventricular hypertrophy leading to LVF

Ischaemic Heart Diseae

Atrial fibrillation

Kidney

Proteinuria

Principles of treatment

To keep the diastolic pressure around about 90 mmhg
Satisfactory control 90-100 mmhg (DBP)

Treatment

Non drug therapy/general measure

Relief of stress

praying
meditation

Diet

Reduced weight (in obese & overweight)
Avoid excess salt consumption
Avoid alcohol consumption
Eat a mixed diet rich in fresh vegetables & fruit

Regular physical exercise like-walking, jogging
Avoid smoking
Investigation lipid profile & treatment according to guidelines
Investigation & management of real & endocrine causes

Drug therapy

Diuretic

Thiazide diuretic
Potassium sparing diuretic: spironolactone
Loop diuretic: Frusemide

2.Beta -blockers

a) Cardio-selective drugs

o Atenolol
o Metoprolol
o Bisoprolol

b) Non-cardio-selective drugs

o Propranolol
o Pindolol

C) combined &beta adrenoceptor antagonists:

o Labetalol
o Carvedilol

Angiotensin converting enzyme(ACE inhibitors)

Captopril
Ramipril

Angiotensin two receptor blocker

o Losartan
o Valsartan

Calcium antagonists

o Amlodipine

Other drugs
a) Alph- 1 blockers
b) Drugs acting directly on vascular smoot muscle

Systolic diastolic

Optimal BP <120 < 80mmhg

Normal <130 mmhg <85mmhg

High normal BP 130/79 mmhg 5-89

Classification of hypertension

Grade 1 ( mild) 140-159 mmhg 90-99 mmhg

Grade 2 160-179 mmhg 100-109 mmhg

Grade 3 > 180, >110

Isolated systolic

Grade-1 systolic Diastolic

140-159 >90

Grade-2 >160 <90

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Prevention of Hypertension the World Health Organization ( WHO) working . WHO is the world largest Heath Organization. They provide various information.