Hypertension

Signs and symptoms of Hypertension
1. Asymptomatic for years
2. When a symptom appears, it’s usually due to organ failure (a complication).
3. Except malignant hypertension (severe headache, nausea or vomiting, confusion, changes in vision, or nosebleeds)
Physiological regulation of blood pressure
Risk factors of Hypertension
1. Age ; Aboce 45
2. Race: Blacks> whites
3. Family history
4. Being overweight or obese
  1. What is obesity?
    1. Excess body fat accumulation with multiple organ-specific pathological consequences.
  2. How can we assess obesity ?
    1. Can be assessted in four Main ways :
      1. Anthropometric
        BMI
        Waist circumference
        Waist hip ratio
      2. Densitometry
      3. Imaging
      4. Bioimpedance
5. No physical activity
6. Using tobacco
7. Too much salt & too little potassium intake
8. Too little vitamin D
9. Drinking too much alcohol
10. Stress
11. Sometimes pregnancy contributes to high blood pressure
Lab investigations
1. Fasting glucose sugar
  1. Normal: 3.9 to 5.5 mmols/l (70 to 100 mg/dl) -- Prediabetes or Impaired Glucose Tolerance: 5.6 to 7.0 mmol/l (101 to 126 mg/dl) -- Diagnosis of diabetes: more than 7.0 mmol/l (126 mg/dl)
2. Electrolytes: K and Na
3. Kidney tests
  1. Urea test
  2. Creatinine clearance
  3. Urinalysis
4. Eye tests
5. Full fasting lipid profile
  1. Includes four basic parameters
    1. LDL
    2. HDL
    3. Triglycerides
    4. Total cholesterol
  2. Why in a fasting state ?
    1. Essential for triglycerides estimation because it remains high for several hours after meal.
  4. What raises & lowers HDL and LDL levels?
Epidemiology of Hypertension
1. Eastern Mediterranean region
2. UAE
Types of Hypertension
1. Primary (essential) hypertension : no identifiable cause.
2. Secondary Hypertension
  1. Cause
    1. Obstructive sleep apnea
    2. Kidney problems
    3. Adrenal gland tumors
    4. Thyroid problems
    5. Congenital blood vessel defects
    6. Illegal drugs, such as cocaine and amphetamines
    7. Alcohol abuse or chronic alcohol use
      1. Can cause yellowish spots
        Other causes can be due to :
        Hepatitis
        Pinguecula
        Hyperlipidemia
        bile stones
        primary disorders of (LDL)-cholesterol metabolism
3. Pulmonary
4. Isolated
Management Guidlines
Treatment
1. Non-pharmacological treatment
  1. Life style changes are essential
  2. Dietary changes
  3. Physical exercise
  4. Weight loss
  5. Sleeping habits
  6. Reduce stress
  7. Regular check-ups
2. Pharmacological treatment
  1. Atenolol
    1. B-Blocker - relaxing blood vessels and slowing heart rate to improve blood flow and decrease blood pressure
    2. Orally taken - One tablet daily
    3. Side effects
      1. Shortness of breath
      2. Swelling of the hands, feet, ankles, or lower legs
      3. Weight gain
      4. Fainting
      5. Drowsiness and tiredness
      6. Depression
  2. Atorvastatin
    1. Works by slowing the production of cholesterol in the body to decrease the amount of cholesterol that may build up on the walls of the arteries and block blood flow to the heart, brain, and other parts of the body.
    2. Side effects
      1. Diarrhea and gas
      2. Heartburn
      3. Memory loss
      4. Lack of energy - tiredness
      5. Fever
      6. Chest pain
      7. Nausea
  3. Enalapril
    1. Works by decreasing certain chemicals that tighten the blood vessels, so blood flows more smoothly and the heart can pump blood more efficiently
    2. Side effects
      1. Dizziness
      2. Cough and hoarseness
      3. Rash
      4. Weakness
      5. Difficulty breathing or swallowing
      6. Yellowing of the skin or eyes
      7. Fever, sore throat, chills, and other signs of infection
  4. Causes of medication noncompliance can be due to :
    1. Patient
      1. Forgetfulness
      2. Cost and inability to get a prescription filled
    2. Medication
      1. Adverse effects
      2. Complicated regimens
    3. Physician
      1. Poor doctor-patient relationship
Complications
1. Hypertensive heart disease
  1. Coronary artery disease
  2. Left ventricular Hypertrophy
  3. Heart failure
2. Stroke
3. Peripheral heart disease
4. Hypertensive Retinoplasty

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Hypertension

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