HYPERTENSION

Defintion
1. Sustained increase in blood pressure, Systolic >140 & Diastolic > 90 mm of Hg
Stages
Classification
1. Primary HTN
  1. Causes
    1. Genics
    2. Environmental factors
      1. Stress
      2. Obesity
        Risk Factors
        Diabetes
        Cancer
        Sleep Apnea
        GERD
        High BP
        Heart Disease
        Definition
        A medical condition in which excess body fat has accumulated to the extent that it may have an adverse effect on health.
        it is defined by
        Body Mass Index (BMI)
        Further evaluated by
        Waist-hip ratio
        ratio of the circum- ference of the waist to that of the hips.
      3. Smoking
        Nicotine - Vasoconstrictor
      4. Physical inactivity
2. Secondary HTN
  1. Causes
    1. Endocrine
      1. Adrenocortical hyperfunction
        HYPO/HYPER-thyrodism
        Pregnancy-induced
        Primary aldosteronism
        Cushing syndrome
    2. Cardiovascular
      1. Coarctation of
        Aorta
        polyarteritis nodosa
      2. Increased intravascular volume
    3. Renal
      1. Renal artery fibromuscular dysplasia
        Renin-producing tumors
        Acute glomerulonephritis
        Renal artery stenosis
        Chronic renal disease
        Polycystic disease
        Renal vasculitis
Complications
1. Eye
  1. Hypertensive retinopathy
2. Renal
  1. Malignant hypetension (Infarction, Renal failure)
    1. Benign nephrosclerosis
3. CNS
  1. TIA
    1. Subarachnoid heamorrhage
      1. Stroke (Haemorrhage, infarction)
4. CVS
  1. Left ventricular hypertrophy
    1. Ischemic Heart Disease
      1. atherosclerosis
        Complications
        dissection
        aneurysm
        embolism,
        rupture
        Peripheral vascular disease
Pathophysiology
1. Blood Pressure = Cardiac Output (CO) X Total Peripheral Resistance (TPR)
2. Increased Peripheral Vascular Resistance
  1. Total Peripheral Resistance
    1. increased by
      1. factors that increase BLOOD VISCOSITY or reduce VESSEL DIAMETER
        Increased pressure
        causes
        HYPERPLASIA of smooth muscles
        Thickened vessels
        with
        Narrowed Lumina
        Leading to
        Plaque formation
        causing weak vessels
        causing Hemorrhage
        Cerebrovascular accident (CVA)
3. increased Cardiac Afterload
  1. increased by
    1. Factors that increase HEART RATE & STROKE VOLUME
      1. Increased workload of L ventricle
        increased Myocardial O2 demand
Diagnostic Tests
1. serum Electrocyte
  1. Especially
    1. K+
2. Preventive measurements
  1. Physical, B.P. checks
    1. requires
      1. High readings of two separate occasions to Dx
3. Routine urinalysis
  1. Fasting glucose sugar
    1. Creatine Levels
Management
1. Pharmacological
  1. Mild hypertension can often be controlled with a single drug.
    1. More severe hypertension may require treatment with several.
  2. initiated with
    1. diuretic,
    2. β-blocker
      1. Atenolol
    3. ACE inhibitor
      1. Enalapril
    4. calcium channel blocker
  3. HMG-CoA reductase inhibitors
    1. Atorvastatin
2. Non-pharmacological
  1. Lifestyle modification
    1. Weight loss
      1. exercise
        stress reduction
        DASH diet
        Increasing potassium intake and restricting sodium
due to deregulation of
1. Arterial Blood Pressure
  1. Main regulators
    1. Baroreceptor Reflex
      1. Fast, neurally mediated reflexes
        control
        A.B.P
        via changes in
        output of the sympathetic
        parasympathetic nervous systems
        to
        Blood vessels
        Heart
      2. Pressure sensors
        Baroreceptors
        in
        Carotid sinus
        aortic arch
        relay information to vasomotor center in medulla
    2. Renin-Angiotension II-Aldosterone System
      1. Activated in response to
        decrease in the Arterial Pressure
        this leads to
        renin release
        by
        juxtaglomerular cells in kidneys
        convert angiotensinogen into angiotensin I
        which is furthur converted into
        angiotensin II
        by
        ACE
        FOUR main actions
        Causes aldostrone release
        by
        adrenal cortex
        Leads to
        sodium reabsorption
        Acts directly on the Na+H+ exchange
        for
        Na+ reabsorption
        Increases thirst and secretion of antidiur- etic hormone
        Acts on arterioles
        to cause
        Vasoconstriction
        increasing
        TPR
Epidemiology

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