Lec 1 Hypertension PDF

Lec1 hypertension By: dr.Manal AL-Abed Definition: Persistent elevation of arterial Blood Pressure greater than 140/90 mmHg & above 130/80 mmHg in the patients with diabetes or renal disease; at least two reading on separated occasion. Class...

Lec1 hypertension By: dr.Manal AL-Abed Definition: Persistent elevation of arterial Blood Pressure greater than 140/90 mmHg & above 130/80 mmHg in the patients with diabetes or renal disease; at least two reading on separated occasion. Classification of hypertension: according to JNC 7 Stage Systolic BP (mmHg) Diastolic BP (mmHg) Optimal 120 80 Normal >130 >85 Prehypertension 130-140 85-90 Stage I 140-160 90-100 Stage II 160-180 100-110 Stage III 110 Types: Primary (essential) hypertension: Secondary hypertension: (curable hypertension) - It represents approximately 95% - It represents approximately 5% of of all cases. all cases. - It has no known cause idiopathic. - Hypertension with a known underlying cause. - Age of onset: usually between 35 - Age of onset: before 25 or after – 55 years. 55 years. - +ve family history - -ve family history. - Predisposing factors: - Rapidly progressive hypertension Genetic - Obesity - Stress - Salt with early complications over intake - Smoking -Alcohol intake  Causes of the 2ry HTN 1-Renal i – Parenchymal: e.g. GN, diabetic nephropathy, pyelonephritis, polycystic kidney ……ect ii – Renovascular: e.g. renal artery stenosis 2- Endocrinal i- Pituitary: Acromegaly ii- Thyroid: - Hypothyroidism. - Hyperthyroidism iii- Parathyroid: Hyperparathyroidism. iv- DM. v- Adrenal: - Conn’s syndrome - Cushing syndrome. - Pheochromocytoma 3-vascular i- Polyarteritis nodosa ii- Polycythemia. iii- Coarctation of the aorta 4- CNS Increase intracranial pressure (ICP) 5- Iatrogenic(drugs) Contraceptive pills. Cortisone & NSAIDs. sympathomimetic agents. Calcium Clinical picture: Symptoms: 1- Asymptomatic in most cases. 2- May discovered accidentally. 3- Headache is usually occipital. 4- Blurring of vision, tinnitus, epistaxis, nausea & vomiting. 5- Complications of HTN may be the first presentation Signs: Blood pressure measurement: persistent elevation > 140/90 mmHg Auscultation of the heart: o Accentuated S2. o S4 o Closed splitting S2. o Ejection systolic murmur o Early diastolic murmur Complications: 1- Cardiac: o Ischemic heart disease: due to atherosclerosis & hypertrophy. o Left Side Heart Failure: due to pressure overload. o Right Side Heart Failure: due to hypertrophy of LV → bulging of the septum in the RV → slight impairment of the filling of RV 2 - Cerebral: o Stroke: cerebral ischemia & thrombosis (infarction) cerebral hemorrhage (stroke) o Hypertensive encephalopathy: > increase cerebral blood flow > increase ICT, brain edema , coma & convulsion may occur. 3 - Renal: o Renal failure. 4 - Retinal: 4 grades o Grade I: Thickening of retinal arterioles (silver wire appearance). o Grade II: Kinking of retinal veins. o Grade III: Hemorrhage & exudates. o Grade IV: Papilledema. 5- Vascular: o Atherosclerosis. o Aortic dissection Investigations not nessessary to all cases 1- Investigations for complications: o Cardiac: X ray, ECG, Echo, …. o Cerebral: CT, MRI brain. o Renal: urine analysis, renal function, renal imaging. 2- Investigations for the cause: when secondary HTN is suspected or in a case of refractory hypertension Treatment: I – Non pharmacological - lifestyle modification. o Lose weight if overweight. o Reduce salt intake. o Reduce dietary fat intake. o Stop smoking. o Regular exercise. o Avoid stress II – Pharmacological: Treatment of associated risk factors e.g. hyperlipidemia Treatment of the cause: in a case of secondary hypertension. Antihypertensive drugs Antihypertensive drugs: includes Diuretics, Sympathetic blockers, Vasodilators, Calcium channel blockers, Angiotensin converting enzymes inhibitors (ACE inhibitors), Angiotensin II receptor blockers (ARBs) Hypertensive urgency: Rapid rise of BP > 220/130 mmHg & not associated with target organ damage. e.g.: renal failure, heart failure. Hypertensive emergency: Rapid rise of BP > 220/130 mmHg & associated with target organ damage. Malignant HTN: Rapid rise of diastolic BP>140 with development of papilledema Accelerated HTN: Similar to malignant HTN without papilledema