Systemic Hypertension.docx

Systemic Hypertension Chronic, usually progressive, raised arterial blood pressure Found in approx. 30 % of adult population Under 50 years old, person would be considered hypertensive if BP was > 140/90 (British Hypertension Society) Hypertension results from an imbalance in the long-term regul...

Systemic Hypertension Chronic, usually progressive, raised arterial blood pressure Found in approx. 30 % of adult population Under 50 years old, person would be considered hypertensive if BP was > 140/90 (British Hypertension Society) Hypertension results from an imbalance in the long-term regulation of either CO or TPR (or both) However – although the baroreceptors do “adapt” to increased BP, they don’t respond to changes in BP in normal way Hypertensives have a higher risk of: Myocardial infarction Strokes Renal Failure High BP damages lining endothelial cells This leads to a number of proliferative responses including atherosclerosis Type of Hypertension Primary hypertension 95% of cases Multifactorial genetic factors Fetal factors Environmental factors Humoral mechanisms Insulin resistance Secondary hypertension With identifiable causes Amenable to curative treatment Causes Renal causes – Renal artery stenosis (most common cause of 2 forms) or aortic stenosis Endocrine causes (Hyperaldosteronism) Tumour (Phaeochromocytoma) Drugs (e.g. steroid medicines, the contraceptive pill ) Pregnancy-induced Hypertensive Emergencies (Accelerated hypertension) Vascular damage on funduscopic examination, such as flame-shaped haemorrhages or soft exudates, but without papilledema. Accelerated (SBP 160-179, DBP 100-109) Result in target organ damage CHF chest pain abnormal renal function, proteinuria Encephalopathy - altered mental status Malignant hypertension Also, a hypertensive emergency Result in target organ damage (same with accelerated) Blood pressure rises rapidly à severe hypertension. Malignant (SBP>180, DBP>120) Vascular damage on funduscopic examination, such as flame- shaped haemorrhages or soft exudates but with papilloedema Fibrinoid necrosis of the vessel wall leading to: Renal failure Heart failure Aortic dissection Stroke NICE (National Institute for Health and Care Excellence) guideline did not differentiate accelerated from malignant hypertension BP of above 180/110 is accelerated hypertension (with Papilloedema present)