Management of Hypertension PDF

Management of Hypertension Dr. Omoregbe Isaac N Department of Pharmacology and Therapeutics Ambrose Alli University 09/08/2024  Hypertension is defined as persistence elevated systolic blood pressure (SBP) of 140 mmHg or greater, diastolic blood pre...

Management of Hypertension Dr. Omoregbe Isaac N Department of Pharmacology and Therapeutics Ambrose Alli University 09/08/2024  Hypertension is defined as persistence elevated systolic blood pressure (SBP) of 140 mmHg or greater, diastolic blood pressure (DBP) of 90 mmHg or greater. Essential hypertension 95% No underlying cause Secondary hypertension Underlying cause Causes of Secondary Hypertension Renal Parenchymal Vascular Others Endocrine Miscellaneous Unknown  Blood Pressure Classification BP SBP DBP Classification mmHg mmHg Normal 100 Hypertension Who are at risk ? Advancing Age Sex (men and postmenopausal women) Family history of cardiovascular disease Sedentary life style & psycho-social stress Smoking ,High cholesterol diet, Low fruit consumption Obesity & wt. gain Co-existing disorders such as diabetes, and hyperlipidaemia High intake of alcohol  Aetiology of Systemic Hypertension Secondary HTN (05%) A. Renal (80%) AGN Renal Artery stenosis CGN, CPN, Polycyst. K.D B. Endocrine Adrenal Primary aldosteronism Cushing’s syndrome Pheochromocytoma Acromegaly Exogenous hormone Oral contraceptive Glucocorticoids Hypothyroidism & Hyperparathyroidism Continue… Others Coarctation of the aorta Pregnancy Induced HTN (Pre-eclampsia) Sleep Apnea Syndrome. Basic concepts in Hypertension Cardiac Output: This is the amount of blood each ventricle is pumping per-minute. Heart Rate: The amount of beat per-minute. Stroke Volume: The amount of blood that each ventricle is pumping per contraction. Peripheral Resistance: The amount of resistance due to blood flow.  CO=HR*SV BP=CO*TPR So, the main cause will likely be something resisting the flow of blood. The main reason for could be increase in arteriolar vasoconstriction. Stimulation of sympathetic nervous system could cause the release Nor-epinephrine, adrenaline, etc, and this could cause the contraction of smooth muscle surrounding the arteries. And will eventually leads to resistance of blood flow. And ultimately increase blood pressure.  Consequences: RAAS system Decrease blood flows to the kidneys, this will lead to the release of renin that will on the angiotensinogen ( Liver) and converted to angiotensin I. Angiotensin converting enzyme now act on angiotrnsin I converting it to angiotensin II (a potent vaso constrictor). This will lead to increase in peripheral resistance. Renin can also release aldosterone and this will cause increase in sodium iron reasorption. This eventually will also allow water to be reasorbed. (Kidney). This will lead to increase in blood volume and eventual increased cardiac output. This will Haemodynamic Pattern in Hypertension Why you need to treat hypertension. Diseases Attributable to Hypertension are: Heart Left Ventricular Gangrene of the Failure Hypertrophy Myocardial Lower Extremities Infarction Aortic Coronary Heart Aneurym Disease HYPERTENSION Hypertensive Blindness encephalopathy Chronic Cerebral Stroke Preeclampsia/ Hemorrhage Kidney Eclampsia Failure Adapted from Dustan HP et al. Arch Intern Med. 1996; 156: 1926-1935 How to treat ?  Treatment Overview  Goals of therapy  Lifestyle modification  Pharmacologic treatment  Algorithm for treatment of hypertension  Follow up and monitoring  Goals of Therapy  Reduce Cardiac and renal morbidity and mortality.  Treat to BP