3. Hypertension is a condition in which the blood vessels have
persistently raised pressure.1
Blood pressure is the product cardiac output and systemic vascular
Hypertensive Urgency is defined as severely elevated BP with no
evidence of target organ damage.2
Hypertensive Emergency is a condition in which elevated blood
pressure (BP) results in target organ damage.2
End Organ damage usually refers to damage to major organs fed by the
circulatory system which can sustain damage due uncontrolled
hypertension, hypotension or hypovolemia.5
World Hypertension Day(May 17; 2018 theme: Know your numbers).
4. American College of Cardiology 2017 Guideline on
Categories of BP in Adults. 6
BP Category SBP DBP
Normal <120 mmHg and <80 mmHg
Elevated 120–129 mm Hg and <80 mmHg
Stage 1 130–139 mm Hg or 80–89 mm Hg
Stage 2 ≥140 mm Hg or ≥90 mm Hg
5. Factors that play a role in the pathogenesis of Hypertension:
Activation of neuro-hormonal systems
▪ Sympathetic nervous system
▪ Renin-angiotensin-aldosterone system
Obesity, Increased salt intake
Factors involved in short term and long term regulation of BP
for adequate tissue perfusion
Cardiac output and circulatory blood volume
Vascular caliber , elasticity and reactivity
Humoral mediation, Neural stimulation
.Complications are largely attributed to the
▪ remodeling of the arterial wall, including accelerated atherosclerosis
6. Vision Eye Institute. Hypertensive retinopathy 2017 . Available from
https://visioneyeinstitute.com.au/eyematters/hypertensive-retinopathy/. [accessed on 19/3/18]
8. This is a syndrome consisting of a sudden elevation of
arterial pressure usually preceded by severe headache
and followed by convulsions, coma or a variety of
transitory cerebral phenomena.3
Symptoms may include
Trouble with balances
Onset is generally sudden
9. CVA is a medical name for
A stroke is a sudden death
of some brain cells due to
lack of oxygen when
blood flow to a part of the
brain is impaired either by
blockage or rupture of a
World stroke day: 29/10
Theme: 1/6 of us will suffer a
stroke in our lifetime; we all
have good reason to prevent
10. Muscular: difficulty walking, paralysis with weak muscles,
problems with coordination, stiff muscles, overactive reflexes,
or paralysis of one side of the body
Whole body: balance disorder, fatigue, light-headedness, or
Visual: blurred vision, double vision, sudden visual loss, or
temporary loss of vision in one eye
Speech: difficulty speaking, slurred speech, or speech loss
Sensory: pins and needles or reduced sensation of touch
Facial: muscle weakness or numbness
Limbs: numbness or weakness
Also common: difficulty swallowing, headache, inability to
understand, mental confusion, or rapid involuntary eye
11. Ischemic stroke occurs when an artery to the
brain is blocked.
Ischemic stroke can be divided into two main
types: thrombotic and embolic.
A thrombotic stroke occurs when diseased cerebral
arteries become blocked by blood clot within the
brain-responsible for almost 50 percent of all strokes.
An embolic stroke is also caused by a clot within an
artery outside the brain itself.
This results in near-immediate physical and
12. Medical history to identify risk factors for
atherosclerotic and cardiac disease:
Hypertension, Diabetes mellitus,Tobacco use
High cholesterol, History of coronary artery disease,
coronary artery bypass, or atrial fibrillation
In younger patients, elicit a history of the following:
Recent trauma, Coagulopathies
Illicit drug use (especially cocaine)
Migraines, Oral contraceptive use
Nausea, vomiting, headache, and a sudden change
in the patient’s level of consciousness are more
common in hemorrhagic strokes
13. Hemiparesis, monoparesis, or (rarely) quadriparesis
Monocular or binocular visual loss
Visual field deficits
Vertigo (rarely in isolation)
Sudden decrease in the level of consciousness
No historical feature distinguishes ischemic from
14. Cranial nerves
Language (expressive and receptive capabilities)
Mental status and level of consciousness
15. A hemorrhagic stroke is either a
brain aneurysm burst or a weakened blood
Blood spills into or around the brain and
creates swelling and pressure, damaging cells
and tissue in the brain.
There are two types of hemorrhagic stroke
16. Blood vessel inside the brain ruptures and
leaks blood into surrounding brain tissue.
High blood pressure and aging blood vessels
are the most common causes of this type of
Sometimes intracerebral hemorrhagic stroke
can be caused by an arteriovenous
17. This type of stroke involves bleeding in the area
between the arachnoid membrane and the pia
mater known as the subarachnoid space.
This type of stroke is most often caused by a
Other causes include:
18. Generalized symptoms, including
nausea, vomiting, and headache, as well as an
altered level of consciousness, may indicate
▪ intracranial pressure and are more common with
hemorrhagic strokes and large ischemic strokes.
Seizures are more common occurring in 28%
of hemorrhagic stroke generally at the
onset of the intracerebral hemorrhage or within
the first 24 hours..
19. Focal symptoms of stroke include the following:
Weakness or paresis that may affect a single extremity, one half of the body,
or all 4 extremities
Monocular or binocular blindness
Blurred vision or visual field deficits
Dysarthria and trouble understanding speech
Vertigo or ataxia
Symptoms of subarachnoid hemorrhage may include the following:
Sudden onset of severe headache
Signs of meningismus with nuchal rigidity
Photophobia and pain with eye movements
Nausea and vomiting
Syncope - Prolonged or atypical
20. Time is of essence in the diagnosis of stroke.
There is urgency to make the diagnosis and determine
whether treatment with thrombolytic medications (clot-
busting drugs) to “reverse” the stroke is a possibility.
The time frame to intervene is narrow and may be as short
as 3 to 4 ½ hours after onset of symptoms
AHA and ASA recommend that everybody be aware
of “FAST“ in recognizing stroke:
Face Drooping, ArmWeakness, Speech Difficulty,Time to
Call 9-1-1(emergency line 112 for Nigeria)
In the emergency department, doctors may perform a
more in depth and standardized neurologic
21. Radiological tests including
CT is used to look for bleeding or masses.
CT perfusion scan done to check brain blood supply (perfusion).
An MRI of the brain may be possibly indicated.
Blood tests may include a
Full blood count
Blood Clotting function with international normalized ratio
(INR), prothrombin time (PT) and partial thromboplastin time
An ECG may be performed to check the heart's rate and
22. Hypertensive retinopathy is retinal
vascular damage caused by
Symptoms usually do not develop until
late in the disease and include blurred
vision or visual field defects.
Signs usually develop late in the
Funduscopic examination shows
vascular wall changes,
yellow hard exudates, and
optic disk edema
▪ World sight day: 2nd Thursday of october(11/10)
24. HHD is a term applied generally to heart
diseases that are caused by the direct or
indirect effects of elevated BP such as
Coronary Artery Disease
Cardiac Arrhythmias and
Congestive Heart Failure
▪ World Heart Day: 29/09
25. Left ventricular hypertrophy is the enlargement
and thickening of the walls of the left ventricle.
Left ventricular hypertrophy is more common in
people who have uncontrolled high blood
26. Left ventricular hypertrophy usually develops
One may experience no signs or symptoms, especially
during the early stages of the condition.
As left ventricular hypertrophy progresses, you may
Shortness of breath
Chest pain, often after exercising
Sensation of rapid
Dizziness or fainting
27. Develops when the major blood vessels that supply
the heart with blood, oxygen and nutrients (coronary
arteries) become damaged or diseased.
This is due to deposition of Cholesterol-containing
deposits (plaque) in the coronary arteries.
28. Chest pain (angina).
pressure or tightness in the chest usually occurs on the
middle or left side of the chest which is generally triggered
by physical or emotional stress.
this pain may be fleeting or sharp and felt in the neck, arm
Shortness of breath.
A completely blocked coronary artery may cause a heart
The classic signs and symptoms of a heart attack include
▪ crushing pressure in the chest and
▪ pain in the shoulder or arm, sometimes with shortness of breath
29. A cardiac arrhythmia is any abnormal heart rate or
In normal adults, the heart beats regularly at a rate of 60
to 100 beats per minute, and the pulse matches the
contractions of the ventricles.
Cardiac arrhythmias sometimes are classified according to
their origin as
ventricular arrhythmias or
They also can be classified according to their effect on the heart
▪ with bradycardia indicating a heart rate of less than 60 beats per
▪ tachycardia indicating a heart rate of more than 100 beats per minute.
31. Congestive heart failure(CHF) is a condition in
which the heart's function as a pump is
inadequate to meet the body's needs.
The symptoms of congestive heart failure
vary, but can include:
Diminished exercise capacity,
shortness of breath and
32. Hypertensive kidney disease is a medical
condition referring to damage to the kidney due
to chronic high blood pressure.
HN can be divided into two types:
benign and malignant.
Benign nephrosclerosis is common in individuals over
the age of 60
Malignant nephrosclerosis is uncommon and affects
1-5% of individuals with high blood pressure, that
have diastolic blood pressure passing 130 mm Hg.
▪ World kidney day(8/03); theme: kidneys & women’s health:
include, value, empower.
33. Chronic high blood pressure causes damages
to kidney tissue including
the small blood vessels, glomeruli, kidney tubules
and interstitial tissues.
The tissue hardens and thickens which is known
The narrowing of the blood vessels means less
blood is going to the tissue and so less oxygen is
reaching the tissue resulting in tissue death
34. Glomerular ischemia
High blood pressure damages the endothelium which
leads to a build-up of plaques and eventual renal arteries
stenosis with consequent ischemic kidney disease leading
to a decrease in the size of the kidneys.
Glomerular hypertension and glomerular
An alternative mechanism of hypertensive nephropathy is
prolonged glomerular hypertension and hence glomerular
hyperfiltration. As a compensatory mechanism, the
unaffected nephrons vasodilate to increase blood flow to
the kidney and increase glomerular filtration across
35. Damage to the glomeruli allows proteins that are
usually too large to pass into the nephron to be
This leads to an elevated concentration of albumin in
Protein in the urine is best identified from a 24-hour
Definitive diagnosis requires morphological
Common histological features include Glomerulosclerosis
which is either focally or globally and characterized by
hardening of the vessel walls..
36. Thank you for your attention
Questions and contributions
37. 1. WHO. Q&As on hypertension. September 2015. Available from
http://www.who.int/features/qa/82/en/ [accessed on 19/3/18]
2. Bisognano JD, Batuman V. Malignant Hypertension. Medscape. Available from
https://emedicine.medscape.com/article/241640-overview [accessed on 19/3/18]
3. Finerly JA. Management of hypertensive encephalopathy. Available from
https://www.ncbi.nlm.nih.gov/pubmed/721056 [accessed on 19/3/18]
4. Internet Stroke Centre. Ischaemic Stroke. http://www.strokecenter.org/patients/about-
stroke/ischemic-stroke/ [accessed on 19/3/18]
5. Prakashkumar K. Kunar J. Biswar TK. Varshil M. Sojib BZ. End Organ Damage in
Hypertensive Geriatric Age Group: A cross sectional study. Journal of Medical Research
and Innovation. Available from https://jmri.org.in/jmri/article/view/75 [accessed on 19/3/18]
6. Whelton PK, Carey RM, Aronow WS, et al. 2017
ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the
Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults.
Journal of the American College of Cardiology. Nov.2016. Available from
42552789.1521573549-211035663.1521573549 [accessed on 19/3/18]