Systemic hypertension

1. OPTOM FASLU MUHAMMED

2. It is termed as ‘iceberg disease’.
Hypertension is also referred to as high blood
pressure or high BP in common terms
It is a medical condition in which the blood
pressure is elevated.

3. Greater than 140 mm hg of systolic blood pressure and
or more than 90 mm hg of diastolic blood pressure at
least 2 of 3 times of measuring the pressure.

4. Systolic blood pressure- state of contraction in heart.
Diastolic blood pressure- state of relaxation in
peripheral blood vessels.

5. Systolic-90 mm hg – 120 mm hg.
Diastolic-60 mm hg -80 mm hg.

6. Systolic diastolic interpretation
Less than 120
mm Hg
Less than 80
mm Hg
Normal
120 to 139 80 to 89 Pre hypertensive
140 to 159 90 to 99 Stage 1 Hypertension
More than or
equal to 160
More than or
equal to 100
Stage 2 Hypertension
> 220 > 120 Hypertensive emergency
Source: Joint national committee on cardiovascular diseases 2003

7. The most common cause for Hypertension is
idiopathic and hence if the cause is not known it
is called as primary Hypertension
If the causes are known then it is called as
secondary hypertension.

8. Glomerulo nephritis It can be acute or chronic and
infective or non infective.
. Bacterial infection of kidney-chronic pylo-nephritis.
. Polycystic kidney disease – It is a cystic genetic disorder of the
kidney.
Apart from these any renal disease which can cause renal
failure will result in secondary hyper tension.

9.  Acromegaly - increased secretion of growth
hormone in adults.
Cushings syndrome – increased secretion of
steroid hormone in children and adults .
Pheochromocytoma - tumor of adrenal medulla.
Drug such as corticosteroid and hormones like
estrogen.

10. The main reason is vasoconstriction which occurs
due sympathetic over-activity due to stress
response.
An overactive renin – angiotensin system leads to
vasoconstriction and retention of sodium and
water.

11. Primary hypertension
Age (older the risk is higher)
Diet (High salt intake/ fatty diet)
Physical activity (sedentary life style)
Alcohol
Obesity
Drugs (steroids, oral contraceptives)
Stress
Family history

12. The gold standard for hypertension is only clinical
measurement using mercury sphygmomanometer
and not lab investigation.
But we need to do investigations to rule out
secondary causes to conclude on primary
hypertension
Better to screen everyone above 40 years every year
and every six months if there is a risk factor

13. Always measure B.P when the patient is
completely relaxed.
The instrument used is mercury
sphygmomanometer .
The cuff of the apparatus should cover up to
three – fourth of his arm.

14. The tubings must be parallel to arteries of the arm.
You must then inflate it until there is radial pulse
depression.
Then deflate and measure the value.
The sound as korotkoff sound
Details in the video link and audio link
 http://www.youtube.com/watch?v=u6saTO8_o2g&feature=related
 http://www.thinklabsmedical.com/stethoscope_community/Sound_Library

15. In the first measurement if there is >220 mm hg of
systolic pressure and >120 mm hg of diastolic pressure
then we can call the patient as hypertensive in the
first measurement and they are infact in emergency.

16. No specific symptoms in majority.
Vague pain
Sub-occipital headache
Restlessness.
Sleepiness.
Dizziness.
vomiting

17. Myocardial infarction or coronary artery
disease
Cerebro vascular accident / stroke
Left ventricular hypotrophy causes cardiac
failure due to increase HTN
Renal failure due to chronic decrease blood
supply to kidney.
Hypertensive Retinopathy

18. We have to rule out secondary hypertension
by certain investigation.
Renal – urine microscopy is done to detect the
presence of albumin.
Presence of RBC, Cast is an indications of
glomerular nephritis.
Excess of WBC indicates kidney infection.
Renal doppler / technicium scan (nuclear
scan) is done to know about blood supply to

19. Diet
 Use <5 gms of salt per day
 Avoid oily food / fatty diet
 Low calorie high fiber diet
Exercise
 Brisk walking, jogging, Swimming etc…
Avoid smoking & alcohol.

20. Usually divided into 4 categories:
• ACE (Angiotensin converting enzyme) inhibitors or
AT receptor blockers
• Beta blockers
• CCB (calcium channel blockers)
• Diuretics & vasodilators

21. Blocks the conversion of Angiotensin to Renin by inhibiting
angiotensin converting enzyme Eg: Enalapril , Lisinopril.
Side effects
• Produce dry cough
• Altered taste sensations (dysguesia)

22. Similar to ACE inhibitors except it blocks the
receptors not the enzyme Eg : Losartan

23. Beta 1:cardiac selective ( Eg: Atenolol )
Non cardiac selective beta blockers
( Eg:Timolol, Propanalol).
Beta blockers with intrinsic
sympathomimetic activity.

24. Mechanism of action:
• Acts on the beta adrenergic receptors.
Side effects:
• Can precipitate asthma in asthmatics-Beta
receptors are present on the bronchus causing broncho
constriction.
• Decreases the cardiac output as well as the
heart rate.
• Can increase the cholesterol level.
• Can mask hypoglycemia in diabetics

25. Allows peripheral vaso dilatation
Causes decrease in the peripheral vascular
resistance
Very safe during pregnancy
 Eg: Nifidepine, Amlodepine.
Side effect: Postural hypotension, Headache,
Edema, Tachycardia

26.  Diuretics Eg: Thiazide diuretics, Hydro chloro
thiazide
Alpha blockers: Prazosin
Vasodilators: Hydralazine and sodium nitroprusside
Centrally acting drugs: Methyldopa

27. Depends upon the blood pressure
If person is pre-hypertensive or stage 1 is – life
style modification should be done first.
Diet and exercises are first modes to control
mild hypertension
If Blood pressure is high – any of the 4 drugs
can be given.

28. If the patient has
Renal problem – ACE inhibitors can be given
Diabetes mellitus – ACE inhibitors can be
given
Asthma – ACE inhibitors can be given
Diabetic / pregnancy – CCB can be given
Anxiety /hyperthyroidism – Beta blockers
can be given

29. They may result in end organ damage e,g.,
Kidney retina
Blood pressure should be reduced fast to prevent
end organ damage. Drugs commonly used are:
• Alpha blockers –Prazosin
• Vasodilators – Sodium nitroprusside / Nitrates
• Alpha + beta blockers – Labatelol
• CCB - Nifedepine