5. Determinant's BP
BP=CO X SVR=HR X EDV - ESV X SVR
CO=HR X SV
CO=is defined as amount of blood pumped out of each ventricle per minute.
HR=The number of times your heart beats per minute (BPM)
SV=is the volume of blood pumped from one ventricle of the heart with each beat.
SV = EDV – ESV
SRV=Vascular function and structure.
Arterial hypertension, simply started is high blood pressure. It is
defined as a persistent evaluation of the systolic blood pressure at
a level of 140 mm Hg or higher and diastolic blood pressure at a
level of 90 mm Hg or higher.
7. CLASSIFICATION OF HTN
Classification Systolic blood pressure Diastolic pressure
Normal ≤120 ≤ 80
Pre HTN 120-139 80-89
High BP Stage 1 140-159 90-99
High BP Stage 2 Higher than 160 Higher than 100
8. Risk factors
9. Clinical manifestation
Nausea and vomiting
Fatigue and confusion
Severe head ache
Irregular heart beat
1.Primary HTN / essential 95%
Is the most common form of hypertension.
The cause of primary hypertension is unknown.
2.Secondary HTN 5%
3.Systolic Isolated Hypertension
It’s a high value of systolic pressure, and a normal value of diastolic pressure
12. 4. Hypertensive crisis
Hypertensive urgency is acute severe elevation in blood pressure (>180/120 mmHg)
without evidence of end organ damage
Usually due to under-controlled HTN.
A severe elevation in blood pressure (usually >180/120 mmHg) complicated by
impending or progressive target organ dysfunction involving neurological, cardiac or
Require lowering of BP within 1 hour to decrease morbidity
Not determined by a BP level, but rather the imminent compromise of vital organ
13. Risk Factors for Primary Hypertension
Age (> 55 for men; > 65 for women)
Elevated serum lipids
Excess dietary sodium
Gender Risk Factors for Primary Hypertension
Obesity (BMI > 30)
Ethnicity (African Americans)
14. 2. Secondary HTN
Some people have high blood pressure caused by an underling condition.
This type of high blood pressure called secondary hypertension. Various
condition and medications can lead to secondary hypertension.
Renal artery stenosis
Oral contraceptive pills
Drug-induced or drug-related
Chronic kidney disease
Reno vascular disease
Chronic steroid therapy and Cushing syndrome
Thyroid or parathyroid disease
Coarctation of the aorta
16. Other types of HTN
1. White coat hypertension
White coat syndrome have normal reading at home and only have high readings
when their BP is taken by a doctor.
2.Isolated systolic hypertension
It’s not uncommon to have either a systolic number that’s elevate while the
diastolic number remains normal.
It’s less common for patients to have elevated diastolic number.
This condition known as isolated systolic hypertension
17. 3.Persistent Hypertension
Characterized by a diastolic blood pressure above 110 to 120 mm Hg.
It results when hypertension is unresponsive to treatment and become a truly
severe emergency condition as the pressure continues to rise unchecked
18. Benign hypertension
is a term used to describe uncomplicated hypertension,
usually of long duration and mild to moderate severity.
Benign hypertension may be primary or secondary.
19. Malignant hypertension
is a syndrome of markedly elevated BP (diastolic BP over 140
mm Hg) associated with papilledema.
Accelerated hypertension is a syndrome of markedly elevated
BP with retinal hemorrhage and exudates.
Accelerated hypertension presumably develops into malignant
hypertension if not well managed.
20. Borderline or labile hypertension
is defined as intermittent elevation of blood pressure
interspersed with normal readings.
Clients with borderline hypertension still carry an increased
risk of developing cardiovascular disease.
21. Resistant hypertension
Resistant hypertension is defined as blood pressure that remains
above goal in spite of the concurrent use of 3 antihypertensive
agents of different classes. Ideally, one of the 3 agents should be a
diuretic and all agents should be prescribed at optimal dose
22. Diagnostic Evaluation
History collection and physical examination
Medical history of diabetes mellitus
Complete blood count
26. 2.Pharmacological management
Angiotensin is a hormone in the body that causes blood vessels to narrow.
The angiotensin converting enzyme inhibitors decreases the production of angiotensin
and in turn that helps lower blood pressure.
Inhibit ACE and formation of angiotensin II and block its effects
Drugs of choice in co-existent diabetes mellitus, Heart failure
Captopril (25-150 mg/day)
Ramipril (1.25-20 mg/day)
27. 2. Alpha blockers
These medicines reduces nerve impulses to blood vessels, reducing the
effects of natural chemicals that narrow blood vessels.
Block α-1 receptors and cause vasodilation
Reduce peripheral resistance and venous return
Exert beneficial effects on lipids and insulin sensitivity
Drugs of choice in patients with co-existing BPH
Prazocin (2-30 mg/day)
Terazocin (1-20 mg/day)
28. 3. Alpha- beta blockers
In addition to reducing nerve impulses to blood vessels, alpha beta blockers
slow the heartbeat to reduce the amount of blood that must be pumped through
Help relax your blood vessels, which lowers your blood pressure.
Labetalol (2-30 mg/day)
Carvedilol (12.5-20 mg/day)
29. 4. Angiotensin II receptor blockers
These medications help relax blood vessels by blocking the action, not
the formation of a natural chemical that narrows blood vessels.
Block the angiotensin II receptor and inhibit effects of
Drugs of choice in patients with co-existing diabetes mellitus
30. 5.Beta blockers
These medications reduce the workload on heart and open blood vessels, causing
heart to beat slower and with less force.
Example: Atenolol, Metoprolol, nebivolol,
Block β1 receptors on the heart
Block β2 receptors on kidney and inhibit release of renin
Decrease rate and force of contraction and thus reduce cardiac output
Drugs of choice in patients with co-existent coronary heart disease
31. 6. Calcium channel blockers
These medicines will block the movement of extra cellular calcium into the cells and causing
vasodilation and decreased heart rate.
These medications relax the muscles of blood vessels. Some slow the heart rate.
Calcium channel blockers relax blood vessels by stopping calcium from entering cells
Cause vasodilation and reduce peripheral resistance
Drugs of choice in elderly hypertensive and those with co-existing asthma
Neutral effect on glucose and lipid levels
32. 7. Diuretics
Example: Hydrochlorothiazide :-Act by decreasing blood volume and cardiac
Decrease peripheral resistance during chronic therapy
Drugs of choice in elderly hypertensive
Diuretics help the kidneys get rid of sodium and water from body. This decreases the
volume of blood in the body and lowers blood pressure.
Diuretics are also called water pills. They help your kidneys remove some salt (sodium)
from your body. As a result, your blood vessels don't have to hold as much fluid and your
blood pressure goes down
E.g. chlorothiazide, furosemide
Spironolactone (25-100 mg/day
These medications acting directly on the muscles in the wall of arteries and
preventing the muscles from tightening and arteries from narrowing. These
medications work directly on the muscles in the walls of arteries.
signal the muscles in the walls of blood vessels to relax
E.g. Nitroglycerin, Sodium nitro prusside
Minoxidil (5-100 mg/day)
Hydralazine (50-300 mg/day)
9.Centrally acting drugs
signal your brain and nervous system to relax your blood vessels
34. Step to Management
weight loss, diet, exercise, stop smoking, limit alcohol
Diuretics or Beta-Blocker
Add second drug or substitute another drug
Add third drug and/or substitute second drug
Continue adding agents from other classes
Referral to hypertensive specialist