Hypertension Flashcards
HYPERTENSION
Hypertension is the most common cardiovascular disease.
It is defined as sustained high Blood Pressure of >140/90mmHg.
It is associated with an increase in vascular peripheral resistance
Classification of Blood Pressure
Normal <120 and <80
Prehypertension 120–139 or 80–89 Stage 1 hypertension 140–159 or 90–99
Stage 2 hypertension ≥160 or
• Hypertensive crises are clinical situations where BP values
are very elevated, typically greater than 180/120 mm Hg.
• They are categorized as either a hypertensive emergency or hypertensive urgency
≥ 100
Etiology of Hypertension
AETIOLOGY
1. Primary Hypertension
- Also know as Essential Hypertension
- Accounts for about 90% cases
- Idiopathic: no specific cause
Family Hx
2. Secondary Hypertension
- Cause is known
- Some are Asymptomatic: 5-10% cases
- Underlaying conditions: Eclampsia, Diabetes, renal failure, heart failure
- Environmental factors: stress, obesity, smoking, high Na diet etc
Neurological causes: Brain tumor and head injury.
- Liver cirrhosis.
RISK FACTORS ASSOCIATED WITH HTN
Age: chance of CAD after 50 years increases Alcohol
Smocking
Excessive dietary intake of Na
Family
Obesity
Sedentary life style Stress
Non modifiable Risk Factor
Ethnic genetic risk(Black)
Age
Gender(men)
Modifiable
Hyperlipidemia
Smocking
Diabetes
Over weight
Stress
Inactivity
Salt intake
Target Organ Damage
Target-Organ Damage
-
hypertension. The primary organs involved are organ damage can develop as a complication of
• Brain (stroke, transient ischemic attack)
Target
• Eyes
• Heart
• coronary revascularization, heart failure)
• Kidney (chronic kidney disease)
• Peripheral vasculature (peripheral arterial disease)
(retinopathy)
(left ventricular hypertrophy, angi
COMPLICATIONS
Atherosclerosis
• Cerebral vascular insufficiency (hypoxia in the Brian)
• Cerebral vascular accident (e.g stroke)
• Congestive heart failure
• Coronary artery disease
• Peripheral vascular insufficiency (hypoxia in the limbs)
• Dissecting aortic aneurysm
• Hypertensive retinopathy
• Hypertensive nephropathy and renal failure
CLINICAL FEATURES
Hypertension is usually asymptomatic until when it has caused complications and damage to target organs.
• At this point, the symptoms are thus associated with the affected organ.
Signs
• Tachycardia
• Cerebral vascular insufficiency
• Lung crepitations
• Hypertensive retinopathy
Symptoms
• Palpitations
• Dizziness
• Shortness of breath
• Blurred vision
INVESTIGATIONS
Urinalvsis
• Fundoscopy (examination of the eye)
• Electrocardiogram
• Echocardiogram - to detect left ventricular hypertrophy.
• Chest x-ray
• Urea, creatinine and electrolytes
• Random blood sugar
• Lipid profile
• Abdominal ultrasound (examines the abdominal aorta)
MANAGEMENT - GOALS OF THERAPY
- BP <140/90 mmg and <130/80 mm Hg for those with diabetes and chronic kidney disease
- To exclude the possibility of a secondary cause of hypertension and other co-morbidities.
- to prevent and lower related complications such as strokes, renal failure and heart failure
TARGETED BLOOD PRESSURE
Patients > 60yrs old < 150/90 mmHg
Diabetes mellitus < 130/80 mmHg
Chronic kidney disease <130/80 mmHg
Patients < 60yrs old <140/80mmhe
NON-PHARMACOLOGICAL TREATMENT
• lifestyle modification;
1. Smoking cessation,
2. Weight reduction to optimal weight, BMI less than 25,
3. Regular exercise,
• Reduction in alcohol intake,
• Dietary modifications(e.g. salt reduction, fat-free diet.).
PHARMACOLOGICAL TREATMENT
• Stepwise approach, use of a combination of drugs for better effect.
STEP ONE
Thiazide Diuretics :Amiloride + Hydrochlorothiazide (5/50mg) OD PO;
OR
• CCB’s : Nifedipine 20mg OD PO, or Amlodipine 5 -10 mg OD PO;
OR
ACE inhibitors : Captopril 25-50mg BD or TDS P.O, Enalapril 5-20mg OD PO). Those who cannot tolerate ACEI may be given;
ARB’s : Losartan potassium 50-100mg OD PO
CHOICE OF DRUG MONOTHERAPY
AGE
- 55yrs or older: either CCBs or Thiazide diuretics
- Black of any age: either CCBs or Thiazide duiretics.
• ETHNICITY
- Blacks (Africa and Caribbean origin but not mixed Race, Asian or Chinese patients): CCBs or Thiazide Duiretics
- Non-Black population: ACE inhibitors or ARBs
- Note: ACEls/ARB’s or BBs monotherapy in Blacks may be less effective BP reduction than in whites.
• CO-MOBIDITY (See the table on the next slide “compelling Conditions”)
STEP TWO
Use a combination of 2 drugs from different classes (e.g.Diuretic + ACEI, or CCB’s + ACEI, or, Diuretic + CCB)
STEP THREE
Use a combination of 3 drugs from different classes (e.g.Diuretic + ACEI + CCB)
