2. ďIt is termed as âiceberg diseaseâ.
ďHypertension is also referred to as high blood
pressure or high BP in common terms
ďIt 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. ďSystolic blood pressure- state of contraction in heart.
ďDiastolic blood pressure- state of relaxation in
peripheral blood vessels.
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. ďThe most common cause for Hypertension is
idiopathic and hence if the cause is not known it
is called as primary Hypertension
ďIf the causes are known then it is called as
secondary hypertension.
8. ďGlomerulo nephritis It can be acute or chronic and
infective or non infective.
. Bacterial infection of kidney-chronic pylo-nephritis.
. Polycystic kidney disease â It is a cystic genetic disorder of the
kidney.
ďApart from these any renal disease which can cause renal
failure will result in secondary hyper tension.
9. ď Acromegaly - increased secretion of growth
hormone in adults.
ďCushings syndrome â increased secretion of
steroid hormone in children and adults .
ďPheochromocytoma - tumor of adrenal medulla.
ďDrug such as corticosteroid and hormones like
estrogen.
10. ďThe main reason is vasoconstriction which occurs
due sympathetic over-activity due to stress
response.
ďAn overactive renin â angiotensin system leads to
vasoconstriction and retention of sodium and
water.
11. ďPrimary hypertension
ďAge (older the risk is higher)
ďDiet (High salt intake/ fatty diet)
ďPhysical activity (sedentary life style)
ďAlcohol
ďObesity
ďDrugs (steroids, oral contraceptives)
ďStress
ďFamily history
12. ďThe gold standard for hypertension is only clinical
measurement using mercury sphygmomanometer
and not lab investigation.
ďBut we need to do investigations to rule out
secondary causes to conclude on primary
hypertension
ďBetter to screen everyone above 40 years every year
and every six months if there is a risk factor
13. ďAlways measure B.P when the patient is
completely relaxed.
ďThe instrument used is mercury
sphygmomanometer .
ďThe cuff of the apparatus should cover up to
three â fourth of his arm.
14. ďThe tubings must be parallel to arteries of the arm.
ďYou must then inflate it until there is radial pulse
depression.
ďThen deflate and measure the value.
ďThe sound as korotkoff sound
ďDetails in the video link and audio link
ď http://www.youtube.com/watch?v=u6saTO8_o2g&feature=related
ď 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. ďNo specific symptoms in majority.
ďVague pain
ďSub-occipital headache
ďRestlessness.
ďSleepiness.
ďDizziness.
ďvomiting
17. ďMyocardial infarction or coronary artery
disease
ďCerebro vascular accident / stroke
ďLeft ventricular hypotrophy causes cardiac
failure due to increase HTN
ďRenal failure due to chronic decrease blood
supply to kidney.
ďHypertensive Retinopathy
18. ďWe have to rule out secondary hypertension
by certain investigation.
ďRenal â urine microscopy is done to detect the
presence of albumin.
ďPresence of RBC, Cast is an indications of
glomerular nephritis.
ďExcess of WBC indicates kidney infection.
ďRenal doppler / technicium scan (nuclear
scan) is done to know about blood supply to
19. ďDiet
ď Use <5 gms of salt per day
ď Avoid oily food / fatty diet
ď Low calorie high fiber diet
ďExercise
ď Brisk walking, jogging, Swimming etcâŚ
ďAvoid smoking & alcohol.
20. ďUsually 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.
ďSide effects
⢠Produce dry cough
⢠Altered taste sensations (dysguesia)
22. ďSimilar to ACE inhibitors except it blocks the
receptors not the enzyme Eg : Losartan
24. ďMechanism 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. ďAllows peripheral vaso dilatation
ďCauses decrease in the peripheral vascular
resistance
ďVery safe during pregnancy
ď Eg: Nifidepine, Amlodepine.
ďSide effect: Postural hypotension, Headache,
Edema, Tachycardia
27. ďDepends upon the blood pressure
ďIf person is pre-hypertensive or stage 1 is â life
style modification should be done first.
ďDiet and exercises are first modes to control
mild hypertension
ďIf Blood pressure is high â any of the 4 drugs
can be given.
28. ďIf the patient has
ďRenal problem â ACE inhibitors can be given
ďDiabetes mellitus â ACE inhibitors can be
given
ďAsthma â ACE inhibitors can be given
ďDiabetic / pregnancy â CCB can be given
ďAnxiety /hyperthyroidism â Beta blockers
can be given
29. ďThey may result in end organ damage e,g.,
Kidney retina
ďBlood pressure should be reduced fast to prevent
end organ damage. Drugs commonly used are:
⢠Alpha blockers âPrazosin
⢠Vasodilators â Sodium nitroprusside / Nitrates
⢠Alpha + beta blockers â Labatelol
⢠CCB - Nifedepine