Hypertension

Each time the heart beats (about 60-70 times a minute at rest), it pumps out blood into

the arteries.

What Is Blood Pressure?Your blood pressure is at its

highest when the heart beats, pumping the blood.

When the heart is at rest, between beats, your blood pressure

falls.

Your blood pressure is always given as these two numbers with one above or before the other.

This is called SYSTOLIC pressure. 120/To

p num

ber

80This is called DIASTOLIC pressure.

Bottom number

CategorySystolic

(Top Number)Diastolic

(Bottom Number)

Normal Less than 120 Less than 80

What Is Normal Blood Pressure?

“Normal” blood pressure is when both numbers are lower than 120/80.

If your blood pressure is in the prehypertensive range:

It means that you don’t have high blood pressure now, but you are likely to develop it in the future.

Unless you take ACTION to prevent it!

“Prehypertension”

Prehypertension 120-139 80-89

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2013 ESH/ESC Guidelines for the management of arterial hypertension

The Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC) - J Hypertension 2013;31:1281-1357

Definitions and classification of office BP levels (mmHg)*

Category Systolic Diastolic

Optimal <120 and <80

Normal 120–129 and/or 80–84

High normal 130–139 and/or 85–89

Grade 1 hypertension 140–159 and/or 90–99

Grade 2 hypertension 160–179 and/or 100–109

Grade 3 hypertension ≥180 and/or ≥110

Isolated systolic hypertension ≥140 and <90

* The blood pressure (BP) category is defined by the highest level of BP, whether systolic or diastolic. Isolated systolic hypertension should be graded 1, 2, or 3 according to systolic BP values in the ranges indicated.

Hypertension:SBP >140 mmHg ± DBP >90 mmHg

What Is High Blood Pressure?

A blood pressure of 140/90 is considered high blood pressure.

High Blood Pressure Systolic Diastolic

Stage 1 140-159 90-99

Stage 2 160 or higher 100 or higher

“Hypertension”

Kieran McGlade Nov 2001 Department of General Practice QUB

Aetiology of Hypertension• Primary – 90-95% of cases – also termed “essential” of “idiopathic”• Secondary – about 5% of cases

– Renal or renovascular disease– Endocrine disease

• Phaeochomocytoma• Cusings syndrome• Conn’s syndrome (hyperaldosteronism)• Acromegaly and hypothyroidism

– Coarctation of the aorta– Iatrogenic

• Hormonal / oral contraceptive• NSAIDs

• Renovascular disease is a progressive condition that causes narrowing or blockage of the renal arteries or veins. These are the blood vessels that take blood to and from the kidneys. It's the general term used for three disorders: renal artery occlusion, renal vein thrombosis, and renal atheroembolism.

• Phaeochomocytoma is a small vascular tumor of the adrenal medulla, causing irregular secretion of epinephrine and norepinephrine, leading to attacks of raised blood pressure, palpitations, and headache.

• Cusings syndrome is a metabolic disorder caused by overproduction of corticosteroid hormones by the adrenal cortex and often involving obesity and high blood pressure.

Coarctation of the aorta

• Coarctation

Hypertension: Predisposing factors

• Advancing Age • Sex (men and postmenopausal women)• Family history of cardiovascular disease• Sedentary life style & psycho-social stress• Smoking ,High cholesterol diet, Low fruit

consumption• Obesity & wt. gain• Co-existing disorders such as diabetes, and

hyperlipidaemia• High intake of alcohol

Haemodynamic Pattern in

Hypertension

Young : BP = CO X TPR

Elderly : BP = CO X TPR

What can high blood pressure do to your body?

Heart Attack

High blood pressure is a major risk factor for heart attack. The arteries bring

oxygen-carrying blood to the heart muscle. If the heart

cannot get enough oxygen, chest pain, can occur. If the flow of blood is blocked, a

heart attack results.

BlindnessHigh blood pressure can eventually

cause blood vessels in the eye to burst or bleed. Vision may become blurred or otherwise impaired and

can result in blindness.

Kidney diseaseKidneys act as filters to rid the

body of waste. High blood pressure can narrow and

thicken the blood vessels of the kidneys. The kidneys filter less fluid and waste

builds up in the blood. The kidneys may fail altogether.

High blood pressure is the most important risk factor for stroke. Very high pressure can cause a break in a weakened blood vessel,

which then bleeds in the brain. This can cause a stroke. If a blood clot blocks one of the narrowed arteries, it can also cause a

stroke.

Stroke

As people get older, arteries throughout the body

"harden," especially those in the heart, brain, and

kidneys. High blood pressure is associated with these "stiffer" arteries. This, in

turn, causes the heart and kidneys to work harder.

Arteries

Heart failureThe heart is unable to

pump enough blood to supply the body's needs.

Diagnosis

Clinical manifestations

• No specific complains or manifestations other than elevated systolic and/or diastolic BP (Silent Killer )

• Morning occipital headache• Dizziness• Fatigue• In severe hypertension, epistaxis or blurred vision

Self-Measurement of BP

Provides information on:1. Response to antihypertensive therapy2. Improving adherence with therapy 3. Evaluating white-coat HTN

Home measurement of >135/85 mmHg is generally considered to be hypertensive.

Home measurement devices should be checked regularly.

Measuring Blood Pressure

• Patient seated quietly for at least 5minutes in a chair, with feet on the floor and arm supported at heart level

•An appropriate-sized cuff (cuff bladder encircling at least 80% of the arm)

•At least 2 measurements

Continue…

• Systolic Blood Pressure is the point at which the first of 2 or more sounds is heard

• Diastolic Blood Pressure is the point of disappearance of the sounds (Korotkoff 5th)

Continue…

Measuring Blood Pressure

• Ambulatory BP Monitoring - information about BP during daily activities and sleep.

• Correlates better than office measurements with target-organ injury.

Continue…

Measuring Blood Pressure

Laboratory Tests

Routine Tests• Electrocardiogram • Urinalysis • Blood glucose, • Serum potassium, creatinine, or the corresponding estimated GFR,

and calcium• Lipid profile, after 9- to 12-hour fast, that includes high-density and

low-density lipoprotein cholesterol, and triglycerides Optional tests

• Measurement of urinary albumin excretion or albumin/creatinine ratio

More extensive testing for identifiable causes is not generally indicated unless BP control is not achieved

How to treat ?

Treatment Overview

Goals of therapyLifestyle modificationPharmacologic treatment Algorithm for treatment of hypertensionFollow up and monitoring

Goals of Therapy

Reduce Cardiac and renal morbidity and mortality.

Treat to BP <140/90 mmHg or BP <130/80 mmHg in patients with diabetes or chronic kidney disease.

Non pharmacological Treatment of hypertension

Avoid harmful habits ,smoking ,alcohal

Reduce salt and high fat diets

Loose weight , if obese

Regular exercise

DASHdiet

Life style modifications

• Lose weight, if overweight• Increase physical activity• Reduce salt intake• Stop smoking• Limit intake of foods rich in fats and

cholesterol• increase consumption of fruits and

vegetables• Limit alcohol intake

Lifestyle Modification

Modification Approximate SBP reduction(range)

Weight reduction 5–20 mmHg / 10 kg weight loss

Adopt DASH eating plan

8–14 mmHg

Dietary sodium reduction

2–8 mmHg

Physical activity 4–9 mmHg

Moderation of alcohol consumption

2–4 mmHg

Antihypertensive Drugs

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AT1 receptor

ARB

Drug therapy for hypertension

Class of drug Example Initiating dose Usual maintenance dose

DiureticsHydrochlorothiazide 12.5 mg o.d. 12.5-25 mg o.d.

-blockers Atenolol 25-50 mg o.d. 50-100 mg o.d.

Calcium Amlodipine 2.5-5 mg o.d. 5-10 mg o.d.channelblockers

-blockers prazosin 2.5 mg o.d 2.5-10mg o.d.

ACE- inhibitors ramipril 1.25-5 mg o.d. 5-20 mg o.d.

Angiotensin-II Losartan25-50 mg o.d. 50-100 mg o.d.receptor blockers