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Essential Hypertension

Essential Hypertension. Prof.Abdullah Saadeh. Definition. Persistent elevation of BP ( ≥ 140/90 mmHg). Classification of BP According to JNC – 7 report. Normal ≤ 120 mmHg systolic and ≤ 80 mmHg diastolic Prehypertention 120 -139 mm Hg systolic and 80-90mm Hg diastolic

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Essential Hypertension

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  1. Essential Hypertension Prof.Abdullah Saadeh

  2. Definition Persistent elevation of BP ( ≥ 140/90 mmHg)

  3. Classification of BP According to JNC – 7 report • Normal ≤ 120 mmHg systolic and ≤ 80 mmHg diastolic • Prehypertention 120 -139 mm Hg systolic and 80-90mm Hg diastolic • Stage -1 Hypertension 140-159 mmHg systolic and 90- 99 mmHg diastolic • Ssage -2 Hypertention ≥ 160 mmHg systolic and ≥ 100 mmHg diastolic

  4. CAUSES • Essential Hypertention (95 %) • Secondary ( 5%) • DRUGS( steroids , Contraceptive pills,NSAIDS,carbenoxolone,Liquorice, sympathomimetics) 2. Cardiovascular (Coarctation of the aorta) 3. Renal (Renovascular i.e RAS and renal artery occlusion or Parenchymal i.e ch. Pyelonephritis,acute and ch.glomeronephritis,obstructive uropathy,polycystic kidney diseaseand hypernephromas.

  5. CAUSES 4.Endocrine: ( pheochromocytoma, 1° aldosteronism, cushing’s,acromegaly,hyperparathyroidism and hypothyroidism). 5.Others (brain tumors with increased intracranial pressure,bulbar poliomyelitis,connective tissue disorders i.e SLE and polyarteriti nodosa,DM nephropathy,Polycythemia rubra vera)

  6. INITIAL or PRIMARY INVESTIGATIONS in HYPERTENSION • Urinalysis • Renal profile • ECG • Chest x-ray • Plain U-T x-ray or renal ultrasound • Urine culture • HB, PCV • FBS,s.lipids,s.urate • Echocardiography

  7. When to investigate for a secondary cause of hypertension • Clues from the history • Clues from physical examination • Clues from initial investigations • Malignant stage hypertension

  8. Complications of hypertension • Cardiovascular(angina,MI,LVH,HF,dissecting aortic aneurysm) • Cerebrovascular(TIA,Thrombotic infarction,intracerebral hemorrhge,encephalopathy) • Peripheral vascular disease(atherosclorosis,intermittent claudication, gangrene) • Retinopathy(Grades1,2,3,4) • Nephropathy(nephrosclerosis,fibrinoid necrosis) • Malignant hypertension

  9. Treatment of hypertension 1st. Non-pharmacological measures: 1. Diet 2. Weight reduction 3. Stopping smoking and excess alcohol consumption 4. Regular exercise ( behavioral, biofeedback therapy) 5. Treatment of other associated risk factors

  10. B. Antihypertensive medications: 1. Diuretics Thiazide, loop, K+ sparing 2. B-Blockers Non-cardioselective Cardioselective Drugs with ISA Alpha and Beta-blockers(labetolol)

  11. 3. Alpha-blockers ( prazosin) 4. Central acting drugs (reserpine, methyldopa,clonidine) 5. vasodilators: 1st. Direct relaxation of arteriolar smooth muscle: -Hydralazine -Minoxidil -Diazoxide -Na-nitroprusside

  12. 2nd. Calcium-channel blockers: - Verapamil - Nifedipine - Amlodipine 3rd. ACE inhibitors : - Captopril - Enalapril - Lysinopril - Quinapril

  13. 6. ARBs - Losartan - Candesartan - Irbisartan - Valsartan

  14. Hypertensive Crisis: Severe hypertension with one of the following: • Heart failure • MI • Renal failure • Encephalopathy • Dissecting aneurysm • Intracerebral hemorrhage • Accelerated or malignant hypertension

  15. Parentral Drugs Used In Hypertensive Emergencies: • Na-nitroprusside infusion • Diazoxide i.v • Hydralazine iv • Furosemide i.v • Phentolamine i.v • Nifedipine s/L • Labetolol i.v ( N.B: B.P shouldn’t be reduced to below diastolic of 100 mmHg )

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