Hypertension
Hypertension
Hypertension
HYPERTENSION
1
HYPERTENSION
Hypertension is defined as systolic blood pressure (SBP)
of 140 mmHg or greater, diastolic blood pressure (DBP)
of 90 mmHg or greater
BP SBP DBP
Classification mmHg mmHg
Normal 120 and 80
Prehypertension 120139 or 8089
Stroke
Coronary heart disease
Heart failure
Cerebral hemorrhage
Myocardial infarction
Left ventricular
hypertrophy Hypertension Chronic kidney failure
Hypertensive
Aortic aneurysm encephalopathy
Retinopathy
Peripheral vascular disease All
Vascular
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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 (bleeding from nose)
blurred vision
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
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)
Ambulatory BP Monitoring - information about BP
during daily activities and sleep.
Self-Measurement of BP
Provides information on:
1. Response to antihypertensive therapy
2. Improving adherence with therapy
DASH
diet
Regular exercise
Thiazide diuretics
Beta receptor
blockers
Alpha receptor
blockers
ACE inhibitors
Angiotensin II
receptor blockers
Calcium channel
blocker
AT1 receptor
ARB Continue.
Diuretics
Example: Hydrochlorothiazide, Furosemide,
Bumetanide
Act by decreasing blood volume and cardiac output
Decrease peripheral resistance during chronic therapy
Drugs of choice in elderly hypertensive
Side effects-
Hypokalaemia
Hyponatraemia
Hyperlipidaemia
Hyperuricaemia (hence contraindicated in gout)
Hyperglycaemia (hence not safe in diabetes)
Not safe in renal and hepatic insufficiency
Beta blockers
Example: Atenolol, Metoprolol, Nebivolol,
Block b1 receptors on the heart
Block b2 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
Side effects-
Lethargy, impotency, bradycardia
Not safe in patients with co-existing asthma and diabetes
Have an adverse effect on the lipid profile
Alpha blockers
Example: Prazosin
Block a-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
Side effects-
Postural hypotension
ACE inhibitors
Example: Losartan
Block the angiotensin II receptor and inhibit effects
of angiotensin II
Drugs of choice in patients with co-existing diabetes
mellitus
Side effects-
Safer than ACE Inhibitors, but may cause hypotension
Calcium channel blockers
Example: Amlodipine, Nifedipine, Verapamil
Block entry of calcium through calcium channels
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
Side effects
Flushing, headache, Pedal edema
Common Drug therapy for hypertension
Not at Goal
Blood Pressure