HypertensiOn

m/s 173 UM
m/s 858 Kumar
m/s 124 oxford
m/s 65 telle’
Def ↑ BP
HPT Systolic Diastolic
BP(mmHg BP(mmHg)
• BP= CO x TPR )
Grade 1 140-149 90-99
• nOrmal systolic= 100- (mild)
140 mmHg Grade 2 160-179 100-109
(moderate)
• nOrmal diastolic= 60- Grade 3 ≥ 180 ≥ 100
90mmHg (>80 for (severe)
DM) Isolated
systolic
• If > 140mmHg HPT HPT

• If <60 mmHg hypo Grade 1 140-149 <90

Grade 2 160 <90

 sigN+symPtOms
• General inspect sign rare causes 2º HPT:
-cushing,acromegaly,polycythaemia,CRF
• Take BPlying & standing
*rise ↑ in diastolic P on standing occur typically in essential HPT
*fall ↓on standing suggest 2º cause,but usually effect of antiHPT drugs.
• Palpate radiofemoral delay
• Check BP in leg if coarctation aorta suspected @ severe HPT discovered
b4 30yrs of age.
• Examine fundi for Keith-Wagener retinal
• Examine CVS look for signs of LVF 2º to HPT,& coarctation aorta
*4th heart sound frequently detectable if BP > 180/110mmHg
• Check abdomen
 palpate for renal @ adrenal masses(possible cause),presence of abdominal
aortic aneurysm(possible complication)
auscultate renal bruit d/t renal artery stenosis (loud systolic –diastolic bruit
prominent in epigastrium )
*most L sided abdominal bruit arise fr splenic art & x significant
*bruit is likely significant if it is short, soft, & midsystolic
• Examine CNS for signs of previous CVA
• Palpate & auscultate carotid art for bruits (stenosis maybe manifestation of
vascular ds & maybe assoc with renal art stenosis)
• Urinalysis (look evidence of renal ds)
 TypeS
1º /Essential HPT 2º HPT Malignant HPT
• -idiopathic • -result fr renal • -uncontrollable,
• (>140/90mmHg) • Severe,and rapidly
(eg:diabetic nephropathy, progressive form with
• Multifactorial: chronic glomeruloneph, many complication
• -genetic adult polycystic ds, chronic • (>200/140mmHg)
• -fetal factor tubulointerstitial nephritis, • Presence of flame-
• (LBWd/t fetal renovascula ds) shaped haemorrhages,
adaptation to cottonwool spots +/-
intrauterine • -endocrine papilloedema (≥ grade
undernutrition with (eg:conn’s,cushing’s, 3 keith wagener retinal
long term changes in changes)
bv structure/in f(x) of adrenal hyperplasia, • *need urgent
crucial hormonal phaeochromocytoma, hospitalization
syst)
• -Environmental acromegaly)
factor • -drugs
obesity (eg: NSAIDs,OCP,steroids,
alcohol intake
Carbenoxolone,liquorice,
sodium intake (salt)
stress symphatomimetics,
vasopressin)
• -Pregnancy
 CauSes
“I CHECK A BP”
• -Idiopathic (essential HPT-90% cases)
• -CNS disorder (cushing reflex)
• -High output stress
• -Endocrine disorder
cushing,acromegaly,thyrotoxicosis,conn’s
synd,pheochromocytoma
• -Coartation of aorta
• -Kidney dsrenal art
stenosis,glomerulonephritis,chronic renal
failure,polycystic kidney
• -Acute stress
• -Birth control pills & other drugs
• -Pregnancy
 cOmpLicatiOn
• Neurological • FundOscopy HPT:
-stroke(cerebral • -graded according to Keith-
infarct,hemorrhage),hypertensi Wagener classification
ve encephalopathy,dementia
• Retina
Grade 1 - tortuosity of the retinal arteries with
-hypertensive retinopathy increased reflectiveness (silver wiring)
• Cardiac Grade 2 - grade 1 plus the appearance
-IHD,aortic aneurysm, of arteriovenous nipping produced when
thickened retinal arteries pass over the
dissecting aneurysm of aorta, retinal veins
LVF Grade 3 - grade 2 plus flame -shaped
haemorrhages and soft ('cotton wool') exudates
• Renal
actually due to small infarcts
-CRF,malignant HPT Grade 4 - grade 3 plus papilloedema (blurring
• Peripheral vascular ds of the margins of the optic disc).

*Grades 3 and 4 are diagnostic of malignant

hypertension
 inVestigatiOn
• FBC Additional ix of young HPT:
• Urinalysis • 24 hr urinary
• Fasting lipid profile vanillylmandelic acid
• ECG-look for LVH -pheochromocytoma
• RP,U-FEME-renal • Renal angiogram
F(x),uric acid -renal artery stenosis
-electrolyte • Hormonal test
imbalance -cushing’s/conn synd
eg:hypoK in
cushing /conn’s synd
• CXR-cardiomegaly
 ManageMent
pharmacO nOnpharmacho
*refer to other note • ■weight reduction - BMI should be
< 25 kg/m2
• ■low-fat and saturated fat diet
• ■low-sodium diet - < 6 g sodium
chloride per day
• ■limited alcohol consumption - <
21 units/week for
• men and < 14 units/week for
women
• ■dynamic exercise - at least 30
minutes' brisk walkper
• day
• ■increased fruit and vegetable
consumption
• ■reduce cardiovascular risk by
stopping smoking and
• increasing oily fish consumption.
****Aim for: ≤ 140mmHg systolic & ≤
85mmHg diastolic BP.