HypertensionBy:Dawit Ayele

Introduction Epidemiology Classification Essential Hypertension Secondary Hypertension Effects of Hypertension Patient Evaluation

Outline

Bp one of the most important public health problems esp.in developed nations.

is: common, asymptomatic, readily detectable, usually easily treatable & often leads to lethal

complications if left untreated

Introduction

Depend on racial composition of population,sex,age & crieria used to define the condition.

Worldwide ~ 1billion individuals with HTN >50million americans have HTN European journal of epid.,june 2005-- prevalence

of HTN and the age-related behaviour of SBP and DBP in a wide sample of male and female Ethiopian Oromos living in rural o.4%

pre-industrial urbanized settings3.15%(8X) BW &life style

Prevalence

Prevalence…

Morbidity- WHO report :-62% cerebrovascular disease

& 49% of IHD with little variation by sex is due to HTN

Mortality-worldwide ~ 7.1 million deaths

per year.

Outcome of extensive educational program

Classification.

No specific cause can be identified

Interplay of various derangement in factors affecting BP

Abnormality may differ in both type & degree in different patients(Known risk frs.-age, race,sex,level of BP, DM, alcoholism , obesity,smoking)

Development of disease is slow & gradual

By time of BPno initiating factor may be apparent

Mechanisms of 1o(essential)HTN

Individuals in whom specific structural organ or gene defect is responsible for HTN

Responsible for small minority of total hypertensives

Patients should not be ignored for:correction of cause may cure HTN & may provide insight to etiology of HTN

Nearly all related to alteration in hormone secretion &/or renal function

Secondary Hypertension

May not manifest but only BP;even if target organ damage is happening(“Silent killer”)

When symptomatic could be non specific or complications (accelerated,malignant,urgency)

Patients with HTN die prematurely

Most common causes of death are:heart disease,stroke and renal failure.

Effects of hypertension

Early compensation of excessive workload is concentric LV hypertrophy

Ultimately: chamber function deteriorates , cavity dilates(LV,LA,Ao root),+/-angina, arrhythmia

sx/sn of CHF(systolic/diastolic/ischemic) ECG ,Echo changes Most deaths due to MI or CHF

Effects on heart

Neurologic effects

Retinal changes(only tissue in w/c arteries & arterioles can be examined directly)

CNS sxs(head ache,vert.,tinn.,sync)

most serious-vascular occlusion,hemorrhage,encephalopathy

Autoregulation of Cerebral Arterial Blood Flow

initial or in mean arterial pressure maintenance of blood flow due to appropriate changes in arteriolar resistance.

More marked changes in pressure loss of autoregulation blood flow (with hypotension) or (with marked hypertension) due to arteriolar thickening

Effects on Kidney LM reveals

fibrinoid necrosis in the preglomerular afferent arteriole

GFR & tubular dysfun.

The normal muscle layer of the media has been replaced by the fibrinoid material.

Hx,P/E,Ix directed at: 1)Uncovering correctable 20 forms 2)Establishing a pretreatment baseline 3)Assessing factors that may influence

the type of therapy or be changed adversely by therapy

4)Determining if target organ damage is present

5)Determining presence of other risk factors for development of arteriosclerotic CV disease

Patient Evaluation

Range from O factor-low risk to 3 or more factors (high risk)

Factors are – smoking, -obesity, -male gender, -high risk equivalent – to having

diabetes , target organ damage(clinical cardiovascular or renal disease) or both high risk if present regardless of other risk factors.

Risk stratification

Initiation of treatment in pts wz htn

Approach after initiating antihypertensive

Thanks