Hypertension

Dr. Asmaa A.

Hypertension (High Blood pressure)

• Hypertension is considered a SBP ≥ 130–139 mm Hg or DBP ≥ 80–89 mm Hg.

• Blood pressure measurement includes systolic and diastolic components, and both are important in determining an individual's cardiovascular risk .

• There is no clear cut-off point between hypertensive and normotensive subjects.

Clinical presentation

Severe cases may present with headache, visual

disturbances or evidence of target organ

damage

Etiology

Secondary hypertension

5-10%

Chronic kidney disease

Endocrine diseases

Vascular causes

Medicatins(steroids, NSAIDs,

cocaine,…)

Primary hypertension

90-95%

No identifiable underlying

cause

Risk factor

• who already have evidence of cardiovascular

disease, or dysfunction.

• Risk is also increased in the elderly and in

people with diabetes or renal failure, further

enhanced by other risk factors such as

smoking, dyslipidaemia, obesity and sedentary

lifestyle.

• In those under the age of 75, men are at greater

risk than women

Diagnosis

• A single high reading of a patient's blood is not

diagnostic. However, a single blood pressure

measurement >180/110 should be considered

diagnostic of hypertension and a referral made so

that therapeutic interventions can be initiated

immediately.

• low blood glucose or a full bladder may cause blood

pressure to vary throughout the day.

Basic Test

Diagnosis Normal range

FBS Less than 100 mg/dl

CBC

Red blood cell count

In men: 4.32-5.72 million cells/mcL

In women: 3.90-5.03 million

cells/mcL

Hemoglobin

In men: 135-175 g/L

In women: 120-155 g/L

Hematocrit

In men: 38.8-50.0 percent

In women: 34.9-44.5 percent

white blood cell count

3,500 to 10,500 cells/mcL

platelet count

150,000 to 450,000/mcL

Basic Test

Diagnosis Normal Range

Lipid profile TC: Less than 170mg/dl

VLDL: 2 and 30 mg/dL.

LDL: Less than 100mg/dL

HDL: More than 45mg/dL

Triglyceride: less than 150mg/dl

S. Creatinine

S. Urea

0.84 to 1.21 mg/dl 15-40 mg/dl

Basic Test

Diagnosis Normal Range

S.Sodium, Potassium, Calcium

S.Sodium: 135-145mmol/L

S.Potassium: 3.6 to 5.2 mmol/L

S.Calcium: 2.2 to 2.7 mmol/L

TSH 0.5-5.7 mU/L

Optional test

Normal Range

Uric acid Normal Uric acid levels are

2.4-6.0 mg/dL (female)3.4-7.0 mg/dL (male).

ECG

Treatment

Treatment• Non-pharmacological approaches

weight loss

Healthy diet (DASH dietary pattern)

Reducing their salt intake.

control their intake of calories and saturated fat.

Physical activity (Regular aerobic exercise)

Alcohol intake should be restricted

Smoking cessation.

Antihypertensive Drugs

• Diuretics.

• β blocker.

• Angiotensin receptor blockers.

• ACE inhibitors.

• Calcium channel blockers.

• Other antihypertensive drugs.

A.Thiazide diuretics: such as hydrochlorothiazide,

chlorthalidone, lower blood pressure initially by

increasing sodium and water excretion. This causes a

decrease in extracellular volume, resulting in a

decrease in cardiac output and renal blood flow.

S/E:thiazide diuretics can induce hypokalemia,

hyperuricemia, hyperglycemia in some patients.

B. Loop diuretics:

Furosemide, bumetanide, torsemide act promptly

by blocking sodium and chloride reabsorption in

the kidneys, it cause decrease renal vascular

resistance and increased renal blood flow, even in

patients with poor renal function or not responded

to thiazide diuretics.

S/E: hypokalemia, increase the Ca++ content in

the urine, whereas thiazide diuretics decrease it.

C. Potassium- sparing diuretics: Amiloride,

triamterene, spironolactone. They are either

aldosterone antagonist or directly inhibiting

sodium transport in DT or CD cells.

S/E:Hyperkalemia, endocrine abnormality

(gynecomastia and antiandrogenic effects).

β blocker:

First generation (non-selective): Propranolol, Timolol,

Nadolol, Sotalol.

Second generation (β1selective): Metoprolol, Atenolol,

Bisoprolol, Acebutolol.

Third generation(Additional alpha –Beta blocking/

vasodilator property): Labetalol, Carvedilol, Nebivolol.

Mechanism of action: β reduce blood pressure

primarily by decrease cardiac output. They may also

decrease sympathetic outflow from CNS and inhibit

release of renin from the kidneys, thus decreasing

formation of AgII and the secretion of Aldosterone.

S/E: Bradycardia, hypotension, fatigue, lethargy,

insomnia, sexual dysfunction, non-selective beta

blocker cause decrease HDL and increase TG.