HYPERTENSION

Dr.SARANYA VINOTH

INTRODUCTION• Hypertension (high blood preassure) also called silent killer is a chronic medical condition characterized by constant elevation of the systolic or diastolic pressure above 140/90 mmHg.

• Because hypertension is almost without symptoms except for headaches in some patients, it hides in the body without knowing it.

•The fact that hypertension is asymptomatic makes it difficult for patients to accept the diagnosis and comply with treatment.

In India more than over 140 million people are believed to be suffering from high blood pressure in the country and the number is expected to cross the 214 million mark in 2030.

Hypertension is a major risk factor for cardio-vascular diseases.

INTRODUCTION

OBJECTIVESAt the end of this presentation you

should understand Define,classify and diagnosis of

hypertension Types of HT Identify risk factors &complications Treatment guidelines Complications and prevention

methods

DEFINITIONHypertension is defined as a systolic

blood pressure (SBP) of 140 mm Hg or more, or a diastolic blood pressure (DBP) of 90 mm Hg.

Blood pressure is the force applied against the walls of the arteries as the heart pumps blood through the body. The pressure is determined by the force and amount of blood pumped and the size and flexibility of the arteries.

PATHOPHYSIOLOGY

CAUSES &RISK FACTORS

TYPESPrimary Hypertension-unknown

etiologySecondary Hypertension-due to

some other medical conditionHypertension in pregnancyMalignant Hypertension with end

organ damageParaoxysmal Hypertension

SIGNS AND SYMPTOMSSevere headacheNausea or vomitingBad headache Confusion Changes in your visionNosebleeds

Investigations Blood pressure evaluationFasting Blood Sugar (FBS) – To

diagnose diabetes Lipid Profile – To diagnose

dyslipidaemia Renal Profile- Serum Urea,

Albumin, Creatinine

Measurement of BPThe patient must be properly

prepared and positionedCaffeine,exercise and smoking

should be avoided for atleast 30 minutes before.

Average of atleast three readings on three different occassions should be recorded.

MANAGEMENT

MANAGEMENTLIFE STYLE MODIFICATIONRegular physical activitySmoking cessationSalt restrictionAlcohol cessationWeight loss

MANAGEMENTDIETARY PLANDASH-Dietary Approach to Stop

Hypertension

MEDICATIONS

A-B-C-D Blood Pressure Medications:

A: ACE inhibitors (angiotensin converting enzyme)prevent the formation of the hormone angiotensin 2 which causes blood vessels to become narrow making the vessels relax, becoming wider, lowering your blood pressure.

B: Beta Blockers reduce nerve impulses to the heart and blood vessels making the heart beat slower with less force to drop your blood pressure and the heart doesn't work a hard.

C: Calcium channel blockers block calcium from entering the muscle cells of the heart and blood vessels making them relax and lowering your blood pressure.

D: Diuretics, or water pills, work in the kidney by flushing out excess water and sodium from the body.

Beta BlockerATENOLOLDecreases myocardial contractilityFall in cardiac outputDecreases blood pressureAdditionally it reduces renin secretion

Dosage-Atenolol 25-100mg once daily

ADVERSE EFFECTS-BradycardiaCongestive heart diseaseAggravates asthmaSleep alteration

CONTRAINDIATIONS:-AsthmaDiabetes mellitusHeart blockHyperlipidemia

Beta Blocker

ACE INHIBITORSEnalaprilActs by inbiting the conversion of

angiotensin 1 to angiotensin 2 thus preventing the vasoconstriction

Used in diabetics.DosageInitial dose (oral): 5 mg orally once a day.Maintenance dose (oral): 10 to 40 mg

orally per day in 1 to 2 divided doses.

Side effects-First dose hypotensionDry coughUrticariaContraindiationRenal failurePregnancy

ACE INHIBITORS

CALCIUM CHANNEL BLOCKERAmlodipineActs by relaxing the smooth muscle in

the arterial wall, decreasing total peripheral resistance thereby reducing blood pressure; in angina, amlodipine increases blood flow to the heart muscle.

Initial dose: 2.5 -5 mg orally once a dayMaintenance dose: 5 to 10 mg orally once a day

Side effects-HeadacheEdemaFatigueNauseaDizzinessMuscle crampsContraindications-PregnancyBreast feeding

CALCIUM CHANNEL BLOCKER

TREATMENT IN DIABETICS

Blood Pressure            No diabetes      Diabetes                No diabetes        Diabetes

Optimal                         <140/85           <140/80                  <130/80              <130/75

Audit Standard             <150/90             <140/85                  <140/85              <140/80

                          Measured in clinic               Mean daytime ABPM                                                                     or home measurement

FOLLOW UPUrine analysis-albumin,sugarComplete blood countLipid profileGlucose levelsOphthalmic examinationECG

THANK YOU