Hypertension

Hypertension

All about Hypertension

blood pressure measurement

Introduction

Hypertension is the level of blood pressure (BP) at which the benefits of treatment outweigh the costs and hazards

Types of Hypertension

Staging of Hypertension Systolic BP Diastolic BP
Prehypertension 120 - 139 mmHg 80 - 89 mmHg
Stage 1 Hypertension 140 - 159 mmHg 90 - 99 mmHg
Stage 2 Hypertension 160 - 179 mmHg 100 - 109 mmHg
Stage 3 Hypertension >180 mmHg >110 mmHg

Causes of Secondary Hypertension

  1. Alcohol
  2. Obesity
  3. Renal Disease
    • Parenchymal Renal Disease - Glomerulonephritis
    • Renal Vascular Disease
    • Polycystic Kidney Disease (PKD)
  4. Endocrine Disease
    • Pheochromocytoma
    • Cushing's Syndrome
    • Thyrotoxicosis
    • Primary Hyperaldosteronism (Conn's Syndrome)
    • Hyperparathyroidism
    • Primary Hyperthyroidism
    • Acromegaly
    • Liddle's Syndrome
    • Congenital Adrenal Hyperplasia (CAH)
  5. Drugs
    • Oral Contraceptives containing oestrogen
    • Anabolic Steroids
    • Corticosteroids
    • NSAIDs
    • Carbenoxolone
    • Sympathomimetic Agent
    • Coarctation of Aorta

Symptoms of Hypertensive Patients

  1. Severe headache
  2. Nosebleed
  3. Fatigue or confusion
  4. Vision problem
  5. Chest pain
  6. Difficulty in breathing
  7. Irregular heartbeat
  8. Blood in the urine
  9. Pounding in your chest, neck or ears
  10. Dizziness
  11. Nervousness
  12. Sweating
  13. Trouble sleeping
  14. Facial flushing
  15. Blood spots in eyes

Signs of Hypertension

  1. Radiofemoral Delay (Coarctation of Aorta)
  2. Enlarged Kidneys (Polycystic Kidney Disease)
  3. Abdominal Bruits (Renal Artery Stenosis)
  4. Characteristic Facies (Cushing's Syndrome)
  5. Blood vesels Atherosclerosis
    • Larger arteries (more than 1 mm in diameter): Internal elastic lamina is thickened, Smooth muscle is hypertrophied and Fibrous tissue is deposited. So vessels dilates and becomes torus with less compliant walls
    • Smaller arteries (less than 1 mm in diameter): Hyaline arteriosclerosis in wall, narrowing of lumen
    • Widespread atheroma develop and may lead to coronary and cerebrovascular diseases
    • These vascular changes increase peripheral vascular resistance which aggravates hypertension. Reduced renal blood flow activates Renin-Angiotensin-Aldosterone-Axis
  6. Central Nervous System
    • Cerebral Haemorrhage and Cerebral Infarction leads to Stroke Carotid Atheroma Subarachnoid Haemorrhage Hypertensive Encephalopathy
  7. Retina
    • Cotton wool exudates and Microaneurysm
    • Retinal ischaemia and infarction
    • Central retinal vein thrombosis
  8. Heart
    • Left ventricular hypertrophy
    • Atrial fibrillation
    • Left ventricular failure
  9. Kidneys
    • Proteinuria
    • Renal failure

Diagnosis of Hypertensive Patients

  1. Accurate BP measurement
  2. Identify contributing factors and underlying causes
  3. Detect any complications eg.target organ damage (blood vessels, CVS, CNS, Retina, Kidney)

Investigations of Hypertensive Patients

  1. Urinalysis of blood, protein and glucose
  2. Blood, urea, electrolytes and creatinine
  3. Blood Glucose
  4. Serum total and HDL Cholesterol
  5. Thyroid Function Tests
  6. 12 - Lead ECG

Management of Hypertensive Patients

  1. Quantification of Cardiovascular Risk
  2. Threshold for Intervention
  3. Treatment Targets
  4. Non-drug Therapy
    • Correcting Obesity
    • Reducing Alcohol intake
    • Quitting Smoking
    • Restricting Salt intake
    • Regular Physical Exercise
    • Increasing consumption
  5. Antihypertensive Drugs
    • Thiazide and other Diuretics
    • ACE Inhibitors
    • Beta blockers
    • Labetalol, Carvedilol
  6. Emergency Treatment for Malignant Hypertension
  7. Adjuvant Drug Therapy
    • Antiplatelet Therapy - Aspirin
    • Statins