Arterial hypertension by dr manoj godara

Arterial hypertension by dr manoj kumar

1. Syndrome of arterial
hypertension.
Diagnosis of arterial
hypertension.
The lecturer: Dr. Manoj Godara

2. Definition
Hypertension (HTN) or high blood pressure
is a cardiac chronic medical condition in
which the systemic arterial blood pressure
is elevated.

3. Etyology:
central nervous system (CNS) and first of all
the sympathetic nervous system;
reninangiotensinaldosterone system;
cardiovascular system mostly it resistant and
major vessels;
kidneys which are responsible for the
maintenance of intra vascular liquids volume.
Disorders of these systems lead into the high
blood pressure.

4. Risk factors:
OBESITY:Obesity is closely related with
the development of arterial BP. Its
frequency is more common in fat
individuals as compare to that with normal
body mass.
ALCOHOL:Alcohol is a big risk factor of
the development of the arterial BP, and
patients who stop the use of alcohol have
improved their status very much.

5. Risk factors:
SMOKING:Smoking is also very important risk
factor, as it has big role in the development of
coronary heart disease, obliterans atherosclerosis
of arteries of the lower limbs and has significant
negative effect on the prognosis of BP.
HYPODYNAMIA: It is to be noted that
hypodynamia is a big risk factor of the development
of arterial BP. Prolonged hypodynamic life style
especially in the patients of middle aged and old
aged negatively effect the prognosis of BP. There
occurs significant relief in the patients with regular
physical training.

6. Risk factors:
HIGH CHOLESTEROL BLOOD LEVEL: It may also develop
into arterial BP. It depresses the effects of baroreceptors of
the carotid zone and arch of the aorta
ENDOCRINE DISORDERS: appears to be also very
important in the development of arterial hypertension,
especially in women in the period of climax. Hypertension
may also be observed in the hypo function of thyroid gland. In
lowered estrogen and androgen functions may also observed
compensatory increase in function of the adrenal glands,
which leads into hypertension. Patients got over diseases of
kidneys in past are now thought to not predisposed to
hypertension.

7. Classification:
Classification of arterial hypertension of adults
(>18years)
Category
Systolic arterial
pressure
(mm.hg)
Diastolic arterial
pressure,
mm.hg.
Optimal <120 <80
Normal <130 <85
High normal 130-139 85-89

8. Classification:
I stage140-159 or 90-99 mm hg.
II stage160-179 or 100-109 mm hg
III stage> or equal to 180 or > or equal
to 110mm hg

9. Classification:
BY ETIOLOGY:
Essential or primary arterial hypertension
(hypertension disease)
Secondary (symptomatic) hypertension

10. Secondary (symptomatic) hypertension
1.1 Renovascular hypertension (I15.0)
1.2 Hypertension secondary to other renal disorders
(I15.1)
1.3 Hypertension secondary to endocrine disorders
(I15.2)
1.4 Other secondary hypertension (I15.8)
1.5 Adrenal
1.6 Kidney
1.7 Medication side effects
1.8 Pregnancy
1.9 Sleep disturbances
1.10 Arsenic exposure
1.11 Potassium deficiency

11. Classification:
Risk factors of
cardiovascular
diseases.
The disturbances
of organs-targets
Clinical
conditions
accompanying
the disease
Factors for the risk
stratification:
●the level of systolic
and diastolic
blood pressure (
degrees of
pressure 1-3 )
●age: males > 55
years
females > 65
years
●hypertrophy of the
left ventricle ( ECG,
Echo-CG, X-ray)
●proteinuria and/or
slight increase of
plasma creatinine
concentration
Cerebrovascular
diseases:
●ischemic insult
●hemorrhagic
insult
●transient
ischemic
attacks

12. ●smoking
●Common
cholesterin blood
level > 6,5 mlmol/l
●diabetes mellitus
●family cases of
early development
of cardiovascular
diseases.
●ultrasound X-ray
signs of
atherosclerotic
carotic, iliac and
femoral arteries
and aorta
disturbances.
●generalized or
focal constriction
of arterial retina.
Heart disease:
●myocardial
infarction
●angina pectoris
●resistant cardiac
insufficiency.
Diseases of
kidneys:
●diabetic
nephropathy
●renal
insufficiency

13. Other factors
unfavorably
influencing on the
prognosis.
●decreased level of
cholesterin LPHD
●increased
cholesterin level
LPLD
●microalbuminuria in
diabetes mellitus
●glucose
tolerance
disturbances
●obesity
●hypodinamia
Diseases of
vessels:
●dissecting aneurysm
●disturbances of the
peripheral arteries
with clinical
evidence.
Expressed hypertonic
retinopathy.
●hemorrhages and
exudates.
●edema of optic papilla
nerve.

14. Stratification of risk for the estimation of
patients prognosis with arterial hypertension.
Otherfactorsofrisk
disturbancesoforgans-
targets, associated
diseases
Bloodpressure,mmhydrargium
StageI
SBP140-159
DBP90-99
StageII
SBP160-179
DBP100-109
StageIII
SBP>180
DBP>110
1.Withoutriskfactors,
disturbancesoforgans–
targets, associated
diseases
2.1-2riskfactors.
3.3riskfactorsandmore
or/anddisturbancesof
organs-targetsor/and
diabetesmellitus
4.Accompaningclinical
conditions.
Lowrisk
Middlerisk
Highrisk
Veryhighrisk
Middlerisk
Middlerisk
Highrisk
Veryhighrisk
High risk
Very high risk
Very high risk
Very high risk

15. Signs and symptoms
Headache;
drowsiness;
confusion;
vision disorders;
nausea, and vomiting
These symptoms are collectively called
hypertensive encephalopathy.

16. Diagnostics:
Diagnosis is based on the confirmation of
high arterial BP and by excluding
symptomatic hypertension. For easier
diagnosis of the arterial hypertension used
method of 2 stages examination of the
patients with arterial hypertension.

17. Laboratory and instrumental
examination:
• Hemoglobin and / hematocrit;
• Urine: microscopy of urinary
sediment, microalbuminuria, a
determination of protein.
Biochemical analysis:
determination of plasma glucose;

18. determination of total cholesterol, LDL,
HDL, triglycerides in the blood serum;
sodium and potassium determination in
serum;
determination of uric acid in the serum;
determination of serum creatinine.
• ECG in 12 standard leads;
• SMAD;
• Echocardiography.

20. Differential diagnostics:
Reno-parenchymal pathology
Reno-vascular hypertension
Pheochromacytoma
Cushing’s disease
Primary hyperaldosteronism

21. 21
Algorithm for Treatment of Hypertension
Not at Goal Blood Pressure (<140/90 mmHg)
(<130/80 mmHg for those with diabetes or chronic kidney disease)
Initial Drug Choices
Drug(s) for the compelling
indications
Other antihypertensive drugs
(diuretics, ACEI, ARB, BB, CCB)
as needed.
With Compelling
Indications
Lifestyle Modifications
Stage 2 Hypertension
(SBP >160 or DBP >100 mmHg)
2-drug combination for most (usually
thiazide-type diuretic and
ACEI, or ARB, or BB, or CCB)
Stage 1 Hypertension
(SBP 140–159 or DBP 90–99 mmHg)
Thiazide-type diuretics for most.
May consider ACEI, ARB, BB, CCB,
or combination.
Without Compelling
Indications
Not at Goal
Blood Pressure
Optimize dosages or add additional drugs
until goal blood pressure is achieved.
Consider consultation with hypertension specialist.

22. Main groups of antihypertensive
remedies:
ß –adrenoblocators:
a). Noncardioselective (ß1), (ß2 )
Propranolol, nadolol, timolol, bopindolol, labetalol,
sotalol, pindolol, alprenolol.
b). Cardioselective (ß1)
Atenolol, metropolol, betaxolol, esmolol,
cemenprolol, talinolol ( cordanum ).
c). With vasodilygaric action:
Bucyndolol, labetolol, pindolol, carvedilol, nebivolol.

23. Main groups of antihypertensive
remedies:
Group IgenerationIIgenerationIIIgeneration
Digidroperidi
nes
NifedipineIsradipine
Nisoldipine
Nicardipine
Nitrendipine
Nimodipine
Amlodipine
Lacidipine
Lercadipine
Bensotiasepin
es
Diltiasem Clentiasem
Phenylalcilam
ines
Verapamil VerapamilSP
Anipamil
Gallopamil

24. Main groups of antihypertensive
remedies:
Inhibitors APF:
Moexipril, perindopril, cilasopril, monopril.

25. Types of hypertensive crisises.
I type–adrenalovic.
II type–noradrenalovic.

26. Variants of hypertensive crisises on
M.S.Kushakovskyi (1982)
Neurovegetative;
Watery-salt;
Convulsive.

27. Prophylaxis of arterial hypertension
Restriction of table salt, supplying the diet with
calium and calcium;
Refusal from overfeeding, keeping of ideal body
weight;
Prevention of hypodinamia; physical exercises
recommended by sport physician;
Exclusion of harmful habits ( smoking, alcohol );
Lowing of overstrain, stereotype disorders,
negative emotions;
Treatment in time of kidneys, vessels, heart,
endocrine disorders