Systemic Hypertension.Powerpoint document

This file contains detailed and explanatory idea about hypertension as it is a condition that affects the world globally. It also helps to indentify the causes of hypertension, signs and symptoms, manifestation hour, and the required Blood pressure figure that will direct you to the diagnosis of hypertension. Management procedures of the condition is also allocated there including medications, Medical tests that should be done, Psychological treatments and also behavioral life changes. The types of hypertension is also described clearly.

2. TITUS CONTEH 22017
KELFALA HASSAN DAWOH
JAMES DUBUYA
ALUSINE M. BUNDU
BANDATIN WILLIAM
DAVID AMA COLIA
OSMAN CONTEH

3. It is termed as ‘iceberg disease’.
Hypertension is also referred to as high blood
pressure or high BP in common terms
It is a medical condition in which the blood
pressure is elevated.

4. Greater than 140 mm hg of systolic blood
pressure and or more than 90 mm hg of diastolic
blood pressure at least 2 of 3 times of measuring
the pressure.

5. Systolic blood pressure- state of contraction in
heart.
Diastolic blood pressure- state of relaxation in
peripheral blood vessels.

6. Systolic-90 mm hg – 120 mm hg.
Diastolic-60 mm hg -80 mm hg.

7. Systolicdiastolic interpretation
Less than 120
mm Hg
Less than 80
mm Hg
Normal
120 to 139 80 to 89 Pre hypertensive
140 to 159 90 to 99 Stage 1 Hypertension
More than or
equal to 160
More than or
equal to 100
Stage 2 Hypertension
> 220 > 120 Hypertensive emergency
Source: Joint national committee on cardiovascular diseases 2003

8. The most common cause for Hypertension is
idiopathic and hence if the cause is not
known it is called as primary Hypertension
If the causes are known then it is called as
secondary hypertension.

9. Glomerulo nephritis It can be acute or chronic and
infective or non infective.
. Bacterial infection of kidney-chronic pylo-nephritis.
. Polycystic kidney disease – It is a cystic genetic disorder
of the kidney.
Apart from these any renal disease which can cause
renal failure will result in secondary hyper tension.

10.  Acromegaly - increased secretion of growth
hormone in adults.
Cushings syndrome – increased secretion of
steroid hormone in children and adults .
Pheochromocytoma - tumor of adrenal
medulla.
Drug such as corticosteroid and hormones
like estrogen.

11. The main reason is vasoconstriction which
occurs due sympathetic over-activity due to
stress response.
An overactive renin – angiotensin system leads
to vasoconstriction and retention of sodium
and water.

12. Primary hypertension
Age (older the risk is higher)
Diet (High salt intake/ fatty diet)
Physical activity (sedentary life style)
Alcohol
Obesity
Drugs (steroids, oral contraceptives)
Stress
Family history

13. The gold standard for hypertension is only
clinical measurement using mercury
sphygmomanometer and not lab investigation.
But we need to do investigations to rule out
secondary causes to conclude on primary
hypertension
Better to screen everyone above 40 years every
year and every six months if there is a risk factor

14. Always measure B.P when the patient is completely
relaxed.
The instrument used is mercury
sphygmomanometer .
The cuff of the apparatus should cover up to three –
fourth of his arm.

15. The tubings must be parallel to arteries of the arm.
You must then inflate it until there is radial pulse
depression.
Then deflate and measure the value.
The sound as korotkoff sound
Details in the video link and audio link
http://www.youtube.com/watch?v=u6saTO8_o2g&feature=related
http://www.thinklabsmedical.com/stethoscope_community/Sound_Libra
ry

16. In the first measurement if there is >220 mm hg
of systolic pressure and >120 mm hg of diastolic
pressure then we can call the patient as
hypertensive in the first measurement and they
are infact in emergency.

17. No specific symptoms in majority.
Vague pain
Sub-occipital headache
Restlessness.
Sleepiness.
Dizziness.
vomiting

18. Myocardial infarction or coronary artery disease
Cerebro vascular accident / stroke
Left ventricular hypertrophy causes cardiac
failure due to increase HTN
Renal failure due to chronic decrease blood
supply to kidney.
Hypertensive Retinopathy

19. We have to rule out secondary hypertension by certain
investigation.
Renal – urine microscopy is done to detect the presence of
albumin.
Presence of RBC, Cast is an indications of glomerular
nephritis.
Excess of WBC indicates kidney infection.
Renal doppler / technicium scan (nuclear scan) is done to
know about blood supply to the kidney.

20. Diet
 Use <5 gms of salt per day
 Avoid oily food / fatty diet
 Low calorie high fiber diet
Exercise
 Brisk walking, jogging, Swimming etc…
Avoid smoking & alcohol.

21. Usually divided into 4 categories:
• ACE (Angiotensin converting enzyme) inhibitors
or AT receptor blockers
• Beta blockers
• CCB (calcium channel blockers)
• Diuretics & vasodilators

22. Blocks the conversion of Angiotensin I to Angiotensin II
by inhibiting angiotensin converting enzyme Eg:
Enalapril , Lisinopril.
Side effects
• Produce dry cough
•Altered taste sensations (dysguesia)

23. Similar to ACE inhibitors except it blocks the
receptors not the enzyme Eg : Losartan

24. Beta 1:cardiac selective ( Eg: Atenolol )
Non cardiac selective beta blockers
( Eg: Timolol, Propanalol).
Beta blockers with intrinsic
sympathomimetic activity.

25. Mechanism of action:
• Acts on the beta adrenergic receptors.
Side effects:
• Can precipitate asthma in asthmatics-Beta
receptors are present on the bronchus causing
broncho constriction.
• Decreases the cardiac output as well as the
heart rate.
• Can increase the cholesterol level.
• Can mask hypoglycemia in diabetics

26. Allows peripheral vaso dilatation
Causes decrease in the peripheral
vascular resistance
Very safe during pregnancy
 Eg: Nifidepine, Amlodepine.
Side effect: Postural hypotension,
Headache, Edema, Tachycardia

27.  Diuretics Eg: Thiazide diuretics, Hydro chloro
thiazide
Alpha blockers: Prazosin
Vasodilators: Hydralazine and sodium
nitroprusside
Centrally acting drugs: Methyldopa

28. Depends upon the blood pressure
If person is pre-hypertensive or stage 1 is –
life style modification should be done first.
Diet and exercises are first modes to control
mild hypertension
If Blood pressure is high – any of the 4
drugs can be given.

29. If the patient has
Renal problem – ACE inhibitors can be
given
Diabetes mellitus – ACE inhibitors can be
given
Asthma – ACE inhibitors can be given
Diabetic / pregnancy – CCB can be given
Anxiety /hyperthyroidism – Beta
blockers can be given

30. They may result in end organ damage e,g.,
Kidney retina
Blood pressure should be reduced fast to
prevent end organ damage. Drugs commonly
used are:
•Alpha blockers –Prazosin
•Vasodilators – Sodium nitroprusside / Nitrates
•Alpha + beta blockers – Labatelol
•CCB - Nifedepine