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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.