Essential Hypertension poliomyelitis by mikeholy

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									Essential Hypertension
    Prof.Abdullah Saadeh
             Definition
 Persistent elevation of BP
( ≥ 140/90 mmHg)
    Classification of BP According to
              JNC – 7 report
 Normal ≤ 120 mmHg systolic and ≤ 80
  mmHg diastolic
 Prehypertention 120 -139 mm Hg systolic
  and 80-90mm Hg diastolic
 Stage -1 Hypertension 140-159 mmHg
  systolic and 90- 99 mmHg diastolic
 Ssage -2 Hypertention ≥ 160 mmHg
  systolic and ≥ 100 mmHg diastolic
BP                Life style   Without compelling      With
classification    modification indication              compelling
                                                       indication

Normal            encourage
Prehypertension   yes         No anti-HTN drugs        Drug(s) for the
                                                       compelling
                                                       indication
Stage 1 HTN       yes         Thiazide-diuretics for   Drug(s)for the
                              most; may consider       compelling
                              ACE,ARB,                 indicatios
                              B-blockers,CCB,or        ( thiazides,
                              combination              ACEI,CCB,ARB,
                                                       B-blocker)
Stage 2 HTN       yes         2-drug combination       Drug(s) for the
                              for most                 compelling
                              (thiazide,ACEI or ARB    indications
                              or B-blocker or CCB)     ( thiazides,
                                                       ACEI, ARB, B-
                                                       blocker, CCB)
                                                       as indicated
                 CAUSES
   Essential Hypertention (95 %)
 Secondary ( 5%)
1. DRUGS( steroids , Contraceptive
    pills,NSAIDS,carbenoxolone,Liquorice,
sympathomimetics)
2. Cardiovascular (Coarctation of the aorta)
3. Renal (Renovascular i.e RAS and renal
    artery occlusion or Parenchymal i.e ch.
    Pyelonephritis,acute and
    ch.glomeronephritis,obstructive
    uropathy,polycystic kidney disease and
    hypernephromas.
                  CAUSES
4.Endocrine: ( pheochromocytoma,
   1° aldosteronism, cushing’s,acromegaly,
   hyperparathyroidism and hypothyroidism).

5.Others
   (brain tumors with increased intracranial
   pressure,bulbar poliomyelitis,connective tissue
   disorders i.e SLE and polyarteriti nodosa,DM
   nephropathy,Polycythemia rubra vera)
INITIAL or PRIMARY INVESTIGATIONS
        in HYPERTENSION
   Urinalysis
   Renal profile
   ECG
   Chest x-ray
   Plain U-T x-ray or renal ultrasound
   Urine culture
   HB, PCV
   FBS,s.lipids,s.urate
   Echocardiography
        When to investigate for a
     secondary cause of hypertension
1.    Clues from the history
2.    Clues from physical examination
3.    Clues from initial investigations
4.    Malignant stage hypertension
    Complications of hypertension
 Cardiovascular(angina,MI,LVH,HF,dissecting
  aortic aneurysm)
 Cerebrovascular(TIA,Thrombotic
  infarction,intracerebral
  hemorrhge,encephalopathy)
   Peripheral vascular
  disease(atherosclorosis,intermittent claudication,
  gangrene)
 Retinopathy(Grades1,2,3,4)
 Nephropathy(nephrosclerosis,fibrinoid necrosis)
 Malignant hypertension
   Treatment of hypertension
1st. Non-pharmacological measures:
  1. Diet
  2. Weight reduction
  3. Stopping smoking and excess alcohol
  consumption
  4. Regular exercise ( behavioral,
  biofeedback therapy)
  5. Treatment of other associated risk
  factors
B. Antihypertensive medications:
 1. Diuretics
      Thiazide, loop, K+ sparing
 2. B-Blockers
     Non-cardioselective
     Cardioselective
     Drugs with ISA
     Alpha and Beta-blockers(labetolol)
3. Alpha-blockers ( prazosin)
4. Central acting drugs (reserpine,
methyldopa,clonidine)
5. vasodilators:
  1st. Direct relaxation of arteriolar smooth
muscle:
-Hydralazine
-Minoxidil
-Diazoxide
-Na-nitroprusside
2nd. Calcium-channel blockers:
  - Verapamil
  - Nifedipine
  - Amlodipine
3rd. ACE inhibitors :
  - Captopril
  - Enalapril
  - Lysinopril
  - Quinapril
6. ARBs
 - Losartan
 - Candesartan
 - Irbisartan
 - Valsartan
      Hypertensive Crisis:
Severe hypertension with one of the
   following:
1. Heart failure
2. MI
3. Renal failure
4. Encephalopathy
5. Dissecting aneurysm
6. Intracerebral hemorrhage
7. Accelerated or malignant hypertension
      Parentral Drugs Used In
     Hypertensive Emergencies:
1.  Na-nitroprusside infusion
2. Diazoxide i.v
3. Hydralazine iv
4. Furosemide i.v
5. Phentolamine i.v
6. Nifedipine s/L
7. Labetolol i.v
 ( N.B: B.P shouldn’t be reduced to below
    diastolic of 100 mmHg )

								
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