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Prof.Abdullah Saadeh
Definition
Persistent elevation of BP ( 140/90 mmHg)
BP classification Normal
Prehypertension
Life style Without compelling modification indication encourage yes No anti-HTN drugs
With compelling indication Drug(s) for the compelling indication Drug(s)for the compelling indicatios ( thiazides, ACEI,CCB,ARB, B-blocker) Drug(s) for the compelling indications ( thiazides, ACEI, ARB, Bblocker, CCB) as indicated
Stage 1 HTN
yes
Thiazide-diuretics for most; may consider ACE,ARB, B-blockers,CCB,or combination 2-drug combination for most (thiazide,ACEI or ARB or B-blocker or CCB)
Stage 2 HTN
yes
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, cushings,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)
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
3.
4.
Clues from the history Clues from physical examination Clues from initial investigations Malignant stage hypertension
Complications of hypertension
Cardiovascular(angina,MI,LVH,HF,dissecting aortic aneurysm) Cerebrovascular(TIA,Thrombotic infarction,intracerebral hemorrhge,encephalopathy)
Peripheral vascular
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
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