HIGH BLOOD PRESSURE HOME Definition. Classification. Diagnosis. Major Risk Factors. complicatio ns of hypertension. hypertensive emergency.

Treatment of hypertension. Tip s for hypertension. Bibliography. • DEFINITION Chronic and sustained elevation of systolic blood pressure, diastolic or both in the arteries above normal. IS A PROBLEM OF HEALTH Large and important by: ITS PREVALENCE IN THE POPULATION. YOUR RELATIONSHIP WITH THE leading cause of mortality. OPPORTUNITIES OFFERED FOR PREVENTION AND CONTRO L. CONSIDERED ONE OF THE FIRST STATEMENT OF PRIMARY REFERENCE. MAN AGE 16 -18 19 -24 25 -29 30 -39 40 -49 50 -59 60 ... NORMAL SYSTOLIC 105-135 105-140 108-140 110-145 110-155 115-165 115-170 HIGH 145 150 150 160 170 175 190 NORMAL DIASTOLIC 60 -86 62 -88 65 -90 68 -92 70 -96 70 98 70 -100 WOMEN AGE 16 18 19 -24 25 -29 30 -39 40 -49 50 -59 60 90 95 ... HIGH 96,100,104 NORMAL SYSTOL IC 106 110 105-135 105-140 108-140 110-145 110-155 115-165 115-170 HIGH 145 150 150 160 170 175 190 Normale s High s values of blood pressure. NORMAL DIASTOLIC 60 -86 62 -88 65 -90 68 -92 70 -96 70 98 70 -100 90 95 96 ALTA 100 104 106 110 1.CLASIFICACIÓN Hypertension can be classified in three ways: A) For the reading level of the PA. B) Because of the importance of organ damage . C) On the etiology. D) for their stability over time (stable, labile) Classification of hypertension by the level of blood pressure reading. <85 85-89 PA PA high normal normal slight hypertension (stage I) moderate hypertension (st age II) severe hypertension (stage III) P r e s i o n a r t e r i a l Diastolic 90-99 100-109 ³ 110 <130 130-139 PA PA high normal normal slight hypertension (stage I) moderate hypertension (st age II) severe hypertension (stage III) Systolic 160-179 140-159 ³ 180

Classification of hypertension by the importance of organ damage Phase I. There are signs of organic disorder objectives. • Left ventricular hypertrophy (LVH) • Focal and generalized narrowing of retina l arteries. • Proteinuria and slight increase in creatinine concentration in pla sma or one of them. Phase II. Appear at least one of the following signs of organic disease Phase III. Symptoms and signs of injury of some organs due to hypertension • Heart: left ventricular failure (LVF). • Brain: cerebral hemorrhage, cerebella r or brain stem: hypertensive encephalopathy. • Fundus: retineanos hemorrhage an d exudates with or without papillary edema. Classification According to Etiology It is said that approximately 90 to 95% of all people with hypertension have pri mary hypertension. This term simply means that no clear organic cause is unknown . The pathogenesis is still unknown but several studies indicate that genetic an d environmental factors play an important role in the development of primary HT. The primary hypertension, idiopathic or essential s hypertension of known cause, is approximately between 5 and 10%. It is importa nt to diagnose because some asos can be cured with surgery or specific medical t reatment. ou can be by: - For cargo volume with increase in extracellular fluid ECF. - For vasoconstriction is an increase in TPR. - For combination of volume o verload and vasoconstriction. Ausàs: renal, endocrine, neurological, pregnancy, drug. Hypertension in primary care is the most common cause of drug intake SECON DARY, especially hormonal contraceptives. 1.DIAGNÓSTICO Set whether or not sustained hypertension over time. To establish whether the pa tient will benefit from treatment. To detect the coexistence of other diseases. To identify the presence or absence of organic disease. To detect the coexistenc e of other vascular risk factors. Rule out any treatable causes of hypertension. FOR PROPER DIAGNOSIS NECESSARY HTA Anamnesis: personal and family history of cardiovascular disease Lifestyle: snuff, alco hol, diet, physical activity, occupation, drug interference 2. Physical examination Weight and height correct T.A. Determination heart rate and Fundus Examination o f neck pulse, heart murmurs, thyroid ... 1.PRINCIPALES RISK FACTORS FOR HTA RISK FACTORS A) Unmodified B) Change A) Unmodified FACTORS People over 65 have increased risk of systolic hypertension. The age of risk is reduced when two or more associated risk factors. AGE

Men are more prone to cancer than women until they reach the age of menopause,€f rom which the frequency in both sexes are equal. This is because nature has give n to women while you are of childbearing age with a protective hormones are estr ogens and thus has less risk of cardiovascular disease. However, in younger wome n there is a particular risk when taking birth control pills. SEX RACE Hypertension occurs more frequently and aggressively in blacks. The presence of cardiovascular disease in a family to 2nd degree of consanguinit y before the sixth decade of life, definitely influence the presence of cardiova scular disease INHERITANCE . B) modifiable factors HTA INFLUENCING BEHAVIOURAL FACTORS BIOLOGICAL FACTORS

• Obesity • Dyslipidemia • DIABETES MELLITUS BEHAVIOURAL modifiable factors The snuff is responsible for the annual death of about 3,000,000 people in the w orld. The snuff is responsible for 25% of chronic disease. Smokers are twice as likely to have hypertension. SMOKING . Drinking a glass of alcohol increases by 1 mmHg systolic and 0.5 mmHg diastolic. It has been shown that daily alcohol consumption in level of 6.6 mmHg SBP and D BP of 4.7 mmHg higher than those who do it once a week, regardless of the total weekly consumption. ALCOHOL A sedentary lifestyle increases in muscle mass (overweight), increased cholester ol. Sedentary A sedentary person has a higher risk (20-50%) of developing hypert ension, high consumption of sodium in salt and low potassium intake are associat ed with hypertension. The consumption of fats, especially saturated animal is a risk factor for hypercholesterolemia because of the power increases atherogenic LDL cholesterol levels. NUTRITION OTHER ENVIRONMENTAL NOISE. STRESS. ALTITUDE. Geographical location. The hardness of dr inking water. ETC.



Other • ALCOHOL • sedentary • NUTRITION

• complications HTA Arteriosclerosis: in response to rising TA blood vessels thicken and lose flexibility, the latter bei ng more vulnerable to the setting of excess fats that circulate in the blood. Coronary intensive care: HBP because the heart is forced to work more effectively to maintain blood flow in tissues, which result in heart failure intensive. Renal disease: a rise above normal levels of TA leads to worse performance in I kidneys, to the point where it can lead to kidney failure. Stroke: When atherosclerosis affects blood vessels of the brain stroke are due to a ruptured vessel (hemorrhagic stroke) or a blockage of blood or a clot (cerebral thrombosi s). • Emergency We have to differentiate the following terms: urgent, accepting arbitrary figure s DBP> 120 mm Hg. hypertensive a hypertensive crisis is any rise in tension leading to an acute medical consu ltation HYPERTENSIVE EMERGENCY situation in which the blood pressure elevation is accompanied a concomitant condition of target organs and requires immediate treatment to avo id the possibility of death or irreversible consequences. In this situation, the application of appropriate behavior patterns immediately can mean the salvation of the individual or prevent irreversible injury that may result. hypertensive emergency: situation in which the blood pressure elevation is acc ompanied by NO of disorders that involve a commitment to immediate and vital, therefore, can be corrected in 24-48 hours with an oral agent. HYPERTENSIVE EMERGENCY FALSE: are elevations tension that do not damage the target organs and are reactive to situations of anxiety, pain syndromes or proce sses of any other nature. Elevated blood pressure is corrected to stop the trigg ering stimulus and requires no specific antihypertensive treatment. Hypertensive emergency Etiology • Hypertensive crisis idiopathic. • Hypertensive crisis by renal or renovascular disease. • Hypertensive crisis secondary to endocrine pathology. • Hypertensive crisis linked to drugs. • Hypertensive crisis secondary to toxic substances: co caine, amphetamines, angel dust. • Hypertensive crisis during pregnancy. • Hyper tensive crisis in special situations. - Refractory hypertension. - Surgery. - Ne urological pathology. - Severe burns. Type Pheochromocytoma. Catecholamine-producing tumor, typically, is a cause of hypert ension. pressure values> 250/140. The symptoms (headache, heat intolerance, trem or, paleness, weakness, fatigue, nausea,€chest or abdominal pain and weight loss ) appear as paroxysmal, and in the intervals between attacks patients are normot ensive and asymptomatic, or even hypotensive. The diagnosis established from the

history, physical examination and determination of catecholamines and metabolit es in plasma and urine. While the treatment is surgical and has curative intent, some care is necessary before and after surgery. Thus, medical treatment is per formed with Phentolamine (alpha-blocker) Among these Syndromes hyperadrenergic different situations include: - SD. Alcoho l withdrawal. - Overdose of amphetamines. - Abuse of diet pills. - SD. Tyramine and MAOIs. - Effect of clonidine withdrawal rebound. - Intake of cocaine or synt hetic drugs. - Crisis of panic. In general, hypertension accompanying these synd romes is of short duration, reaching a peak very quickly, then returned to norma l. The drugs of choice in these situations are the alpha-blockers and beta-block ers Hypertensive emergency Diagnosis. • Confirm that this is a true hypertensive crisis. • Discriminate properly betwe en urgency and hypertensive emergency. • Initiate the study of its etiology. To do all this we will build on: Treatment. • HISTORY: In the hypertensive patient known is important to clarify the origin of hypertension, duration and impact on target organ, presence of concomitant di seases and previous treatment characteristics. If the patient is not known hyper tensive will have more relevance the clinical characteristics and evolution of t he crisis. • Physical examination: First, keep the patient at rest in a quiet pl ace without noise for at least 30 minutes, then a new measurement of the PA, bec ause sometimes, to discriminate between urgency and emergency. There shall be fu ll general examination aimed at assessing the potential impact of target organs (SN, circulatory system, retinal vessels). BE SURE TO REVIEW THE PRACTICE fundus figures for patients with PAD> 120 mmHg, as funduscopic abnormalities may impos e specific therapeutic approaches. • TESTING: In principle it would be necessary to do anything. However, according to the suspected etiology, pathology or cond ition accompanying target organ may be necessary to practice: blood count, creat inine and serum electrolytes, urine analysis, ECG and chest X-ray .. Every patient with a hypertensive emergency may be treated in outpatient half. S ent to hospital only those cases that do not respond to treatment or requiring a ny additional test that can not be done outside the hospital. The decrease of bl ood pressure should be obtained gradually, between 12-48 hours, as a sudden decr ease or obtaining very low levels of PA could lead to decreases in cerebral or c oronary flow, thereby affecting disease in these territories . On 1 goal should be to reduce 20-25% of initial value of the PA, not descending to SBP <160 mmHg or DBP <100 mm Hg. The subsequent decline is slow and monitored to prevent ische mic events in target organs. Most hypertensive emergencies are handled with a si ngle drug 1.Tratamiento No drug: - Weight reduction - reducing the consumption of alcohol, reducing salt intake, physical exercise (before recommending it to an EKG). - Diuretic + b-adrenergic blocker - K-sparing diuretics + ACE - ACE + channel bl ockers, Ca - adrenergic blocker + Ca channels - Diuretic + a-1-adrenergic - rece ptor antagonist of angiotensin II + diuretic Pharmacological: 1.Consejos for hypertensive

1.BIBLIOGRAFIA Community Nursing. Masson The médico.net Tuotromédico.com