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Prepared by: Dr. Hossam A. Gabr MARAFIQ Company Physician Yanbu
Hypertension WHO classified a Blood pressure (BP ) of 130-139/85-89 as a high normal BP so BP of 140/90 or more is consider as a high BP (Hypertension) Medical Services .
so Many people may have hypertension without knowing it. stroke and other problems. It is a major health problem. usually without symptoms. It is a major risk factor for heart diseases. Medical Services .Why I must know about HTN? Ø Ø Ø Ø Ø Ø Hypertension is one of the most common worldwide diseases afflicting humans 25% of adults suffering from HTN. Serious complication can be avoided by regular blood pressure check up and treatment the HTN as soon as it is diagnosis. You may feel no symptoms yet the body is slowly being destroyed by high blood pressure. Hypertension is a silent killer.
BP should be measured with a cuff which cover 2/3 of the arm. At least three check-up in different seating with 5 minutes resting before each check-up should be taken. HTN occurs when this pressure is increase. before HTN is diagnosed (except in sever HTN “ malignant HTN “raise in Bl p with diastolic Bl p > 140 or target organ affected) Medical Services . patient must not ingest caffeine for an hour before check-up & not smoke for 25 minutes. patient over the age 65 years & diabetic patient should be checked for Postural changes.What is the BP? Ø Ø It is the forced that blood press by it in the blood vessels and this pressure is sufficient for transferring the blood from the heart to the other organs.
120(systolic) / 80 (diastolic ) l l Medical Services .What do Blood Pressure Numbers Mean? l Top number (Systolic)= Pressure while heart is beating “pressure when 1st sound is heard” Bottom number (Diastolic)= Pressure while heart is resting between beats “pressure when last sound is heard” For ex.
Who are at risk of having hypertension? Ø Ø Ø Ø Ø Ø Ø Ø Ø Ø Ø Those who are smokers males who Are over age 50 and or black People who are 10% over their ideal body weight People who take more than two bottles of beer or two shots of whiskey each day. People who are regularly eat salty and fatty foods People who are constantly under a lot of stress People who Are not physically active People whose cholesterol level is over 200 mg/dl People who have diabetes People with heart disease (chest pains or heart attack) People who had stroke Medical Services .
2. 3. Heart –> leads to arteriosclerosis. heart attack & heart failure Brain –> leads to stroke and internal bleeding Kidneys –> leads to renal failure and the need for dialysis Eyes –> leads to blindness Peripheral Blood Vessels –> leads to peripheral vascular diseases like Medical Services limping (claudication) and 1. 2. The organs usually affected are the following: 1. causes damage to various organs in the body resulting to other diseases.Why is hypertension a serious problem? Hypertension if uncontrolled. .
American Heart Association Recommended Blood Pressure Levels BP Category Optimal Normal High Normal Systolic (mmHg) < 120 < 130 130-139 and and or Diastolic (mmHg) < 80 < 85 85-89 Follow-up Recheck 2 years Recheck 2 years Recheck 1 year Stage 1 (mild HTN) 140-159 or 90-99 Confirm within months Stage 2 (moderate HTN) Stage 3 (severe HTN) 160-179 or 100-109 Evaluate within 1 month Evaluate immediately 180 or > or 110 or > Medical Services .
and is sometimes curable. The other types include: Ø Malignant Hypertension. is diagnosed in the majority of people. Ø Resistant Hypertension Ø Isolated Systolic Hypertension Ø White Coat Hypertension Ø Medical Services .Types of HTN There are two major types of hypertension and four less frequently found types. that has no known cause. The two major types are: Ø Primary or essential hypertension. Ø Secondary hypertension is often caused by reversible factors.
Primary or essential hypertension v v v About 90-95% of the cases No obvious or identifiable cause Has a multi factorial etiology. fetal. may be genetic. alcohol intake. stress) Medical Services . environmental (like obesity. sodium intake.
acromegaly. carbenoxolone and vasopressin. phaeochromocytoma. Pregnancy. adrenal hyperplasia. Cardiovascular causes like coarctation of aorta. Sleep Apnea Syndrome. Drug like oral contraceptive.Secondary hypertension v v about 5-10% of the cases increases BP is the result of a specific and potentially treatable cause: a. chronic glomerulonephritis.etc b. d. conn’s syndrome. Renal diseases (over than 80% of HTN) like diabetic nephropathy. e. Medical Services . Cushing’s syndrome.. adult polycystic disease…. f. Endocrine causes like. pill. thyroid dysfunction…ect c. steroids .
Malignant Hypertension Is said to be rapid raise in BP with diastolic BP > 140. it may lead to death form progressive heart failure. Unless the patient was treated. despite a tripledrug regime. renal failure or stroke. Without effective treatment there is a 1year survival of less than 20% Resistant Hypertension If blood pressure cannot be reduced to below 140/90 mmHg. resistant hypertension is considered Medical Services .
lifestyle and diet is believed to be the root cause .Isolated Systolic Hypertension Ø Ø Ø Ø Ø the systolic blood pressure. Medical Services . added drugs. (the top number). It is importance to treating ISH. as it significantly reduces the incidence of stroke and heart disease Treatment starts with lifestyle modification. is consistently above 160 mm Hg. and the diastolic below 90 mm Hg Usually occur in older people due to arteriosclerosis of the arteries. and if needed.
Medical Services . It confirmed.White Coat Hypertension Ø Ø Ø Ø blood pressure is only high when tested by a health professional. or a 24-hour monitoring device. with repeat readings outside of the clinical setting. It does not need to be treated Regular follow-up is recommended to ensure that persistent hypertension has not developed.
fasting blood sugar and lipids. blurring of the vision. echocardiogram. ECG. creatinine and electrolytes. epistaxis. serum urea. Other investigations done according to the case.v Usually most of the patients have no complain. sometime there are headache. Medical Services . urine analysis. chest pain C/p of HTN INVESTIGATIONS v Routine investigations of HTN are: chest X-ray.
It should be considered in three stages: Ø Ø Ø Management Assessment Non-Pharmacological Treatments Pharmacological Treatments Medical Services .
During the Assessment Ø Ø Ø 2ry causes should be excluded The target organ affected by BP should evaluated Any concomitant condition should be identified. Medical Services .
Non Pharmacological Treatment lifestyle changes is an important first step in the treatment of high blood pressure . This include the following: l l l l l l l l Loose weight if your overweight Stop smoking Get regular physical activity Manage your stress Limited alcohol consumption Eating a healthy diet Reducing the amount of sodium in your diet to 2. Discuss the use of some medications Medical Services .300 milligrams (about 1 teaspoon of salt) a day or less.
Ø This medication must be under supervision of a physician. -------etc. calcium-channel blockers.blockers. angiotensin -converting enzyme inhibitors. diuretics. Medical Services .Pharmacological Treatment Ø There are many groups of antihypertensive drugs like B. angiotensin II receptor antagonists.
Stop smoking. exercises. decrease your body weight and do regular exercises Medical Services . Be cooperative with your physician and help him for controlling your BP by following his advises about your life style (food. avoid salty foods. Avoid excessive alcohol.REMEMBER You must do the following: Ø Ø Ø Ø Go to clinic for regular chick up and evaluation by the physician. Eat a low-fat diet . Sharing your family in your controlling of your Bl p as may be one or more of them have HTN and all of yours will help each other. smoking. ---etc) and medication.