Hypertension:

Normal Blood pressure : < or equal 140 -90 (systolic-diastolic). Diastolic BP : -some consider 85 as normal Bp 90 as a border Line . 100 Hypertension 120 Malignant Hypertension.(usually patient survive until 1.5 -2 years )

Etiology:
We have 2 Types: Essential (primary)- 85%-90% majority ,the Causes (risk factors): 1. with age 30. 2. Obesity 3. High salt Intake Secondary Causes: 1. Alcohol 2. Pregnancy 3. Vascular causes: 1. coarcation of aorta ( High Blood pressure in the upper half of the body 2. Renal artery stenosis(RAS) : which caused By a. Fibromascular stenosis (especially in Females). b. Atherosclerosis (which found more in Diabetic patients). 4.Renal diseases :1. Renal failure. 2. Glomerular Nephritic . you know one of the major functions of kidney is to control Blood pressure by Renin Angiotensin system . 5.endocrine causes.

Presentation of the disease:

-its variable -Asymptomatic -Symptomatic: headache, visual distribution chest pain ,lower limb edema, tiredness . -Complications .

Physical signs :
Most important : 1.Blood pressure heart S1 and S2 increase. 2.Body examination: -retina (hypertensive damage),-CNS (stroke , cerebrovascular accident),-kidney.

lab Examination:
1.Chest x-ray (to detect fluid in the lung ). 2.ECG , helps us in detecting LUH (left ventricle hypertrophy )and IHD( Ischemic heart disease). 3. (ECHO )Echocardiography. WIKI :- is a sonogram of the heart also known as a cardiac ultrasound, it uses standard ultrasound techniques to image two-dimensional slices of the heart. 4.Urine analysis(urine ,electrolytes ,kidney function test ).

Management:
1st step in management is lifestyle Modifications . In case of hypertensive&complication patient needs Emergency. Aim of treatment is to decrease Hp to normal Blood pressure (<140/<90).

Drugs:
1.Beta Blockers (Imp. Adrenaline). 2.ca-channel Blockers. 3.ACE-inhibitors (Angiotension converting enzyme inhibitors ). 4.Diuretics(not much Imp.): for heart failure and high Bp . 5.central reacting antihypertensive : like Alpha-metaldopa(very good esp. in pregnancy). 6.Angiotension receptor Blocker(ARB) 7.Alpha-Blockers (increase Adrenaline release).

Ischemic Heart disease: 1st cause of death worldwide The main cause of IHD is : Atherosclerosis .

Atherosclerosis: Cholesterol(lipid) deposition in Blood vessels -> lead damage to endothelial cells of the vessels which are very smooth.

We have Modified and Non-modified risk factors of Atherosclerosis : Unmodified : 1.Age (the risk increase with age ) 2.Sex (male>female ) ,BUT after menopause( ( it will be equal bw both gender. 3.Family History (sudden death of young age). Modified : 1.Blood pressure . 2.Diabetes mellitus. 3.High cholesterol level. 4.smoking .

presentation of IHD:
1.Sudden death: - arrhythmia -ventricular fibrillation. 2.Myocardial Infraction(MI): we see if there is Necrosis of the heart muscle . patient complain of- chest pain ,ECG changes ,Increase of cardiac enzyme (ALT,MB fraction ,LOH ,Troponine).

3.Angina without evidence of MI We have 2 forms: 1. Angina pectoris (fixed obstruction) which stable. 2. Unstable Angina (chronic Obstruction). -Note: in MI we have total Occlusion. 4.Heart failure : LVF or RVF or BOTH (CONGESTIVE).

lab Examination:
1. ECG 2. Cardiac enzyme: Not elevated for very long period of time. 3. CXR (chest X-ray): very Important to every patient. 4. ECHO. 5. Stress ECG. 6. Coronary Angiography ( - :)Brachial artery. -Femoral Artery.

Treatment :
Best Drug -> Aspirin (Anti platelets Drug). 2. Beta blockers . 3. Nitrates (for chest pain) 4. Morphine.