HTN Presentation CHOs 2022
HTN Presentation CHOs 2022
HTN Presentation CHOs 2022
CHOs in training-Year 3
• Essential hypertension
– 95%
– No underlying cause
• Secondary hypertension
– Underlying cause
Causes of
Secondary Hypertension
• Renal
– Parenchymal
– Vascular
– Others
• Endocrine
• Miscellaneous
• Unknown
Blood Pressure
Classification
• Advancing Age
• Sex (men and postmenopausal women)
• Family history of cardiovascular disease
• Sedentary life style & psycho-social stress
• Smoking ,High cholesterol diet, Low fruit consumption
• Obesity & wt. gain
• Co-existing disorders such as diabetes, and
hyperlipidemia
• High intake of alcohol
Haemodynamic Pattern in
Hypertension
Elderly : BP = CO X TPR
Aetiology of Systemic Hypertension
Continue…
Diseases Attributable to
Hypertension
Chronic Cerebral
Stroke Preeclampsia/ Hemorrhage
Kidney
Eclampsia
Failure
Target Organ Damage
Heart
• Left ventricular hypertrophy
• Angina or myocardial infarction
• Heart failure
Brain
• Stroke or transient ischemic attack
Chronic kidney disease
Peripheral arterial disease
Retinopathy.
Clinical manifestations
Routine Tests
• Electrocardiogram
• Urinalysis
• Blood glucose,
• Serum potassium, creatinine, or the corresponding estimated GFR, and
calcium
• Lipid profile, after 9- to 12-hour fast, that includes high-density and
low-density lipoprotein cholesterol, and triglycerides
Optional tests
• Measurement of urinary albumin excretion or albumin/creatinine ratio
More extensive testing for identifiable causes is not generally indicated
unless BP control is not achieved
Treatment Overview
Goals of therapy
Lifestyle modification
Pharmacologic treatment
Algorithm for treatment of hypertension
Follow up and monitoring
Goals of Therapy
DASH
diet
Regular exercise
AT1 receptor
ARB Continue….
Drug therapy for hypertension
Example: Hydrochlorothiazide
• Act by decreasing blood volume and cardiac output
• Decrease peripheral resistance during chronic therapy
• Drugs of choice in elderly hypertensives
Side effects-
• Hypokalaemia
• Hyponatraemia
• Hyperlipidaemia
• Hyperuricaemia (hence contraindicated in gout)
• Hyperglycaemia (hence not safe in diabetes)
• Not safe in renal and hepatic insufficiency
Beta blockers
Example: Losartan
• Block the angiotensin II receptor
and inhibit effects of angiotensin
II
• Drugs of choice in patients with
co-existing diabetes mellitus
Side effects-
safer than ACEI, hypotension,
Alpha blockers
Example: prazosin
• Block a-1 receptors and cause vasodilation
• Reduce peripheral resistance and venous
return
• Exert beneficial effects on lipids and
insulin sensitivity
• Drugs of choice in patients with co-existing
BPH
Side effects-
Postural hypotension,
Antihypertensive therapy:
Side-effects and Contraindications
Not at Goal
Blood Pressure
Improper BP measurement
Excess sodium intake
Inadequate diuretic therapy
Medication
• Inadequate doses
• Drug actions and interactions (e.g., (NSAIDs), illicit drugs,
sympathomimetics, OCP)
• Over-the-counter drugs and some herbal supplements
Excess alcohol intake
Identifiable causes of HTN
THE END!