Objective the Program:

At the end of the session the participants will be able to:

 State the definition and epidemiology of
hypertension
 Describe the Classification and categories of
hypertension
 Explain the signs and symptoms of Hypertension
 State diagnosis study might be performed in
Hypertension
 Explain the management of Hypertension
 Signs and Symptoms

• Often remains asymptomatic until complications develop.

• Usually discovered on blood pressure measurement during
routine examination.
• Patient may suffer from severe headaches, fainting attacks,
dizziness, nausea and vomiting for which they seek medical
attention.
 Causes
The cause of Primary hypertension is NOT KNOWN, but It is
thought to be due to multiple risk factors such as familial
history of the disease, race, obesity, tobacco smoking, stress,
and a high-fat or high-sodium diet

Secondary hypertension is related to an underlying disease

process such as renal parenchymal disorders (kidney failure
which is both a cause and an effect of hypertension), renal
artery disease, endocrine and metabolic disorders, central
nervous system disorders, and narrowing of the aorta
(coarctation )
H Classification of Blood Pressure [ >18 Years Old and Older ]
Y
P BP CLASSIFICATION
SISTOLIC BLOOD
PRESSURE (mmHg) *
DIASTOLIC BLOOD
PRESSURE (mmHg) *

E
NORMAL < 120 And < 80
R PRE-HYPERTENSION 120 - 139 Or 80 - 89
STAGE 1 HYPERTENSION 140 - 159 Or 90 - 99
T STAGE 2 HYPERTENSION  160 0r  100

E Classification of Blood Pressure (Adult ages 18 and older) JNC VII

N
S Note : When systolic and diastolic pressures fall into different
I categories, the higher category should be used to classify the
individual's blood pressure status.
O
N
H
Y Categories of high blood pressure :
P 1. Hypertensive emergencies/ hypertensive crisis . [ 1 % ]
E It requires immediate blood pressure reduction to prevent or
limit damage to target organs
R
T 2. Hypertensive urgency
E When the blood pressure elevation presents a risk for
imminent target organ damage although acute organ injury
N has not yet occurred.
S
I
O
N
H
Categories of high blood pressure - Cont’d:
Y
P 3. Acute hypertensive (non-emergency / non-urgency)
E When a patient is found to have stage 3 of hypertension [
R SBP 180 mmHg, and DBP  110 mmHg with no signs and
symptoms of evolving target organ
T
E
N 4. Transient hypertension
Occurs in association with other conditions such as anxiety,
S alcohol-withdrawal syndromes, and some toxicologic
I substances.
O
N
H Pathogenesis
Y The resistance of arteriole factor:

P • Humoral, hemo-dynamic, neural factors may cause

E contractile or structural changes of the arteriole resulting
increases in it pressure.
R
T • According to the increase of pressure, the arterioles will
response it by thickening or remodeling of the arteriole
E tissue.
N
S • There may be either proliferation of vascular smooth
muscle cells or increase in size associated with
I endoreplication of the DNA that cause narrowing of the
O luminal diameter causes increased resistance and provides
mechanical advantage in the response to vasoconstrictors
N
Pathogenesis – Cont’d

The endothelium factor:

•Endothelium-derived dilator factors are important in the

control of vascular tone.

•It's produces several potent vasodilator substances,

including the prostaglandins- undefined dilator factors and
nitric oxide

•Endothelium-dependent vasodilation is impaired in the

coronary vascular bed in human hypertension.
H
Y
Complications:
P
E • Atherosclerotic Heart Disease
R • Cerebro Vascular Insufficiency With Or Without Strokes

T • Retinal Hemorrhage
• Renal Failure
E
• Nephrosclerosis
N
• Encephalopathy
S • Cardiac Failure
I
O
N
HH Diagnostic Studies
YY
PP • BUN, creatinine, electrolyte, glucose level, CBC, ECG,
urinalysis, and chest x-ray to look for evidence of target
EE organ damage
RR
• Elevation of BUN, Creatinine and potassium level may
TT indicate renal impairment.
EE
• Hypoglycemia can increase blood pressure and simulate
NN hypertensive encephalopathy or stroke
SS
II • Microangiopathic hemolytic anemia may occur as a
result of vascular damage after an acute severe
OO elevation of blood pressure.
NN
Diagnostic Studies

•Presence of ST -T wave changes may be evidence of

ischemia, electrolyte abnormalities, or left ventricular
hypertrophy.

•The chest x-ray showing evidence of left- side a

congestive heart failure.

•Patient with neurologic symptoms, computed

tomography (CT) of the head should be performed to
look for evidence of stroke or hemorrhage
H
Treatment
Y
P  Diuretics [ hydrochlorothiazide and amiloride ], the effect of
E diuretics on arterial compliance is unclear and produced no
R significant change in the distensibility of the common carotid
artery
T
E  Direct vasodilators [ isosorbide dinitrate ] have beneficial
effects on arterial compliance. which resulted primarily from
N relaxation of vascular smooth muscle.
S
 Calcium antagonists / Calcium channel blockers [
I nifedipine ] have the potential to improve arterial compliance
O
N
Treatment –cont’d

Beta-Blockers therapy has shown variable effects on

arterial compliance.

 ACE inhibitors [captopril, lisinopril, and perindopril ]

can greatly increase arterial compliance. Their
beneficial on hypertension may be due to their action
on the endothelium
H
Prevention
Y
P
Avoid The Known Risk Factors such as :
E
R • Ensuring A Low Salt Diet
T • Avoid High-Cholesterol and Fatty Foods
• Adequate Regular Exercise
E
• Reduce Stress and Anxiety By Counseling
N • Avoiding Smoking
S • Reduce Consumption Of Alcohol
I
O
N