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    Hypertension

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    tejaswi71117

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    Hypertension

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    12 views19 pages

    Hypertension

    Uploaded by

    tejaswi71117

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 19

    HYPERTENSION

    DR. P. TEJASWI
    OBJECTIVES

    • DEFINITION
    • TYPES
    • PATHOPHYSIOLOGY
    • CLINICAL PRESENTATION
    • TREATMENT
    DEFINITION

    • Hypertension is a long term complication in which blood pressure in the


    arteries is persistently elevated.
    • The SBP will be more than or equal of 140mm of Hg and DBP will be
    more than or equal of 90mmof Hg
    TYPES
    • PRE HYPERTESION : SBP : 120-139 mm of Hg
    DBP : 80-89 mm OF Hg
    • HYPERTENSION stage 1 : SBP : 140-159 mm of Hg
    DBP : 90-99 mm of Hg
    • HYPERTENSION stage 2 : SBP : more or equal to 160 mm of Hg
    DBP : moreor equal to 100 mm of Hg
    • Pregnancy induced HTN : because of increased production of hormones
    and enzymes during pregnancy
    ETIOLOGY
    • PRIMARY HTN : it is the elevation in BP without an identified cause
    • SECONDARY HTN : it is the elevation in BP with an exact cause. This
    type accounts for 5-10% of total cases
    • The causes of secondary HTN includes
    1. congenital narrowing of aorta.
    2. renal disease.
    3. endocrine disorders like brain tumors and head injury.
    4. neurological disorders like brain tumors and head injury
    • Sleep apnea
    • Medications like oral contraceptive pills, NSAIDS and cocaine.
    • Cirrhosis of liver
    RISK FACTORS
    • AGE : chance of CAD after 50 yrs of age
    • Alcohol, smoking and DM
    • Excessive dietary intake of sodium
    • Gender
    • Family history
    • Obesity
    • Sedentary life style
    • stress
    PATHOPHYSIOLOGY

    In secondary forms of hypertension, the underlying pathways are well


    understood:
    • In renovascular hypertension, renal artery stenosis causes decreased
    glomerular flow and pressure in afferent arteriole. this induces
    renin secretion, increase vascular tone and blood volume via the RAA
    pathway.
    • Single gene disorders cause severe but rare forms of hypertension :
    1. gene defects affecting enzymes involved in aldosterone metabolism
    (e.galdosterone synthetase, 11 beta hydroxylase, 17 alpha
    hydroxylase): this leads to increase in aldosterone , increased salt and
    water resorption, plasma volume expansion and hypertension

    2. Mutation affecting proteins that influence sodium reabsorption


    (e.g.,liddle syndrome caused by gain of function mutation in epithelial
    Na+ channel protein that increase distal tubular reabsorption of Na+
    MECHANISM OF ESSENTIAL HYPERTENSION

    1. GENETIC FACTORS :

    single gene disorders


    polymorphisms in several genes that affect BP ( Angiotensinogen and
    angiotensin receptor genes

    2. Reduced renal sodium excretion: - increase in fluid volume, increased


    cardiac output, and peripheral vasoconstriction thereby increasing BP
    3. Vasoconstrictive influences : structural changes in vessel wall, increase
    in PR
    4. Environmental factors such as stress, obesity, smoking, physical
    activity and heavy salt consumption
    CLINICAL PRESENTATION
    • Severe headache
    • Blurred vision
    • Dizziness
    • Nausea
    • Vomiting
    • Fatigue
    • Confusion
    • Epistaxis
    • Chest pain
    • Shortness of breadth
    VASULAR PATHOLOGY IN HTN

    • Hyaline arteriosclerosis:
    Injured endothelial vessels
    Increased smooth muscle cell matrix
    • Hyperplastic arteriosclerosis:
    Laminations show smooth muscle cells
    Thick duplicated basement membrane
    Fibrinoid necrosis
    Vessel wall necrosis
    TREATMENT

    • LIFE STYLE MODIFICATION :


    weight reduction
    DASH (Dietary approaches to stop hypertension)
    Dietary sodium reduction
    reduction of alcohol consumption
    exercise
    stress management
    PHARMACOLOGICAL THERAPY

    • Various groups of drugs are used for the treatment of hypertension


    which includes
    DIURETICS
    BETA BLOCKERS
    ALPHA BLOCKERS
    CALCIUM BLOCKERS
    REFERENCES

    ROBBINS AND COTRAN PATHOLOGIC BASIS OF DISEASE


    SOUTH EAST EDITION VOLUME I

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