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HYPERTENSION

MOHAMMED GHAYAS AHMED


GROUP – 4
6TH YEAR 1ST SEMESTER
FAMILY MEDICINE
TSMU
HYPERTENSION
• HYPERTENSION IN ADULTS :
• This is a condition in which the blood pressure of an adult is persistently higher
than 140/90 mmHg in a non-diabetic, or above 130/80 mmHg in a diabetic.
• Hypertension carries an increased risk of early death from stroke, heart attack,
heart failure and kidney failure if not properly controlled.
• Once a diagnosis of hypertension is made, the individual should be evaluated for
the cause of the hypertension.
• Most patients with hypertension will require two or more antihypertensive
medications to achieve the desired target blood pressure.
• The choice of medication is influenced by individual patient factors such as age,
sex, cardiovascular risk, associated medical conditions and adverse effects
CAUSES
• Primary hypertension - In the majority of patients no specific underlying cause is
identified. Risk factors associated with this type of hypertension include
increasing age, family history, excess body weight, excessive alcohol intake.
• Secondary hypertension - In about 10% of cases, hypertension may be due to a
kidney disease, endocrine disorder, renal artery stenosis or coarctation of the
aorta
SYMPTOMS
• There are no complaints that are specific for hypertension
• Most patients with hypertension may have no symptoms
• Occasionally, patients may complain of
• Headache,Palpitation,Dizziness,Easy fatigability
CATEGORIES
• Normal: Less than 120/80 mm Hg;
• Elevated: Systolic between 120-129 and diastolic less than 80;
• Stage 1: Systolic between 130-139 or diastolic between 80-89;
• Stage 2: Systolic at least 140 or diastolic at least 90 mm Hg;
• Hypertensive crisis: Systolic over 180 and/or diastolic over 120,
with patients needing prompt changes in medication if there
are no other indications of problems, or immediate
hospitalization if there are signs of organ damage
CLINICAL ALGORITHIM
TREATMENT GOALS
•To reduce blood pressure levels to 140/90
mmHg or less (130/80 mmHg or less in
diabetics)
•To prevent cardiovascular, cerebrovascular and
renal complications
•To identify and manage secondary
hypertension appropriately
NON-PHARMACOLOGICAL TREATMENT
• Reduce salt intake
• Reduce animal fat intake
• Ensure regular fruit and vegetable intake
• Weight reduction in obese and overweight individuals
• Regular exercise e.g. brisk walking for 30 minutes 3 times
a week
• Reduction in alcohol consumption and Cessation of
smoking
PHARMACOLOGICAL TREATMENT
• Thiazide diuretics
• Bendroflumethiazide (bendrofluazide), oral, 2.5 mg daily
• Beta-blockers:
• Atenolol, oral, 50 -100 mg daily
• Bisoprolol, oral 5-20 mg daily
• Carvedilol, oral, 6.25-25 mg 12 hourly
• Angiotensin-converting enzyme (ACE) inhibitors:
• Lisinopril, oral, 5-40 mg daily
• Ramipril, oral, 2.5-10 mg daily
• Angiotensin receptor blockers:
• Losartan, oral, 25-100 mg daily
• Candesartan, oral, 4-32 mg daily
• Valsatan, oral, 80-160 mg daily
• Calcium channel blockers:
• Nifedipine retard, oral, 10-40 mg 12 hourly
• Amlodipine, oral, 5-10 mg daily
• Vasodilators:
• Hydralazine Adults Oral, 25-50 mg 12 hourly Slow IV injection over 20 minutes, 5-10 mg diluted with 10 ml
Normal Saline. Repeat after 20-30 minutes if necessary
SOURCE
• The 2017 ACC/AHA hypertension guideline