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BLOOD PRESSURE IS DEFINED AS THE PRESSURE EXERTED BY THE WALL 0F THE ARTERIES DUE TO THE FLOW OF BLOOD.
BLOOD PRESSURE CAN BE EXPRESSED IN :SYSTOLIC BLOOD PRESSURE:- THE MAXIMUM PRESSURE EXERTED IN THE ARTERIES DURING THE SYSTOLE OF THE HEART. NORMAL 110-140 mm/Hg.
DISTOLIC BLOOD PRESSURE:- THE MINIMUM PRESSURE IN THE ARTERIES DURING THE DISTOLE OF THE HEART. NORMAL 60-80 mm/Hg
NERVOUS MECHANISM
RENAL MECHANISM
HORMONAL MECHANISM
LOCAL MECHANISM
HYPERTENSION
Hypertension is a chronic medical condition in which the blood pressure is elevated to 140/90 mmHg. It is also referred to as high blood pressure.
Classification of BP
Normal 120 mmHg systolic and 80 mmHg diastolic Prehypertention 120 -139 mm Hg systolic and 80-90mm Hg diastolic Stage -1 Hypertension 140-159 mmHg systolic and 90- 99 mmHg diastolic Stage -2 Hypertention 160 mmHg systolic and 100 mmHg diastolic
CAUSES
Essential Hypertention (95 %):- B.P increases with age because of with increase of age the elasticity of the blood vessels decreases with result increase in peripheral resistance thus increase in B.P.
Secondary ( 5%)
1. DRUGS( steroids , Contraceptive pills,NSAIDS,carbenoxolone,Liquorice, sympathomimetics) 2. Cardiovascular (Coarctation of the aorta) 3. Renal (Renovascular i.e RAS and renal artery occlusion or Parenchymal i.e ch. Pyelonephritis,acute and ch.glomeronephritis,obstructive uropathy,polycystic kidney disease and hypernephromas.
4.Endocrine: ( pheochromocytoma,
1 aldosteronism, cushings,acromegaly, hyperparathyroidism and hypothyroidism).
5.Others
(brain tumors with increased intracranial pressure,bulbar poliomyelitis,connective tissue disorders i.e SLE and polyarteritis nodosa,DM nephropathy,Polycythemia rubra vera)
INITIAL or PRIMARY INVESTIGATIONS in HYPERTENSION Urinalysis Renal profile ECG Chest x-ray Renal ultrasound Urine culture FBS,s.lipids,s.urate Echocardiography
2.
3. 4.
Clues from the history Clues from physical examination Clues from initial investigations Malignant stage hypertension
Complications of Hypertension
Treatment of hypertension
1st. Non-pharmacological measures: 1. Diet 2. Weight reduction 3. Stopping smoking and excess alcohol consumption 4. Regular exercise ( behavioral, biofeedback therapy) 5. Treatment of other associated risk factors
B. Antihypertensive medications:
1. Diuretics + Thiazide, loop diuretics, K sparing 2. B-Blockers Non-cardioselective Cardioselective Alpha and Beta-blockers(labetolol)
2nd. Calcium-channel blockers: - Verapamil - Nifedipine - Amlodipine 3rd. ACE inhibitors : - Captopril - Enalapril - Lysinopril - Quinapril
3. Alpha-blockers ( prazosin) 4. Central acting drugs (reserpine, methyldopa,clonidine) 5. vasodilators: 1st. Direct relaxation of arteriolar smooth muscle: -Hydralazine -Minoxidil -Diazoxide -Na-nitroprusside
Na-nitroprusside infusion Diazoxide i.v Hydralazine iv Furosemide i.v Phentolamine i.v Nifedipine s/L Labetolol i.v
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