Overview of Hypertention

Causes :

Essential ( primary ) : related to age , sex, genetics, race, DM  lack of exercise and smoking.

secondary : which result from underlying causes such as :

Drugs : steroids, contraceptive pills

Pregnancy : preeclampsia, eclampsia

Renal : renal artery stenosis, pyelonephritis, renal artery atherosclerosis

Endocrine : Cushing, corns, acromegaly  

Manifestations :

Increase the blood pressure, Occipital morning headache, Blurring of vision, and Polyuria.

Organ damage ( as complication) : 

Heart : angina

Brain : stroke, TIA

kednis : renal failure

Vessels : aneurysm

Investigations :

* Urine examination

* Blood sugar, Electrolytes, Chest X-ray ( left ventricular hypertrophy ), ECHO ( left ventricular hypertrophy ), Abdominal US, Lipid profile, VMA ( vanillylmandelic acid ), Aldosterone level and Urinary cortisol.

Treatment :

Life style,  if there is inadequate response so continue on ( life style + B-blockers or diuretics ). if inadequate response so either increase the dose of the drug, or substitute another drug or add third drug. if still inadequate response so add the third drug

Non pharmacological treatment :

Reduction of weight, Stop smoking, Exercise, Avoid vasopressor drugs, Increase intake of Ca and K.

pharmacological treatment :

* Diuretics: frusemide, hydrochlorothizide, spironolactone.

Side effects : hypokalemia, hypomagnesemia, hypocalcemia, hyponatremia, hyperglycemia.

* B-blockers : propranolol, atenolol.

Side effects : decrease heart rate, postural hypotension, broncospasm.

* ACE inhibitors : captopril, enalapril.

Side effects : cough, decrease blood pressure, rash.

* Angiotensin II receptor blocker : valsartan, losartan.

Side effects : dry mouth, asthma, rash, constipation, dyspepsia, insomnia

* Calcium channel blockers : deltiazem, verapamil, nifedipine.

Side effects : increase heart rate, headache, edema, flushing.

* Alpha 1 receptor blocker : prazosin, doxazin.

Side effects : palpitation, orthostatic hypotension.

* Centrally acting alpha 2 : clonidine, methyl dopa.

Side effects : orthostatic hypotension, hepatitis, Influenza.

*Peripherally acting adrenergic antagonist : reserpine.

Side effects : orthostatic hypotension, depression, diarrhea, peptic ulcer

Hypertensive emergency :

1. Diuretics : furosemide

2. Vasodilators : nitroprusside, nitroglycerine, nicardipine, hydralazine

3. Adrenergic inhibitor : phentolamine, esmolol, labetalol.

By: Dr. Mustafa Aljubbawy

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