Hypertension, types, causes, symptoms, investigation, treatment


 A systolic (pressure measured when heart contracts)  >139 mm Hg, and / or a Diastolic BP ( pressure when heart relaxes) >89 mmHg. 

Criteria for classification of BP:-
Category                    Systolic       Diastolic
Normal  -                   <120             <80
Pre- hypertension   120-139        80-89
Hypertension
Stage -1                      140-159        90-99
Stage -2                      >=160           >=100

Hypertension (Crisis) :-
  1. Hypertension Emergencies (Malignant hypertension) are characterized by severe elevations in BP (>180/120mm hg) with progressive end- organ dysfunction. 
  2. Hypertension Urgencies (Accelerated Hypertension) are associated with severe elevation s in BP but no progressive target organ dysfunction. 
Types of Hypertension:-
  1. Primary Hypertension:- also known as Essential Hypertension Accounts for 95% causes of hypertension, No universally established cause known
  2. Secondary Hypertension:- less common causes of hypertension 5% , by use of certain medicine, or secondary to other potentially rectifiable causes. 
Causes:- 
  1. Essential hypertension
  2. Renal - Acute Nephritis, pyelonephritis, Polycystic Kidneys, Diabetic Neuropathy
  3. Endocrine - Pheochromocytoma, Cushing's syndrome, Thyrotoxicosis, Myxedema. 
  4. Pregnancy induced hypertension
  5. Cardiovascular - Coarctation of Aorta
  6. Neurological - Raised Intra cranial pressure
  7. Drugs - Cocaine
  8. Miscellaneous - Polycythemia, Hypercalcaemia 
Effects of Hypertension:- the common organs damaged by long standing Hypertension are Heart, kidney, Blood vessels, Retina and CNS. 

Symptoms due to hypertension:-
  • Headache
  • Dizziness
  • Epistaxis ( bleeding through nose) 
  • CVS - Dyspnea on exertion, Angina
  • Kidneys - Haematuria, Polyuria, Nocturia
  • CNS - stroke, Convulsions, Unconscious ness, Dizziness
  • Retina - Blurred Vision / Sudden  blindness
  • Edema
  • Weakness
  • Joint pains. 
Investigation:- 
  • Pressure measuring gauge check bp 
  • Chest X- ray, 
  • Imaging of Abdomen ( Sonography, CT scan, MRI) 
  • ECG for LV hypertrophy
  • Urinalysis
Treatment
Lifestyle Modification:-
  • Salt restrictions
  • Weight reduction
  • Stop Smoking
  • Diet control
  • Limit of Alcohol Intake
  • Relaxation
  • Regular exercise
Pharmacological treatment:-
  • Diuretics
  • Beta blockers
  • Calcium channel blockers
  • ACE inhibitors
  • Angiotensin 2 blockers
  • Alpha Blockers
  • Vasodilators. 



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