In this article we will discuss about the Hypertension:- 1. Meaning of Hypertension 2. Factors influencing Essential Hypertension 3. Causes of Secondary Hypertension 4. Clinical Symptoms 5. Complications 6. Investigations 7. Management 8. Drug Therapy.
Contents:
- Meaning of Hypertension
- Factors influencing Essential Hypertension
- Causes of Secondary Hypertension
- Clinical Symptoms of Hypertension
- Complications of Hypertension
- Investigations done in Relation to Hypertension
- Management of Hypertension
- Anti-hypertensive Drug Therapy
1. Meaning of Hypertension:
Hypertension is defined as the levels above generally accepted ‘normal’, e.g., 140/90 at the age of 20, 160/95 at the age of 50. The risks associated with a particular blood pressure are dependent upon the combination of risk factors which include age (risk increases with age), gender (males > females), race (Blacks > whites), diet (high salt), smoking and coronary artery disease.
Anxiety, discomfort and unfamiliar surroundings can lead to a transient rise in blood pressure. In most cases, a specific underlying cause of hypertension is not found. Such patients are said to have essential hypertension.
2. Factors influencing Essential Hypertension:
a. Genetics and familial.
b. Socio economic (related to social deprivation).
c. Dietary factors (high salt intake, high alcohol, and caffeine).
d. Hormonal factors (high renin).
e. Neurotransmitters (acetylcholine, norepinephrine, substance p, serotonin, dopamine).
3. Causes of Secondary Hypertension:
a. Renal disease (parenchymal renal disease, polycystic kidney disease, renal artery stenosis).
b. Endocrine disorders (Cushing’s syndrome, hyperparathyroidism, acromegaly, primary hypothyroidism).
c. Drugs (oral contraceptives containing oestrogens, corticosteroids, anti-inflammatory drugs).
d. Pregnancy (± pre-eclampsia).
4. Clinical Symptoms of Hypertension:
a. Headache or polyuria.
b. Angina, left ventricular failure and cerebrovascular disease.
c. Palpitations and sweating.
5. Complications of Hypertension:
The adverse effects of hypertension involve the central nervous system, the retina, the heart and the kidneys.
Central Nervous System:
a. Stroke may result from cerebral hemorrhage.
b. Transient cerebral ischemic attacks are more common.
c. Transient disturbances of speech or vision, fits and loss of consciousness.
d. Papilledema is common.
Retina:
a. Arteriolar damage.
b. “Cotton wool” exudates are associated with infarction.
c. Small white dense deposits of lipid persist for years.
Heart:
a. A pressure load on the heart and left ventricular hypertrophy and ultimately left ventricular failure.
b. Higher incidence of coronary artery disease.
Kidneys:
a. Damage to the renal vessels.
b. Proteinuria and progressive renal failure.
6. Investigations done in Relation to Hypertension:
a. Urine analysis (protein, glucose, hematuria).
b. Plasma (urea, creatinine).
c. Plasma electrolytes (sodium, potassium).
d. Plasma (cholesterol, triglycerides).
e. ECG.
f. Chest radiography.
7. Management of Hypertension:
a. Weight reduction diet, reduction of heavy alcohol consumption, avoidance of excess salt consumption.
b. Regular exercise programme is encouraged.
c. Stopping of smoking.
d. Testing of cholesterol including HDL, LDL and triglyceride.
8. Anti-hypertensive Drug Therapy:
a. Beta-adrenoceptor antagonists—especially relevant in the presence of angina.
b. Thiazide diuretic—for the elderly.
c. Calcium antagonists—when beta-adrenoceptor not tolerated, can be used in combination with them.
d. Aspirin—indicated to reduce cardiac and stroke complications.
e. Angiotensin—converting enzyme inhibitors—may be used as an alternative to beta-adrenoceptor antagonist or calcium antagonist.