HYPERTENSION

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BLOOD PRESSURE Blood pressure (BP) is the pressure exerted by circulating blood upon the walls of blood vessels, and is one of the principal vital signs. When used without further specification, "blood pressure" usually refers to the arterial pressure of the systemic circulation. During each heartbeat, blood pressure varies between a maximum (systolic) and a minimum ( diastolic) pressure.

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DEFINITON Hypertension (HTN) or high blood pressure, sometimes arterial hypertension, is a chronic medical condition in which the blood pressure in the arteries is elevated. This requires the heart to work harder than normal to circulate blood through the blood vessels. Blood pressure involves two measurements, systolic and diastolic, which depend called SILENT on whether the heart muscle is contracting KILLER (systole) or relaxed between beats (diastole). NO CURE is available, but PREVENTION and Normal blood pressure at rest is within the range of MANAGEMENT decrease the incidence of 100-140mmHg systolic (top reading) and 60hypertension and disease sequel 90mmHg diastolic (bottom reading). High blood pressure is said to be present if it is persistently at or above 140/90 mmHg.

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BLOOD PRESSURE CLASSIFICATION ACCORDING TO JOINT NATIONAL COMMITTEE (JCN)

Systolic pressure Classification (JNC7)[2] Diastolic pressure

mmHg

mmHg

Normal

90119

6079

Prehypertension

120139

8089

Stage 1 hypertension

140159

9099

Stage 2 hypertension

160

100

Isolated systolichypertension

140

<90

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CAUSES There are two types of high blood pressure: Primary (essential) hypertension In 90 to 95 percent of high blood pressure cases in adults, there's no identifiable cause. This type of high blood pressure, called essential hypertension or primary hypertension, tends to Secondary hypertension develop gradually over many years. The other 5 to 10 percent of high blood pressure cases are caused by an underlying condition. This type of high blood pressure, called secondary hypertension, tends to appear suddenly and cause higher blood pressure than does primary hypertension. Various conditions and medications can lead to 4/16/12 secondary hypertension, including:

Kidney abnormalities Tumors of the adrenal gland Certain congenital heart defects Certain medications, such as birth control pills, cold remedies, decongestants, OTC pain relievers and some prescription drugs Illegal drugs, such as cocaine and amphetamines

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RISK FACTORS PREDISPOSING FACTOR

q

AGE GENDER RACE FAMILY HISTORY / GENETICS

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RISK FACTORS PRECIPITATING FACTOR

q

OVERWEIGHT OR OBESE SEDENTARY LIFESTYLE

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PATHOPHYSIOL OGY PRIMARY HYPERTENSION Arterial blood pressure is a product of total peripheral resistance and cardiac output. Cardiac output is increased by conditions that increases heart rate, stroke volume or both. Peripheral resistance is increased by factors that increase blood viscosity or reduce the lumen size of vessels, especially the arterioles

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Changes in the arteriolar bed, causing increased peripheral vascular resistance

Abnormally increased tone in the sympathetic nervous system that originates in the vasomotor system center Increased blood volume

Increase in arteriolar thickening caused by genetic factors

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Abnormal renin release, resulting in the formation of angiotensin II which constricts the arteriole and increase blood volume

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SECONDARY HYPERTENSION

Chronic Renal Disease is the most common cause of 2nd HPN . Insult to the kidney from chronic glomerulonephritis or renal artery stenosis interferes with sodium excretion, the renin angiotensin aldosterone system or renal perfusion causing cortisol blood Cushings Syndrome increased pressure to increase. levels raise blood pressure by increasing renal sodium retention, angiotensin II levels, and vascular response to epinephrine.

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Primary Aldosteronism, increased intravascular volume altered sodium concentration in vessels walls, or very high aldosterone levels cause vasoconstriction and increased resistance. Pheochromocytoma is a chromafin cell tumor of the adrenal medulla that secretes epinephrine and norepinephrine. Epinephrine increases cardiac contractility and rate , where as norepinephrine increases peripheral vasclar resistance.

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CLINICAL FINDINGS elevated blood pressure readings on at least 2 consecutive occasions after initial screening

occipital headache (may worsen on rising in the morning as a result of increased intracranial pressure) nausea and vomiting and vomiting may occur. bruits (which may be heard over the abdominal aorta or carotid, renal and femoral arteries caused by stenosis or aneurysm dizziness, confusion and fatigue caused by 4/16/12 decreased tissue perfusion due to

nocturia caused by an increase in blood flow to the kidneys and an increase in glomerular filtration. edema pressure caused by increased capillary

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TEST RESULTS

Serial blood pressure measurements may be useful Urinalysis may show protein, casts, RBC or WBC suggesting renal disease: presence of catecholamines associated with pheochromocytoma or glucose suggesting diabetes. Elevated blood urea nitrogen and serum creatinine levels suggestive of renal disease or hypokalemia indicating adrenal dysfunction (primary hyperaldosteronism) Complete blood count may reveal other
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TREATMENT Lifestyle changes can help lower the risk of developing hypertension. In many patients with mild high blood pressure, reaching and maintaining a healthy weight, exercising regularly, limiting alcohol and salt, and stopping smoking can decrease blood pressure levels to normal and may be the only treatment required. The risks associated with gender, race, and increasing age, There do not disappear of lifestyle changes however, are several classes withdrugs available to treat in many cases, Each class works differently, and, hypertension. a treatment plan that includes targeting a is necessary to controlblood pressure medications specific aspect of persistent high regulation. Frequently, a patient will need to take a blood pressure. couple of different medications together to achieve blood pressure control. Your doctor will work with 4/16/12 you to select the combinations and dosages that are