Hypertension

Definition

When the blood flow in artery raised high and sentence to high systolic pressure followed by pulse rate decreased, then it is called Hypertension (HTN). It is know also 'High blood pressure' (HBP).




Types

Primary where etiology is obscure

Secondary to some recognizable disease


Essential or primary hypertension

This type of hypertension with obscure etiology. It is most common form and affects both sexes.

Definite-       Systolic over 160 mm of hg

                      Diastolic over 96 mm of Hg

Borderline-  Systolic over 140 mm of Hg

                      Diastolic over 90 mm of Hg

Normal-       Systolic below 140 mm of Hg

                     Diastolic below 90 mm of Hg


Etiology or causation

Age between 40-60 years

Heredity is an important factor

Obesity is usually associated

Smoking 

Hypercholesterolemia

Nervous factors

  • Temperamental 
  • Emotional stress
Increased Na+ intake, NSAIDs

Alcohol


Secondary hypertension

Generally secondary to some disease condition such as:

Renal disorders

Endocrinal disorders

  • Cushing's syndrome
  • Pheochromocytoma
  • Primary hyperaldosteronism

Toxemia of pregnancy

Neurogenic disorders

Connective tissue disorders

Coarctation of aorta


Symptoms / Signs

  • High blood pressure is often detected on routine examination
  • Very rarely symptoms are present
  • In early stages the hypertension is fluctuant. It will raise to abnormal levels under the influence of emotional changes etc. and later on it becomes permanently elevated even at rest and continues.


Hypertensive urgencies

  • Diastolic blood pressure > 120 mm of Hg with minimal target organ damage
  • Grade 1 and 2 fundoscopic changes
  • Postoperative or preoperative uncontrolled hypertension


Investigation

  • History
  • Family history of hypertension
  • History of renal disease
  • Undue breathlessness
  • Clinical features of other responsible diseases
  • Assessment of blood pressure
  • Examination of cardiovascular system
  • Evidence of left ventricular hypertrophy
  • Signs of cardiac failure
  • Evidence of ischemic heart disease
  • Examination of optic fundus
  • Femoral pulse must be palpated
  • ECG shows ST-T wave changes
  • Echocardiography
  • Renal function tests


Hypertensive emergencies

  • When diastolic blood pressure 120 mm of Hg with major organ damage such as CNS or Kidney or Cardiovascular
  • Intracranial or subarachnoid hemorrhage
  • CVA, hypertensive encephalopathy
  • Acute aortic dissection, pulmonary edema
  • Myocardial infarction, Unstable angina
  • Eclampsia
  • Grade III or IV K W fundoscopic changes


Complication of hypertension

Heart complication:

  • Right ventricular failure
  • Coronary artery disease may be associated
  • Left ventricular enlargement and subsequent hypertrophy


Cerebral complications:

  • Headache, dizziness, vertigo
  • Headache is usually occipital, starts on waking and improves with the day
  • Encephalopathy
  • Cerebral hemorrhage
  • Cerebral thrombosis
  • Gradual cerebral deterioration


Eye changes:

  • Haziness of vision
  • Progressive hemorrhage and thrombosis commonly occurs in patients with hypertension


Renal:

Progressive renal failure


Pre-eclampsia syndrome

  • It is of unknown etiology, characterized by hypertension, edema, proteinuria occurring after 20 weeks of gestation
  • When only hypertension is present, it is called gestational hypertension
  • If patient of Pre-eclampsia develops seizures it is called eclampsia, it can occur in antenatal, intra and early post partum period
  • Pre-eclampsia often develops in primiparas with diabetes
  • Diagnosis
  • Rise in systolic blood pressure of 30 mm if Hg and or a raise in diastolic blood pressure of 15 mm of Hg calls for medical attention.


Complications

  • Fits
  • Retinal hemorrhage
  • Pulmonary edema
  • Coma
  • Severe epigastric pain
  • Headache
  • Intra-uterine growth retardation


Treatment

  • Non drug therapy
  • Weight reduction
  • Low sodium diet
  • Potassium, magnesium and calcium supplementation
  • High PUFA diet
  • Moderation of alcohol
  • Psychological factors should be treated first
  • Rest
  • Exercise


Homeopathic medicines

Aconite Nep

Glonoine

Baryta Mur

Crategus ox.

Post a Comment

Previous Post Next Post