When the blood flow in the artery is raised high and sentence to high systolic pressure followed by pulse rate decreased, then it is called Hypertension (HTN). It is known also 'High blood pressure (HBP).
Primary where etiology is obscure
Secondary to some recognizable disease
Essential or primary hypertension
This type of hypertension with obscure etiology.
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/causation
Age between 40-60 years
Heredity is an important factor
Obesity is usually associated
Smoking
Hypercholesterolemia
Nervous factors
- Temperamental
- Emotional stress
Alcohol
Secondary hypertension
The secondary hypertension 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 the early stages, hypertension is fluctuant. It will rise 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 the cardiovascular system
- Evidence of left ventricular hypertrophy
- Signs of cardiac failure
- Evidence of ischemic heart disease
- Examination of the 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 a patient with Pre-eclampsia develops seizures it is called eclampsia, it can occur in the antenatal, intra, and the early postpartum period
- Pre-eclampsia often develops in primiparas with diabetes
- Diagnosis
- A rise in systolic blood pressure of 30 mm if Hg and or a rise 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
Crataegus ox.
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