BLOOD PRESSURE вЂў The arterial blood pressure reflects the rhythmic ejection of blood from the left ventricle into the aorta. вЂў (blood pressure = cardiac output Г— peripheral vascular resistance) вЂў stroke volume (amount of blood that the heart ejects with each beat . вЂў heart rate or number of times the heart beats each minute. вЂў The systolic blood pressure reflects the rhythmic ejection of вЂў blood into the aorta, ideally is less than вЂў 120 mm Hg, вЂў The diastolic blood pressure is maintained by the energy вЂў that has been stored in the elastic walls of the aorta during вЂў Systole, is less than 80 mm Hg. вЂў The difference between the systolic and diastolic pressure (approximately 40 mm Hg) is called the pulse pressure. HYPERTENTION вЂў DEF : sustained high blood pressure , blood pressure 140/90 , at least two reading on separate occasion is considered hypertension . вЂў High blood pressure (hypertension) is one of the most important preventable causes of premature morbidity and mortality in the world . вЂў Hypertension is a major risk factor for ischaemic and haemorrhagic stroke, myocardial infarction, heart failure, chronic kidney disease, cognitive decline and premature death. вЂў The risk associated with increasing blood pressure is continuous, with each 2 mmHg rise in systolic blood pressure associated with a 7% increased risk of mortality from ischaemic heart disease and a 10% increased risk of mortality from stroke. вЂў Diastolic pressure is more commonly elevated in people younger than 50. With ageing, systolic hypertension becomes a more significant problem, as a result of progressive stiffening and loss of compliance of larger arteries. вЂў At least one quarter of adults (and more than half of those older than 60) have high blood pressure. CLASSIFICATION OF HT вЂў Stage 1 hypertension :Clinic blood pressure is 140/90 mmHg or higherand subsequent ambulatory blood pressure monitoring (ABPM) daytime average or home blood pressure monitoring (HBPM) average blood pressure is 135/85 mmHg or higher. вЂў Stage 2 hypertension : Clinic blood pressure is 160/100 mmHg or higher and subsequent ABPM daytime average or HBPM average blood pressure is 150/95 mmHg or higher. вЂў Severe hypertension : Clinic systolic blood pressure is 180 mmHg or higher or clinic diastolic blood pressure is 110 mmHg or higher. ETIOLOGY PRIMARY (ESSENTIAL ) HYPERTENTION вЂў In about 95% of cases no cause of hypertension can be identified . вЂў The onset of essential hypertension is usually between ages 25 and 55 years it is uncommon before age 20 . CAUSES вЂў PRECIPITATING FACTORS : 1. Genetic factors . 2. Obesity , lack of exercise . 3. Heavy alcohol intake . 4. Excessive salt intake . 5. Cigarette smoking . 6. Polycythemia . 7. NSAIDs . 8. Low potassium intake . 9. Sympathetic over activity . 10. Insulin resistance . SECONDARY HYPERTENSION вЂў In about 5% of cases , cause of hypertension can be discovered. вЂў Most of patients are young . CAUSES вЂў 1. 2. 3. вЂў 1. 2. 3. 4. 5. 6. RENAL DISEASE : Renal vascular disease . Parenchymal renal disease (glomerulonephritis) . Polycystic kidney disease . ENDOCRINE DISEASE : Pheochromocytoma . cushingвЂ™s syndrome . Primary peraldosteronism (connвЂ™s syndrome) . Hyperparathyroidism . Thyrotoxicosis . Acromegaly . вЂў 1. 2. 3. вЂў вЂў вЂў DRUGS : oral contraceptives containing oestrogens . Steroids . NSAIDs . ALCOHOL . COARCITATION OF THE AORTA . PRE-ECLAMPSIA . CLINICAL FEATURES SYMPTOMS 1. Mostly asymptomatic discovered on routine examination or when a complication arises . 2. Suboccipital pulsating headache , mainly at morning . 3. Somnolence . 4. Confusion . 5. Visual disturbances . 6. Nausea and vomiting . signs 1. In majority of patients, high blood pressure may be the only sign . 2. Features of cause of hypertension . 3. Features of complications . Complication CNS 1. STROKE : it results from cerebral hemorrhage or infarction mostly as a complication of hypertension . 2. HYPERTENSIVE ENCEPHALOPATHY : it is characterized by severe hypertehsion with neurological symptoms e.g. transient disturbance of speech or vision, disorientation, fits and unconsciousness . 3. SUBARACHNOID HEMORRHAGE : it is also more common in hypertensive patients . 4. MULTI-INFARCT DEMENTIA . RETINA вЂў Retinal changes are graded as following : вЂў GRADE I : tortuosity of the retinal arteries with increased reflectiveness ( silver wiring ) . вЂў GRADE II : grade I plus appearance of arteriovenous nipping produced when thickened retinal arteries pass over the retinal vein . вЂў GRADE III : grade II plus flame-shaped hemorrhages and soft вЂњcotton wool вЂњ exudates due to small infarcts . вЂў GRADE IV : grade III plus papiloedema ( blurring of the margins of the optic disc ) . HEART вЂў Left ventricular hypertrophy . вЂў Ischemic heart disease . вЂў Aortic dissection . KIDNEYS вЂў Long standing hypertension may cause nephrosclerosis (hypertensive nephropathy) that causes proteinuria and progressive renal failure . MANAGEMENT вЂў The clinical management of hypertension is one of the most common interventions in primary care . INVESTIGATIONS вЂў вЂў вЂў вЂў вЂў вЂў вЂў URINE ANALYSIS : for proteinuria, hematuria and casts . HEMATOCRIT : polycythemia . SERUM UREA AND CREATININE : renal failure . LIPID PROFIL : dyslipdemia . ECG : left ventricular hypertrophy . CHEST X-RAY : cardiomegaly , heart failure . ECO . TREATMENT WHO SHOULD BE TREATED вЂў Patient with mild hypertension without other cardiac risk factor should be treated non-pharmacologically with modification of life-style such as regular exercise, low salt intake Lifestyle interventions вЂў Lifestyle advice should be offered initially and then periodically to people undergoing assessment or treatment for hypertension . вЂў Ascertain peopleвЂ™s diet and exercise patterns because a healthy diet and regular exercise can reduce blood pressure. вЂў Relaxation therapies can reduce blood pressure . вЂў Ascertain peopleвЂ™s alcohol consumption and encourage a reduced intake if they drink excessively . вЂў Discourage excessive consumption of coffee and other caffeinerich products. вЂў Encourage people to keep their dietary sodium intake low . вЂў Offer advice and help to smokers to stop smoking. Initiating treatment вЂў Offer antihypertensive drug treatment to people aged under 80 years with stage 1 hypertension who have one or more of the following: 1. target organ damage 2. established cardiovascular disease 3. renal disease 4. diabetes 5. a 10-year cardiovascular risk equivalent to 20% or greater. вЂў Offer antihypertensive drug treatment to people of any age with stage 2 hypertension . вЂў For people aged under 40 years with stage 1 hypertension and no evidence of target organ damage, consider seeking specialist evaluation of secondary causes of hypertension and a more detailed assessment of potential target organ damage. This is because 10-year cardiovascular risk assessments can underestimate the lifetime risk of cardiovascular events in these people THANK YOU .