HYPERTENSION

Presented by: Dr. Bukola Olajide

What is Hypertension?
Hypertension (HTN) or high blood pressure 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 on whether the heart muscle is contracting (systole) or relaxed (diastole) between beats.

CLASSIFICATION
Classification (JNC7) Normal Systolic pressure mmHg 90119 kPa 1215.9 Diastolic pressure mmHg 6079 kPa 8.010.5

Prehypertension
Stage 1 hypertension Stage 2 hypertension Isolated systolic hypertension

120139
140159 160 140

16.018.5
18.721.2 21.3 18.7

8089
9099 100 <90

10.711.9
12.013.2 13.3 <12.0

CAUSE Primary hypertension Primary (essential) hypertension is the most common form of hypertension, accounting for 9095% of all cases of hypertension.[1]In almost all contemporary societies, blood pressure rises with aging and the risk of becoming hypertensive in later life is considerable. Hypertension results from a complex interaction of genes and environmental factors. Secondary hypertension Secondary hypertension results from an identifiable cause. Renal disease is the most common secondary cause of hypertension.[ Hypertension can also be caused by endocrine conditions, such as Cushing's syndrome, hyperthyroidism, hypothyroidism, acromegaly, Conn's syndrome or hyperaldosteronism, hyperparathyroidism and pheochromocytoma. Other causes of secondary hypertension include obesity, sleep apnea, pregnancy, coarctation of the aorta, excessive liquorice consumption and certain prescription medicines, herbal remedies and illegal drugs.

Epidemiology
As of 2000, nearly one billion people or ~26% of the adult population of the world had hypertension.

It was common in both developed (333 million) and undeveloped (639 million) countries. It is more common in blacks and native Americans and less in whites and Mexican Americans, rates increase with age, and is greater in the southeastern United States.
Hypertension is more prevalent in men (though menopause tends to decrease this difference) and those of low socioeconomic status.

Signs and symptoms

Hypertension is rarely accompanied by any symptoms, and its identification is usually through screening, or when seeking healthcare for an unrelated problem. A proportion of people with high blood pressure reports the following: Headaches (particularly at the back of the head and in the morning) Lightheadedness vertigo Tinnitus (buzzing or hissing in the ears) Altered vision or fainting episodes. Insomnia (Poor Sleep)

Treatment

Lifestyle modifications
The first line of treatment for hypertension is identical to the recommended preventive lifestyle changes and includes: dietary changes, physical exercise, and weight loss. Dietary change such as a low sodium diet is beneficial. A long term (more than 4 weeks) low sodium diet in Caucasians is effective in reducing blood pressure, both in people with hypertension and in people with normal blood pressure. Also, the DASH diet (Dietary Approaches to Stop Hypertension), a diet rich in nuts, whole grains, fish, poultry, fruits and vegetables lowers blood pressure. A major feature of the plan is limiting intake of sodium, although the diet is also rich in potassium, magnesium, calcium, as well as protein.

Medications
Several classes of medications, collectively referred to as antihypertensive drugs, are currently available for treating hypertension. Drug prescription should take into account the patient's absolute cardiovascular risk (including risk of myocardial infarction and stroke) as well as blood pressure readings, in order to gain a more accurate picture of the patient's cardiovascular profile.

Prevention
Much of the disease burden of high blood pressure is experienced by people who are not hypertensive. Consequently, population strategies are required to reduce the consequences of high blood pressure and reduce the need for antihypertensive drug therapy. Lifestyle changes are recommended to lower blood pressure, before starting drug therapy.

proposed lifestyle changes for the primary prevention of hypertension:

maintain normal body weight for adults (e.g. body mass index 2025 kg/m2) reduce dietary sodium intake to <100 mmol/ day (<6 g of sodium chloride or <2.4 g of sodium per day) engage in regular aerobic physical activity such as brisk walking (30 min per day, most days of the week) limit alcohol consumption to no more than 3 units/day in men and no more than 2 units/day in women consume a diet rich in fruit and vegetables (e.g. at least five portions per day); consume a diet with reduced content of saturated and total fat.

Conclusion
Effective lifestyle modification may lower blood pressure as much an individual antihypertensive drug. Combinations of two or more lifestyle modifications can achieve even better results

? Questions