Hyper Tens!On

Hypertension
Dr.Ahsan Rafiq
Hypertension
Hypertension is defined as a systolic blood pressure

(SBP) of 140 mm Hg or more, or a diastolic blood
pressure (DBP) of 90 mm Hg or more.
Hypertension (HTN) or high blood pressure, sometimes

called arterial hypertension is a chronic medical
condition in which the blood pressure in the arteries is
elevated.
Normal Range
100-140mmHg systolic (top reading)
60-90mmHg diastolic (bottom reading).
High blood pressure is said to be present if it is persistently at

or above 140/90 mmHg.
History
William Harvey (1578–1657), who described the circulation of

blood in his book "De motu cordis
previously Known as "hard pulse disease" consisted in

reducing the quantity of blood by blood letting or the
application of Leeches.
Advancement was done with the first thiazide diuretic,

developed from the antibiotic sulfanilamide, which became
available in 1958
Classification
Primary (essential) hypertension

Secondary hypertension
Pulmonary hypertension
Neurogenic hypertension
Gestational Hypertension
Primary Hypertension
In the vast majority of people cause of hypertension

remain unknown: referred as "essential hypertension"
 It may develop as a result of environmental or genetic

causes.
 Primary or essential hypertension accounts for 90-95%
of adult cases.
Symptoms
Vertigo
Headaches Lightheadedness Tinnitus
Altered vision
Causes Primary Hypertension
Aging
Racial factors
Environmental factors
Secondary hypertension
Secondary hypertension results from an identifiable
cause
 It has multiple etiologies, including renal, vascular,
and endocrine causes.
 secondary hypertension accounts for 2-10% of cases.
Symptoms
kidney diseases or endocrine diseases
Thyroid disease
Acromegaly
Renal artery stenosis

Causes of Secondary hypertension
Cushing's syndrome
Hyperthyroidism
Hypothyroidism
Acromegaly
Conn's syndrome or hyperaldosteronism
Pheochromocytoma
Other causes of secondary hypertension include obesity, sleep apnea, pregnancy.
Pulmonary Hypertension
Pulmonary hypertension (PH) is an increase of
blood pressure in the lung vasculature(pulmonary
artery, pulmonary vein, or pulmonary capillaries)
symptoms
Shortness of breath
Dizziness
Fainting
Nausea
According to the most recent classification, it can be
Arterial
Venous
Hypoxic
Thromboembolic
Miscellaneous
Neurogenic Hypertension
It result of chronic high activity of the autonomic

nervous system and known as "neurogenic
hypertension
Gestational Hypertension
 High blood pressure in pregnancy can be classified

as pre-existing hypertension, gestational
hypertension or pre-eclampsia.
Pre-eclampsia
 serious condition of the second half of pregnancy
 characterized by increased blood pressure
 presence of protein in the urine.
 headache, visual disturbance (often "flashing
lights"), vomiting, pain over the stomach, and
swelling are common symptoms.
Eclampsia
 is a hypertensive emergency
 with several serious complications including vision
loss, brain swelling, seizures, kidney failure,
pulmonary edema, and disseminated intravascular
coagulation (a blood clotting disorder).
Regulation of Blood Pressure
 Blood pressure modulation by effects on cardiac output

and peripheral resistance.
Pathogenesis of Hypertension
Ninety percent to 95% of hypertension is

idiopathic (essential hypertension)
Secondary Factors
Genetic Factors
Hypothetical scheme for the
pathogenesis of essential hypertension
Vascular Pathology in Hypertension
A. Hyaline arteriolosclerosis. The arteriolar wall is hyalinized and the lumen is markedly
narrowed.
B. Hyperplastic arteriolosclerosis (onion-skinning) causing luminal obliteration (arrow),
with secondary ischemic changes, manifest by wrinkling of the glomerular capillary
vessels at the upper left
Prognosis
Diagnosis
Typical tests performed Diagnosis
• Microscopic urinalysis
Renal • Creatinine
• Serum sodium, potassium, calcium.

Endocrine • TSH
• Fasting blood glucose

Metabolic • HDL, LDL, and total cholesterol
• Triglycerides
• Hematocrit,
Other • Electrocardiogram
• Chest radiograph
Hypertensive crisis
 Hypertensive Urgencies: No progressive target-organ
dysfunction. (Accelerated Hypertension)
 Hypertensive Emergencies: Progressive end-organ

dysfunction. (Malignant Hypertension)
In Infants and children
.
British Hypertension Society
guidelines proposed the following lifestyle
changes
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);
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.
Medications
Calcium channel blockers
Beta-blockers
Diuretics
ACE-inhibitor
Calcium channel blockers
Beta-blockers
Diuretics
ACE-inhibitor
Society and Culture
 The World Health Organization.

 The World Hypertension League (WHL),
 Umbrella organization of 85 national hypertension societies and leagues,
recognized that more than 50% of the hypertensive population worldwide
are unaware of their condition.
Hypertension In Pakistan
The National Health Survey of Pakistan estimated that hypertension affects
18% of adults
33% of adults above 45 years old
it was shown that 18% of people in Pakistan suffer from hypertension with every
third person over the age of 40 becoming increasingly vulnerable to a wide range
of diseases.
Health Care Structure to Control
Hypertension
 In Pakistan, health units range from
Basic health units (BHUs)
Tertiary referral centres
The BHUs cover around 10 000 people, whereas the larger rural health centres (RHCs)
cover around 30 000 to 450 000 people.
Primary health center (PHC) units comprise both BHUs and RHCs. The Tehsil
Headquarters Hospital (THQ) covers the population at sub-district level.
Complications
Utilizations of these units is generally low due to
Lack of services and facilities available
Uncooperative staff
Inaccessibility
Lack of education
 Just 33% of the population has access to health facilities in an area with a 5 km radius.
 This place is a huge burden on District Headquarters Hospital (DHH) as a vast number of population
have no choice other than to move there for treatment.
 As a result this increases, specifically, the work load of the health facility team, and in general, total
expenditures.
Steps Taken By Our Government
The Ministry of Health in pakistan has re-strategised by appointing
More Doctors
Pharmacists 
Supporting staff
Increasing the medical and technical budgets of hospitals.
There is hardly any change seen regarding awareness, control or management of

hypertension in particular.
Graph showing prevalence of awareness, treatment and
control of hypertension compared between the four studies
80
73 72
70 68
61
60
55 54
51
50
%Adults
1988-1992
40
35 1992-2002
31 2002-2007
29
30 27 2007-2012
20
10
10
0
Awearness Treatment Control
Axis Title
Role of Pharmacist
Educating those over 50 years of age on the importance identifying and
managing BP
Identifying at-risk individuals with pre-hypertension and talking with them about
lifestyle modifications to lower BP
Recommending appropriate drug therapies to practitioners
Educating patients on why multiple medications maybe needed
Compelling patient to adhere to their therapy
Providing self monitoring equipment to patients with hypertension and

teaching them how to use them properly
Best Control To All Diseases
Always stay happy 

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Hypertension

Hypertension is defined as a systolic blood pressure

Hypertension (HTN) or high blood pressure, sometimes

100-140mmHg systolic (top reading)

60-90mmHg diastolic (bottom reading).

High blood pressure is said to be present if it is persistently at

William Harvey (1578–1657), who described the circulation of

previously Known as "hard pulse disease" consisted in

Advancement was done with the first thiazide diuretic,

Primary (essential) hypertension

In the vast majority of people cause of hypertension

 It may develop as a result of environmental or genetic

Headaches Lightheadedness Tinnitus

Renal artery stenosis

Conn's syndrome or hyperaldosteronism

It result of chronic high activity of the autonomic

 High blood pressure in pregnancy can be classified

 Blood pressure modulation by effects on cardiac output

Ninety percent to 95% of hypertension is

• Serum sodium, potassium, calcium.

• Fasting blood glucose

 Hypertensive Emergencies: Progressive end-organ

consume a diet rich in fruit and

Effective lifestyle modification may lower

Calcium channel blockers

 The World Health Organization.

33% of adults above 45 years old

 In Pakistan, health units range from

Basic health units (BHUs)

Tertiary referral centres

Utilizations of these units is generally low due to

Lack of services and facilities available

Increasing the medical and technical budgets of hospitals.

There is hardly any change seen regarding awareness, control or management of

Recommending appropriate drug therapies to practitioners

Educating patients on why multiple medications maybe needed

Compelling patient to adhere to their therapy

Providing self monitoring equipment to patients with hypertension and

Always stay happy 

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