HYPERTENSION

 

Definition

 

Hypertension is defined as:

 

· Office BP: ≥ 140 mmHg systolic and/or ≥ 90 mmHg diastolic

· Ambulatory/Daytime: ≥ 135/85 mmHg

· Nighttime: ≥ 120/70 mmHg

· 24-hour average: ≥ 130/80 mmHg

· Home BP: ≥ 135/85 mmHg

 

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Aetiology

 

1. Systolic Hypertension

 

· Increased stroke volume: Aortic regurgitation, PDA, fever, thyrotoxicosis

· Decreased aortic compliance: Aortic atherosclerosis

 

2. Diastolic Hypertension

 

· Essential Hypertension (90% of cases):

  · Genetic factors

  · Disturbed autonomic function

  · Excessive renin secretion

  · Defective renal salt handling

  · Insulin resistance → Na reabsorption, vascular smooth muscle growth

· Secondary Hypertension:

  · Neurogenic: ↑ICP, medullary tumors

  · Vascular: Coarctation of aorta, vasculitis (PAN, Takayasu)

  · Endocrine: Pheochromocytoma, Conn’s syndrome, Cushing’s, hyperparathyroidism, acromegaly, myxedema

  · Renal: Renal artery stenosis, glomerulonephritis, pyelonephritis, polycystic kidneys, diabetic nephropathy

  · Miscellaneous: Drugs (OCPs, steroids), toxemia of pregnancy

 

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Clinical Picture

 

Uncomplicated Hypertension

 

· Often asymptomatic (“silent killer”)

· Symptoms: headache, tinnitus, dizziness, epistaxis, palpitations

· Signs:

  · BP elevation

  · Pulse: increased volume in systolic HTN, diminished in diastolic HTN

  · Pulsus alternans (LV strain)

  · Retinopathy (Keith-Wagener classification)

  · Cardiac: heaving apex, ↑S2, ejection click, S4 gallop

 

Complicated Hypertension

 

· CNS: TIA, stroke, cerebral hemorrhage, hypertensive encephalopathy

· Eyes: Hypertensive retinopathy (Grades I–IV)

· Cardiac: LVH, heart failure, coronary artery disease, arrhythmias

· Vascular: Atherosclerosis, aortic dissection, hemorrhage

· Renal: Proteinuria, hematuria, renal failure

· Accelerated/Malignant HTN: Diastolic > 130 mmHg + retinopathy Grade III/IV