CLINICAL ASPECTS OF HYPERTENSION APPROACH TO THE PATIENT WHEN HYPERTENSION IS SUSPECTED, BP SHOULD BE MEASURED AT LEAST TWICE DURING TWO SEPARATE EXAMINATIONS AFTER INITIAL SCREENING

OPTMAL <120<80 NORMAL <130<85 HIGH NORMAL HYPERTENSION STAGE HYPERTENSION STAGE HYPERTENSION STAGE 3 >180>110 ISOLATED HYPERTENSION >140<90 CATOGORYSBPDBP

SIGNS & SYMPTOMS MOST PATIENTS HAVE NO SIGNS & SYMPTOMS. WHEN SYMPTOMS ARE PRESENT THEY FALL INTO THREE CATEGORIES 1. SYMPTOMS RELATED TO ELEVATED BP 2. SYMPTOMS RELATED TO HYPERTENSIVE VASCULAR DISEASE 3. SYMPTOMS RELATED TO UNDERLYING DISEASE, IN THE CASE OF SECONDARY HYPERTENSION

1. SYMPTOMS RELATED TO ELEVATED BP HEADACHE – LOCALISED TO OCCIPITAL REGION DIZZINESS EASY FATIGABILITY PALPITATIONS

2. SYMPTOMS RELATED TO VASCULAR DISEASE EPISTAXIS BLURRING OF VISION EPISODES OF DIZZINESS ANGINA PECTORIS DYSPNOEA – DUE TO CARDIAC FAILURE

3. SYMPTOMS RELATED TO UNDERLYING DISEASE POLYURIA, POLYDYPSIA, MUSCLE WEEKNES - IN PATIENTS WITH PRIMARY ALDOSTERONISM WEIGHT GAIN – IN PATIENTS WITH CUSHINGS SYNDROME EPISODIC HEADACHE, PALPITATIONS, POSTURAL DIZZINESS – IN PATIENTS WITH PHEOCHROMOCYTOMA

HISTORY FAMILY H/O HYPERTENSION IS VERY IMPORTANT SINCE IT TENDS TO RUN IN FAMILIES HABITS – SMOKING, ALCOHOL COMSUMPTION DIET – HIGH SALT COMSUMPTION H/O 1.REPEATED UTI – AS SEEN IN CHRONIC PYLONEPHRITIS 2. WT GAIN AS IN CUSHINGS SYNDROME 3. WT LOSS AS IN PHEOCHROMOCYTOMA ALL RESULTS IN SECONDARY HYPERTENSION.

PHYSICAL EXAMINATION GENERAL APPEARANCE FUNDOSCOPIC FINDINGS EXAMINATION OF HEART ABDOMINAL EXAMINATION COMPARE BP AND PULSE IN TWO UPPER EXTREMETIES AND IN SUPINE AND STANDING POSITIONS

LAB INVESTIGATIONS E C G URINE ANALYSIS SERUM CHOLESTEROL SERUM K +, Ca 2+

SPECIAL TEST TO RULE OUT SECONDARY HYPERTENSION RENOVASCULAR DISEASE – DOPPLER FLOW STUDIES PHEOCHROMOCYTOMA – 24 HR URINE ANALYSIS FOR CREATININE CUSHINGS SYNDROME - 24 HR URINE ANALYSIS FOR CREATININE & CORTISOL PRIMARY ALDOSTERONISM – PLASMA ALDOSTERONE

MANAGEMENT I NON PHARMACOLOGICAL THERAPY IF SBP < 140 mmHg DBP < 90 mm Hg IT INCLUDES WT REDUCTION, BMI <25 Kg /m 2 LOW FAT & SATURATED FAT DIET LOW SODIUM DIET < 6 gms DAILY LIMITED ALCOHOL CONSUMPTION DYNAMIC EXERCISE INCREASED FRUIT & VEGETABLE CONSUPTION DECREASED SMOKING II DRUG THERAPY

EFFECTS OF HYPERTENSION 1ON CVS –CARDIAC ENLARGEMENT –MI –CCF 2ON EYES –RETINAL EXUDATES AND HAEMORROHAGES –PAPILLEDEMA 3ON KIDNEYS -- IMPAIRED RENAL FUNCTIONS 4ON NERVOUS SYSTEM -- CEREBROVASCULAR ACCIDENT