Racial, genetic, life style influence: Type extent of complications (renal failure and stroke are more common in blacks). Response to dietary therapy (low salt reach fruit and vegetable diet). Antihypertensive drugs (less control with ACE inhibitor and beta blockers in blacks).

Hypertensive patient can be categorized according to their risk profile: Group a (low risk): no TOD, no other risk factors and no associated cardiovascular disease. Group b (intermediate risk): one or more additional risk factors but not diabetes or TOD. Group c (high risk): diabetes, TOD and/or associated cardiovascular disease.

CV risk factors:

TOD:

How to measure blood pressure?

Cuff size: 12 X 26cm bladder in most adults. 12 X 40cm bladder in obese (arm circumference > 33cm). 10 X 18cm bladder in thin adults or children (arm circumference < 26cm).

Before taking blood pressure the patient should: Avoid smoking, eating and coffee for at least two hours prior to measurement. Urine should be voided if necessary. Talking should be avoided five minutes before and during blood pressure measurement. Blood pressure should be measured in quiet room with comfortable temperature.

Right arm (if volume of pulse is equal in both arms). Supine or sitting (standing in special conditions). Arm should be supported. Cuff is directly to skin. Bladder is centered on brachial artery. Edge of the cuff is 3cm above the elbow.

Use palpatory method first. Inflate to 30 mmHg above pulse oclusion pressure. Use the cone of stethoscope. Cone is firmly applied over brachial artery. Cone is not touching cuff. It isn’t essential to keep manometer at heart level Repeated inflation with incomplete deflation will damp korotkov sounds.

Standing BP should be taking in: First visit evaluation. Elderly patients above 60 years. Diabetic patients. Patients with postural symptoms. Patients on potent VD or large doses of diuretics. Standing BP should be measured 2 minutes after standing.

Medical history: Previous levels of high BP and history of treatment. Symptoms of TOD. Symptoms suggestive secondary hypertension. Current drug intake (contraceptive pills, NSAI).

Medical history: Co morbid conditions (diabetes, bronchial asthma, gout, migraine, depression). Family history of diabetes, CAD, stroke or renal disease. Life style factors: salt and fat intake, smoking, physical and alcohol consumption.

Clinical examination: BP measurements. Weight and height. Peripheral, femoral pulses and neck bruits. Cardiac examination: LVH, 3 rd HS, loud 2 nd sound, ejection murmur over aortic area and AR murmur.

Clinical examination: Abdominal examination: renal mass, aortic aneurysm or bruits. Chest examination: OLD. Neurological examination: level of consciousness speech, motor power, lateralization and PN.