1. Essential Hypertension
Prof.Abdullah Saadeh

2. Definition
Persistent elevation of BP
( ≥ 140/90 mmHg)

3. Classification of BP According to JNC – 7 report
Normal ≤ 120 mmHg systolic and ≤ 80 mmHg diastolic
Prehypertention mm Hg systolic and 80-90mm Hg diastolic
Stage -1 Hypertension mmHg systolic and mmHg diastolic
Ssage -2 Hypertention ≥ 160 mmHg systolic and ≥ 100 mmHg diastolic

4. Life style modification Without compelling indication
BP classification
Life style modification
Without compelling indication
With compelling indication
Normal
encourage
Prehypertension
yes
No anti-HTN drugs
Drug(s) for the compelling indication
Stage 1 HTN
Thiazide-diuretics for most; may consider ACE,ARB,
B-blockers,CCB,or combination
Drug(s)for the compelling indicatios
( thiazides, ACEI,CCB,ARB,B-blocker)
Stage 2 HTN
2-drug combination for most (thiazide,ACEI or ARB or B-blocker or CCB)
Drug(s) for the compelling indications
( thiazides, ACEI, ARB, B-blocker, CCB) as indicated

5. CAUSES Essential Hypertention (95 %) Secondary ( 5%)
DRUGS( steroids , Contraceptive pills,NSAIDS,carbenoxolone,Liquorice,
sympathomimetics)
2. Cardiovascular (Coarctation of the aorta)
3. Renal (Renovascular i.e RAS and renal artery occlusion or Parenchymal i.e ch. Pyelonephritis,acute and ch.glomeronephritis,obstructive uropathy,polycystic kidney disease and hypernephromas.

6. CAUSES 4.Endocrine: ( pheochromocytoma, 5.Others
1° aldosteronism, cushing’s,acromegaly, hyperparathyroidism and hypothyroidism).
5.Others
(brain tumors with increased intracranial pressure,bulbar poliomyelitis,connective tissue disorders i.e SLE and polyarteriti nodosa,DM nephropathy,Polycythemia rubra vera)

7. INITIAL or PRIMARY INVESTIGATIONS in HYPERTENSION
Urinalysis
Renal profile
ECG
Chest x-ray
Plain U-T x-ray or renal ultrasound
Urine culture
HB, PCV
FBS,s.lipids,s.urate
Echocardiography

8. When to investigate for a secondary cause of hypertension
Clues from the history
Clues from physical examination
Clues from initial investigations
Malignant stage hypertension

9. Complications of hypertension
Cardiovascular(angina,MI,LVH,HF,dissecting aortic aneurysm)
Cerebrovascular(TIA,Thrombotic infarction,intracerebral hemorrhge,encephalopathy)
Peripheral vascular disease(atherosclorosis,intermittent claudication, gangrene)
Retinopathy(Grades1,2,3,4)
Nephropathy(nephrosclerosis,fibrinoid necrosis)
Malignant hypertension

10. Treatment of hypertension
1st. Non-pharmacological measures:
1. Diet
2. Weight reduction
3. Stopping smoking and excess alcohol consumption
4. Regular exercise ( behavioral, biofeedback therapy)
5. Treatment of other associated risk factors

11. B. Antihypertensive medications:
1. Diuretics
Thiazide, loop, K+ sparing
2. B-Blockers
Non-cardioselective
Cardioselective
Drugs with ISA
Alpha and Beta-blockers(labetolol)

12. 3. Alpha-blockers ( prazosin)
4. Central acting drugs (reserpine, methyldopa,clonidine)
5. vasodilators:
1st. Direct relaxation of arteriolar smooth muscle:
-Hydralazine
-Minoxidil
-Diazoxide
-Na-nitroprusside

13. 2nd. Calcium-channel blockers:
- Verapamil
- Nifedipine
- Amlodipine
3rd. ACE inhibitors :
- Captopril
- Enalapril
- Lysinopril
- Quinapril

14. 6. ARBs
- Losartan
- Candesartan
- Irbisartan
- Valsartan

15. Hypertensive Crisis: Severe hypertension with one of the following:
Heart failure MI
Renal failure
Encephalopathy
Dissecting aneurysm
Intracerebral hemorrhage
Accelerated or malignant hypertension

16. Parentral Drugs Used In Hypertensive Emergencies:
Na-nitroprusside infusion
Diazoxide i.v
Hydralazine iv
Furosemide i.v
Phentolamine i.v
Nifedipine s/L
Labetolol i.v
( N.B: B.P shouldn’t be reduced to below diastolic of 100 mmHg )