Is considered when blood pressure is elevated for a chronic or long period of time.
Also seen as High blood pressure and HTN
Normal blood pressure is 140/80 and below
Too low of blood pressure is not good either – not considered hypertension
Two main categories
1.) Primary – when cause is unknown – also referred to as essential – 95% of the cases
2.) Secondary – Is when the cause is known – 5% of cases
Symptoms
• Many have no symptoms at all
• Headache
• Dizziness
• Nausea
• Heart racing
• Vision changes
Symptoms in infants
- Failure to thrive
- Irritability
- Seizures
- Lethargy
- Respiratory distress
*** - if hypertension is a secondary cause from another disease then symptoms of that disease are often present as well
Factors that play a key role include:
- Age
- Race
- Obesity
- Stress
- Smoking
- Genetics or heredity
*** Pregnancy induced hypertension can be seen and can lead to preeclampsia or eclampsia
- Is when a persons blood pressure is elevated above the normal level
- However, this level is not yet at the level to be considered hypertension.
- Systolic is between 120 and 139 mm Hg
- Diastolic is between 80 and 89 mm Hg
- When over 140/90 mm Hg – is considered hypertension
Over 50 million Americans have High Blood Pressure
- A large portion – 65-70% know they have increased blood pressure
- Around 30% are not aware of their condition.
- However, only 50% who are aware of their condition are taking medication
- And only half who take medications are under 140/90
Causes:
Essential Hypertension
- This is a very complex disorder
- By definition has no identifiable cause
- Affects 90-95% of individuals with hypertension
Risk factors:
1.) Increase Age
2.) Increase Weight (Obesity)
3.) Sedentary lifestyle
4.) Increase Alcohol intake
5.) Increase Salt intake
6.) Genetic changes
Secondary Hypertension
- Seen in only 5% of those with hypertension
1.) Endocrine diseases
- Cushings Syndrome
- Pheochromocytoma
- Hyperaldosteronism (Conn’s syndrome)
- Hyperthyroidism
- Hypothyroidism
- Acromegaly
- Hyperparathyroidism
- Others
2.) Kidney diseases
- Chronic renal failure
- Kidney disease
3.) Cancers
4.) Medication
- Alcohol
- Stimulants
- Hormonal contraception
- Nasal decongestants
- others
5.) Pregnancy
6.) Obstructive Sleep Apnea
7.) Neurological disorders
8.) others
Some major complications of hypertension are:
1. Stroke
2. Coronary Heart Disease
3. End-stage Renal Failure
4. Heart Failure
5.) Arterial Aneurysms
Blood pressure is the pressure of blood itself against the arteries
Similar to the pressure it takes to blow up a balloon.
The difference is that blood is always moving and the air inside a balloon is contained
Two numbers measure blood pressure:
1. Systolic pressure
2. Diastolic pressure
Systolic – measures cardiac output
Diastolic – measures arterial resistance
Resistant Hypertension
This is a difficult portion of this disease.
It is seen when someone with hypertension is still uncontrolled even though 3 or more medications are being used.
Only a small amount of those with hypertension will develpe this “resistance”
Exercise Hypertension
Elevated blood pressure only during exercise
The spike is often seen in the Systolic pressure which can exceed 250 mm Hg
Diagnosis often occurs when systolic goes above 200 mm Hg and medication is required when above 220 mm Hg
Treatment
Diuretics for those with:
• Heart Failure
• Coronary Heart Disease
• Diabetes Mellitus
• Stroke risk
Thiazide
• Hydrochlorothiazide
• Metolazone
• Chlorthilidone
- Block sodium respoorption in cortical diluting segment – at terminal point of loop of Henle.
- Become ineffective when GFR goes below 30-40 mL/min
Loop Diuretics
• Furosemide
• Bumetanide
• Torsemide
- Inhibit chloride reabsorption in ascending limb of the loop of Henle
Potassium-Sparing agents
• Spironolactone
• Triamterene
• Eplerenone
• Amiloride
- Can be used in combo with Loop diuretics and Thiazides
- Triameterene and Amiloride work in distual tubule to limitpotassium secretion
- Spironolactone inhibits aldosterone – which is often elevated in Congestive Heart Failure (CHF)
- Eplerenone is used for post MI cases (heart attacks)
Beta-Blockers for those with:
• Heart Failure
• Past history of Myocardial Infarction
• Coronary Heart Disease
• Diabetes Mellitus
Beta Blockers
• Acebutolol (Sectral)
• Atenolol (Tenormin)
• Betaxolol (Kerlone
• Bisoprolol & HCTZ (Ziac)
• Carteolol (Cartrol)
• Carvedilol (Coreg)
• Labetalol (Normodyne, Trandate)
• Metoprolol (Lopressor, Toprol XL)
• Nadolol (Corgard)
• Penbutolol (Levatol)
• Pindolol (Visken)
• Propranolol (Inderal)
• Timolol (Blocadren)
ACE Inhibitors for those with:
• Heart Failure
• Past history of Myocardial Infarction
Coronary Heart Disease
• Diabetes Mellitus
• Chronic Kidney Disease
• Stroke risk
• Benazepril (Lotension)
• Captopril (Capoten)
• Enalapril (Vasotec)
• Fosinopril (Monopril)
• Lisinopril (Prinivil, Zestril)
• Moexipril (Univasc)
• Perindopril (Aceon)
• Quinapril (Accupril)
• Ramipril (Altace)
• Trandolapril (Mavik)
- Block the rennin-angiotension-aldosterone system
- Reduce deaths by 20% with those who have symptoms of Heart failure
ARBs for those with:
• Heart Failure
• Diabetes Mellitus
• Chronic Kidney Disease
Angiotension II Receptor Blockers
• Candesartan (Atacand)
• Eposartan (Teveten)
• Irbesartan (Avapro)
• Losartan (Cozaar)
• Olmesartan (Benicar)
• Telmisartan (Micardis)
• Valsartan (Diovan)
Combinations
• Eposartan + HCTZ (Teveten HCTZ)
• Irbesartan + HCTZ (Avalide)
• Losartan + HCTZ (Hyzaar)
• Olmesartan + HCTZ (Benicar HCT)
• Telmisartan + HCTZ (Micardis HCT)
• Valsartan + HCTZ (Diovan HCT)
CCB for those with:
• Diabetes Mellitus
• Chronic Kidney Disease
Calcium Channel Blocker
Nondihydropyridine Agents
• Diltiazem (Cardizem, Dilacor, Tiazac)
• Verapamil (Calan, Ssoptin, Verelan, Covera)
Dihydropyridines
• Amlodipine (Norvasc)
• Felodipine (Plendil)
• Isadipine (DynaCirc)
• Nicardipine (Cardene)
• Nifedipine (Adalat, Procardia)
• Nisoldipine (Sular)
Alpha-Adrenoceptor Blockers
• Prazosin (Minipress)
• Terazosin (Hytrin)
• Doxazosin (Cardura)
Central Sympatholytics
• Cloidine (Catapres, Wytensin, Tenex, Aldomet)
• Guanfacine (Tenex)
• Guanabenz (Wytensin)
• Methyldopa (Aldomet)
Peripheral Neuronal Antagonists
• Reserpine (Serpasil)
Aldosterone Antagonists for those with:
• Heart Failure
• Past history of Myocardial Infarction
The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: The JNC 7 report in JAMA 2003; 289:2560
Diet
The Dietary Guidelines for Americans reports adults should not consume more than 2,400 milligrams of sodium daily.
It is believed that foods high in Omega – 3 – Fatty acids can help hypertension
Calcium and Magnesium may be helpful
Increase Fruits and Vegetables
Increase low-fat dairy products
Drugs for Hypertensive Emergiencies
• Nitroprusside [ Nipride]
• Nitroglycerin
• Labetalol [Normodyne, Trandate]
• Esmolol [Brevibloc]
• Nicardipine [Cardene]
• Nifedipine [ Adalat, Procardia]
• Clonidine [Catapres]
• Captopril [Capoten}
• And others