Hello my fellow steemians, welcome to my new post in health series where i will be discussing common health problems prevalent in our communities.
Today we will be discussing about Hypertension- 'Hypertension is a condition in which arterial BP is chronically elevated. BP occurs within a continuous range, so cutoff levels are defined according to their effect on patients’ risk.'
AETIOLOGY
In more than 95% of cases, a specific underlying cause of hypertension cannot be found. Such patients are said to have essential hypertension. The pathogene- sis of this is not clearly understood. Many factors may contribute to its development, including renal dys- function, peripheral resistance vessel tone, endothelial dysfunction, autonomic tone, insulin resistance and neurohumoral factors. Hypertension is more common in some ethnic groups, particularly Black Americans and Japanese, and approximately 40–60% is explained by genetic factors. Important environmental factors include a high salt intake, heavy consumption of alco- hol, obesity, lack of exercise and impaired intrauterine growth. There is little evidence that ‘stress’ causes hypertension.
CAUSES OF SECONDARY HYPERTENSION
.alcohol
.obesity
.Pregnancy (pre-eclampsia)
renal disease
• Renal vascular disease
• Parenchymal renal disease, particularly glomerulonephritis • Polycystic kidney disease
Endocrine disease
• Phaeochromocytoma
• Cushing’s syndrome
• Primary hyperaldosteronism (Conn’s syndrome) • Glucocorticoid-suppressible hyperaldosteronism • Hyperparathyroidism
• Acromegaly
• Primary hypothyroidism
• Thyrotoxicosis
• Congenital adrenal hyperplasia due to 11-β-hydroxylase
or 17α-hydroxylase deficiency
• Liddle’s syndrome
• 11-β-hydroxysteroid dehydrogenase deficiency
drugs
• e.g. Oral contraceptives containing oestrogens, anabolic steroids, corticosteroids, NSAIDs, carbenoxolone, sympathomimetic agents
Coarctation of the aorta
HYPERTENSION: INVESTIGATION OF ALL PATIENTS
• Urinalysis for blood, protein and glucose
• Blood urea, electrolytes and creatinine
Hypokalaemic alkalosis may indicate primary
hyperaldosteronism but is usually due to diuretic therapy
• Blood glucose
• Serum total and HDL cholesterol
• 12-lead ECG (left ventricular hypertrophy, coronary artery
disease)
HYPERTENSION: investigation of selected patients
• Chest X-ray: to detect cardiomegaly, heart failure, coarctation of the aorta
• Ambulatory BP recording: to assess borderline or ‘white coat’ hypertension
• Echocardiogram: to detect or quantify left ventricular hypertrophy
• Renal ultrasound: to detect possible renal disease
• Renal angiography: to detect or confirm presence of renal
artery stenosis
• Urinary catecholamines: to detect possible
phaeochromocytoma
• Urinary cortisol and dexamethasone suppression test: to
detect possible Cushing’s syndrome
• Plasma renin activity and aldosterone: to detect possible
primary aldosteronism
BENEFIT OF ANTIHYPERTENSIVE DRUG THERAPY
‘Diuretics or β-blockers have been shown to reduce the risk of coronary heart disease by 16%, stroke by 38%, cardiovascular death by 21% and all causes of mortality by 13%. The effects of ACE inhibitors and calcium antagonists are similar. NNTB varies greatly according to the absolute baseline risk of cardiovascular disease.’
HYPERTENSION IN OLD AGE
• Prevalence: affects more than half of all people over the age of 60 (including isolated systolic hypertension).
• risks: hypertension is the most important risk factor for MI, heart failure and stroke in older people.
• Benefit of treatment: absolute benefit from antihypertensives is greatest in older people (at least up to age 80 years).
• target BP: similar to that for younger patients.
• tolerance of treatment: antihypertensives are tolerated as
well as in younger patients.
• drug of choice: low-dose thiazides, but in the presence
of coexistent disease (e.g. gout, diabetes) other agents may be more appropriate.
OPTIMAL TARGET BLOOD PRESSURES DURING ANTIHYPERTENSIVE TREATMENT: BHS GUIDELINES
Clinic measurements
no diabetes
< 140/85
diabetes
< 130/80
mean day-time ambulatory < 130/80 < 130/75 or home measurement
n.B. Both systolic and diastolic values should be attained.
Reference and Sources:- Davidson's principle of medicine 26/e
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