Hypertension

Hypertension is a serious disease which may be asymptomatic. According to JNC-7 normal blood pressure is 120/80 mmHg and a blood pressure equal to or more than 140 mmHg systolic and 90 mmHg diastolic is hypertension.

• Etiology is unknown in 90 – 95% cases.
• Greater than normal tension or tone.

2. In adults, a condition in which the blood pressure (BP) is higher than 140 mm Hg systolic or 90 mm Hg diastolic on three separate readings recorded several weeks apart.

Normal blood pressure: systolic <120 mmHg and diastolic <80 mmHg Prehypertension: systolic 120-139 mmHg or diastolic 80-89 mmHg Hypertension:

•         Stage 1: systolic 140-159 mmHg or diastolic 90-99 mmHg Stage 2: systolic ≥ 160 or diastolic ≥ 100 mmHg

Optimal blood pressure: systolic <120 mmHg and diastolic <80 mmHg Normal: systolic 120-129 mmHg and/or diastolic 80-84 mmHg High normal: systolic 130-139 mmHg and/or diastolic 85-89 mmHg Hypertension:

•         Grade 1: systolic 140-159 mmHg and/or diastolic 90-99 mmHg Grade 2: systolic 160-179 mmHg and/or diastolic 100-109 mmHg Grade 3: systolic ≥ 180 mmHg and/or diastolic ≥ 110 mmHg Isolated systolic hypertension: systolic ≥ 140 mmHg and <90 mmHg

Arterial pressure is regulated by :

• Peripheral and central adrenergic systems .-
• Renal
• Hormonal
• Vascular factors

1. Average prevalence is >50% in non-whites.
2. Frequency of hypertension is more in men.
3. In females, prevalence increases after age of 50 years.
4. In the upper class of society blood pressure increases with age.

• Essential Hypertension is arterial hypertension with no definable cause.

Secondary hypertension :

• When a specific organ or defect is responsible for hypertension, it is called secondary hypertension. The causes are many, in­volving different organs.

Classification of arterial hypertension

1 Systolic hypertension with wide pulse pressure

• Arteriosclerosis
• AR
• Thyrotoxicosis Hyperkinetic circulation Fever
• AV fistula
• PDA

2. Systolic and diastolic hypertension

•  Renal causes
  • Chronic pyelonephritis
  • Acute and chronic glomerulonephritis
  • Polycystic renal disease
  • Renovascular stenosis
• Arteriolar nephrosclerosis Diabetic nephropathy
• Renin producing tumors
•  Endocrinalcauses ‘e
  • Oral contraceptives
• Adrenocortical hyperfunction
  • Cushing’s disease and syndrome
  • Primary hyperaldosteronism
  • Congenital or hereditary adreno geni­tal syndromes
• Pheochromocytoma
• Myxedema
• Acromegaly
•  Neurogenic causes
  • Psychogenic
• b Familial dysautonomia (Riley-Day syn­drome)
  • Increased intracranial pressure
•  Miscellaneous causes
  • Coarctation of aorta
  • Polyarteritis nodoses
  •  Hypercalcemia
  • Drugs like glucocorticoids, cyclosporine
•  Unknown etiology
• • Essential hypertension
  • Toxaemia of pregnancy
  • Acute intermittent porphyria