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Hypertension

Definition
  • > 140/90 on 2 separate equations
Risk Factors
  • Black
  • Age
  • Male
  • Smoker
  • Obesity
  • High fat diet
  • Stress
  • Anxiety
  • Lack of exercise
  • Alcohol
  • Sedentary lifestyle
  • FHx
Differential diagnosis
  • Oral contraceptives
  • Chronic kidney disease
  • Obstructive sleep apnoea
  • Anxiety
  • Stress
  • Renal artery stenosis
  • Cushing's
  • Hyperthyroidism
  • Pregnancy
  • Preeclampsia
  • Pheochromocytoma
  • White coat syndrome
Epidemiology
  • 30% general population
  • 40-45% black adults
Aetiology
  • Genetic
    • FHx
    • Decreased nephron number
  • Fetal
    • Decreased birth weight
  • Environmental
    • Stress
    • Obesity
    • Diet
  • Humoral
    • RAAS
    • Decreased salt sensitivity
    • Insulin resistance (cf diabetes)
  • Secondary causes
    • Renal disease
    • Endocrine disease
    • 8-10% pregnancy
Clinical features
  • Visual changes/blindness
  • Nosebleeds
  • Headache
  • Stroke
  • Chronic heart disease
  • Aneurysms
  • Kidney damage
  • Heart failure
Pathophysiology
  • Atheroma formation
    • Macrophage cells that contain
    • Between the endothelium lining and the smooth muscle wall central region (media) of the arterial tube
    • Macrophage cells take up LDLs
    • Classification:
      • Type I: Isolated macrophage foam cells[2][6]
      • Type II: Multiple foam cell layers[2][6]
      • Type III: Preatheroma, intermediate lesion[2][6]
      • Type IV: Atheroma[2][6]
      • Type V: Fibroatheroma[2][6]
      • Type VI: Fissured,ulcerated, hemorrhagic, thrombotic lesion[2][6]
      • Type VII: Calcific lesion[2][6]
      • Type VIII: Fibrotic lesion[2][6]
  • Causes narrowing of peripheral vessels
  • => Raised TPR
    • Causes raised BP
    • BP = CO x TPR 
Investigations
  • BP measurement
  • Blood lipids
    • TG
    • Cholesterol
    • LDL, HDL and ratio
Management

a) conservative
  • Diet
  • Exercise
  • Smoking cessation
b) medical
  • Five options
    • A = ACE inhibitors
    • B = Beta blockers
    • C = Calcium channel blockers
    • D = Thiazide-type diuretic
    • AB = Alpha blocker
  • < 55 years
    • A initially
    • Then add C or D
    • Then try all of A, C, D
    • Then add B, AB or further diuretics
  • > 55 years
    • C or D initially
    • Then add A
    • Then try all of A, C, D
    • Then add B, AB or further diuretics
c) surgical

Prognosis

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