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