Causes of hypertension:

A)  Primary or Essential hypertension:

1. Genetic and familial factors.
2. Socio-economic factors.
3. Diatory factors: Obesity, high salt intake, caffeine.
4. Lack of excretion and impaired intrauterine growth.
5. Hormonal factors: High renin, reduced nitric oxide.
6. Neurotransmitters: Acetylcholine, nor-Adrenaline.

B) Secondary hypertension:

1. Vascular: Coarctation of aorta.
2. Renal disease:

• Renal vascular disease.
• Parenchymal diseasae, particularly AGN, CGN.
• Polycystic Kidney disease.
• Dibetic nephropathy.

3. Endocrine disease:

• Pheochromocytoma.
• Cushing’s syndrome.
• Conn’s syndrome.
• Hyperparathyroidism.
• Primary hypothyroidism.

4. Drugs:   a) Oral contraceptives containing oestrogen.b) Corticosteriods.c) NSAIDs.
5. Alcohol.
6. Obesity.
7. Pregnancy:

• Pre-eclampsia.
• Eclampsia.

Symptoms of hypertension : 

1. Asymptomatic : Most of the cases symptoms appear after detection of hypertension.
2. Symptoms of cardiological factors : 

• Headache
• Vertigo
• Palpitation
• Polyurea
• Dizziness
• Pain in the back and neck

   3. Symptoms due to complication : 

• Anginal pain
• Breathlessness due to LVF
• Blurring of vision

   4. Family history of hypertension.

   5. Patient gives history of smoking.

   6. Prior history of renal disease.

Signs of Hypertension : 

1. Pulse : Usually normal but may have high volume.
2. Blood pressure : Raised
3. Apex beat : It is heaving  in character & displaced downwards and laterally.
4. Heart sound : Aortic component of the 2nd heart sound is loud in aortic area.
5. Added sound : Apical or aortic ejection systolic murmur.
6. If bilateral basal crepitation : Possibly due to LVF.

Investigations of Hypertensions :

1. Urine analysis for protein, glucose, RBC
2. Blood urea, electrolytes and creatinine.
3. Blood glucose to see diabetes mellitus.
4. Serum total & HDL cholesterol.
5. 12-lead ECG (To detect LVH and coronary artery disease).
6. CXR : To detect cardiomegaly, heart failure, coarctation of aorta.
7. Ambulatory BP recording: To assses borderline hypertension
8. Echocardiogram to detect LVF.
9. Renal ultrasound: to detect renal disease.
10. Renal angiography: to detect renal artery stenosis.

Treatment of Hypertension :

A) General measure:

1. Relief of stress and relaxation techniques
2. Diet

• Reduce weight.
• Avoid excess salt consumption.
• Avoid alcohol consumption.

  3. Regular physical exercise, like- walking, jogging.

4. Avoid smoking

B) Antihypertensive drugs:

1. Diuretics:

• Thiazide diuretics : Bendrofluazide 2.5mg daily or Cyclopenthiazide 0.5mg.
• Potassium sparing diuretics: Spirinolactone 50- 200mg daily.
• Loop diuretics: Frusemide 40mg daily is helpful in patient with renal and cardiac impairment.

2. Beta-adrenoceptor antagonists (B- blocker):

a) Cardio-selective drugs (B1 antagonists):

• Atenolol 50-100mg daily. Or
• Bisoprolol 5-10mg daily.

b) Non-cadio selective drugs:

• Propranolol 40 – 120mg thrice daily orally.
• Pindolol 15-30mg daily.

c) Combined alpha & Beta adrenoceptor antagonists :

• Lebetalol 200mg 2.4g daily in divided doses
• Carvedilol 6.25-25mg 12 hourly.

3. Angiotensin converting enzyme inhibitors (ACE-I): 

• Captopril 25-75mg 12 hourly.
• Ramipril 5-10mg daily.

4. Angiotensin-II recptor blockers: Similar effects as ACE-I

• Losartan 50-100mg daily.
• Valsartan 40-160mg daily

5. Calcium antagonists:

• Amlodipine 5-10mg daily.
• Nifedipine 30-90mg daily.

6. Hypertension in pregnancy:  Methyldopa is safe 250mg 2-3 times daily.

Complication of hypertension:

A. Central nervous system:

1. Stroke
2. Hypertensive encephalopathy.
3. Transient ischaemic attack (TIA).
4. Subarachnoid haemorrhage.
5. Carotid atheroma.

B. Retina:

1. Hypertensive retinopathy. 

C. Heart

1. Left ventricular failure.
2. Ischaemic heart disease (IHD).
3. Atrial fibrillation.

D. Kidney:

1. Proteinuria.

2. Progressive renal failure.