Causes and Management of hypertension


Define hypertension : Persistent rise of blood pressure above the upper limit of normal level according to the age and sex of the patient.

We have described in article :

Causes of hypertension

Symptomsof hypertension

Signs of hypertension

Investigations of hypertension

Treatment of hypertension

Complication of hypertension


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.
  1. Endocrine disease:
  • Pheochromocytoma.
  • Cushing’s syndrome.
  • Conn’s syndrome.
  • Hyperparathyroidism.
  • Primary hypothyroidism.
  1. Drugs:   a) Oral contraceptives containing oestrogen.b) Corticosteriods.c) NSAIDs.
  2. Alcohol.
  3. Obesity.
  4. 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.

  1. 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.
  1. 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.
  1. Angiotensin converting enzyme inhibitors (ACE-I): 
  • Captopril 25-75mg 12 hourly.
  • Ramipril 5-10mg daily.
  1. Angiotensin-II recptor blockers: Similar effects as ACE-I
  • Losartan 50-100mg daily.
  • Valsartan 40-160mg daily
  1. Calcium antagonists:
  • Amlodipine 5-10mg daily.
  • Nifedipine 30-90mg daily.
  1. 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.


1 Response

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