1. **Pathophysiology**
1.1. **Increased systemic vascular resistance (SVR) due to**
1.1.1. Vasoconstriction
1.1.2. Structural changes in blood vessels
1.2. **Increased cardiac output (CO):**
1.2.1. Related to volume overload or sympathetic overactivity.
1.3. **Compensatory Mechanisms and Neurohormonal Activation**
1.3.1. SNS
1.3.1.1. increases heart rate, contractility, and vasoconstriction occurs to maintain BP.
1.3.2. RAAS
1.3.2.1. Reduced renal perfusion activates RAAS, leading to Na and H2O retention to increase blood volume. Raises BP - dysregulation
1.3.3. Endothelial dysfunction: Reduced nitric oxide availability.
1.3.3.1. Reduced nitric oxide avalability
2. **Categories**
2.1. **Prehypertension** (Elevated): 120-129/<80 mmHg
2.2. **Stage 1 HTN:** 130-139/80-89 mmHg
2.3. **Stage 2 HTN:** ≥140/≥90 mmHg
2.4. **Stage 3 HTN:** ≥180/≥110 mmHg
2.5. **Malignant HTN:** Severe elevation in BP (>180/>120 mmHg) with evidence of end-organ damage (e.g., retinopathy, encephalopathy).
3. **Clinical Presentation**
3.1. Often asymptomatic (“silent Killer”)
3.2. **Sympptoms when present**
3.2.1. Headache (often occipital).
3.2.2. Palpitations
3.2.3. Dizziness
3.2.4. Fatigue
3.3. **Severe HTN (hypertensive emergency)**
3.3.1. Chest pain
3.3.2. Shortness of breath
3.3.3. Neurological deficits (stroke-like symptoms).
4. **Examination Findings**
4.1. **Vital Signs**
4.1.1. Elevated BP readings on multiple occasions.
4.2. **Cardiac exam**
4.2.1. S4 heart sound
4.2.2. Signs of heart faliure
4.3. **Vascular exam**
4.3.1. Diminished peripheral pulses (in secondary HTN).
4.3.2. Bruits (renal disease)
4.4. **Fundoscopy**
4.4.1. Hypertensive retinopathy: Arteriovenous nicking, flame hemorrhages, papilledema.
5. **Complications**
5.1. **Cardiovascular**
5.1.1. Left ventricular hypertrophy
5.1.2. Heart failiure
5.1.3. Myocardial Infarction
5.2. **Renal**
5.2.1. Chronic kidney disease (CKD),
5.2.2. Hyperrtensive neuropathy
5.3. **Cerebrovascular**
5.3.1. Stroke
5.3.2. Transient ischemic attack
5.3.3. Vascular dementia
5.4. **Ophthalmic**
5.4.1. Hypertensive retinopathy
5.4.2. Vision loss
6. **Definition**
6.1. Hypertension (HTN) is a chronic medical condition characterized by persistently elevated blood pressure (BP) above the normal range (typically ≥140/90 mmHg for adults).
7. **Etiology**
7.1. **Primary (essential) hypertension (90-95%)**
7.1.1. Idiopathic
7.1.2. Genetic
7.1.3. Age or lifestyle
7.2. **Secondary hypertension (5-10%)**
7.2.1. Renal disease - Renal artery stenosis
7.2.2. Endocrine disorders - pheochromocytoma, hyperaldosteronism
7.2.3. Medications - Corticosteroids, NSAIDs
8. **Investigations**
8.1. **Basic Tests**
8.1.1. BP measurements: Ambulatory BP monitoring.
8.1.2. Urinalysis: Proteinuria or hematuria.
8.1.3. Blood tests: Electrolytes, creatinine, lipid profile, fasting glucose.
8.2. **Advanced Tests**
8.2.1. ECG: Signs of left ventricular hypertrophy.
8.2.2. Echocardiogram: Assess cardiac function.
8.2.3. Fundoscopy: Retinal changes.
8.3. **Tests for Secondary cause**
8.3.1. Renal ultrasound
8.3.2. Plasma renin and aldosterone levels.
9. **Treatment**
9.1. **Lifestyle changes **
9.1.1. Diet: DASH diet, reduced sodium intake.
9.1.2. Exercise: Moderate aerobic activity (150 minutes/week).
9.1.3. Limit alcohol, avoid smoking.
9.2. **Medications**
9.2.1. First-line drugs
9.2.1.1. Angiotension II Receptor Blockers (losartan)
9.2.1.2. ACE Inhibitors (enalapril, lisinopril)
9.2.1.3. Diuretics (furosemide)
9.2.1.4. Calcium channel blockers (amlodipine)
9.2.2. Others
9.2.2.1. Aldosterone Antagonists (spironolactone)
9.2.2.2. Beta Blockers (metoprolol, carvedilol)
9.3. **Hypertensice emergency**
9.3.1. IV antihypertensives (labetalol, nitroprusside)
10. **Prevention/ Precautions**
10.1. **Primary **
10.1.1. Healthy Lifestyle & Stress Management
10.1.2. DASH diet
10.1.3. Regular exercise
10.1.4. Quit smoking & alcohol
10.1.5. Regular health checkups
10.2. **Secondary **
10.2.1. Early detection (regular BP monitoring).
10.2.2. Adherence to medications
10.2.3. Control comorbidities (e.g., diabetes, dyslipidemia).