Name: Onifade Opeoluwa Bisola

Hypertension
•Systemic hypertension: defined as persistently
elevated systolic and or diastolic blood pressure ≥
140 &/or 90mm respectively one or more
occasions at least four hours apart •Isolated
systolic hypertension: is a persistently elevated
SBP ≥ 140mmHg while DBP remains normal <90
mmHg

Categories of blood pressure :

1. British Guidelines (NICE - National Institute

for Health and Care Excellence)

• Optimal: SBP <120 mmHg and DBP <80

mmHg
 • Normal: SBP 120–129 mmHg and DBP
80–84 mmHg

• High-normal: SBP 130–139 mmHg and

DBP 85–89 mmHg

• Grade 1 Hypertension: SBP 140–159

mmHg or DBP 90–99 mmHg

• Grade 2 Hypertension: SBP 160–179

mmHg or DBP 100–109 mmHg

• Grade 3 Hypertension: SBP ≥180 mmHg

or DBP ≥110 mmHg

2. American Heart Association (AHA)

Guidelines

• Normal: SBP <120 mmHg and DBP <80

mmHg

• Elevated: SBP 120–129 mmHg and DBP

<80 mmHg
 • Stage 1 Hypertension: SBP 130–139
mmHg or DBP 80–89 mmHg

• Stage 2 Hypertension: SBP ≥140 mmHg

or DBP ≥90 mmHg

3. World Health Organization (WHO)

WHO adopts a classification similar to the British

and AHA systems, recognizing that hypertension
can vary globally due to population and
environmental factors.

Classification of hypertension

Essential hypertension :
• This is high blood pressure that is
multi-factorial and doesn’t have one
distinct cause. It’s also known as
idiopathic or essential hypertension.
• It is multifactorial; genetic (40-60%)
and environmental factors.
Cause of essential hypertension include;
 1.Genetic factors
Blood pressure tends to run in families and
children of hypertensive parents tend to have
higher blood pressure than age-matched
children of parents with normal blood
pressure.
This familial concordance of blood pressure
may be explained, at least in part, by shared
environmental influ-ences. However, there still
remains a large, still largely unidentified
genetic component.
2.Fetal factors
Low birth weight is associated with
subsequent high blood pressure. This
relationship may be due to fetal adaptation to
intrauterine undernutrition with long-term
changes in blood vessel structure or in the
function of crucial hormonal systems.
3.Environmental factors: Among the several
environmental factors that have been
 proposed, the following seem to be the
most significant:
Obesity. Fat people have higher blood
pressures than thin people. There is a risk,
however, of overestimation if the blood
pressure is measured with a small cuff. Adjust
the bladder size to the arm circumference.
Sleep disordered breathing seen in obesity
may also be an additional risk factor
4.Alcohol intake: Most studies have shown a
close relationship between the
consumption of alcohol and blood
pressure level. However, subjects who
consume small amounts of alcohol seem
to have lower blood pressure level than
those who consume no alcohol.
5.Sodium intake: A high sodium intake has
been suggested to be a major determinant
of blood pressure differences between and
within populations around the
 world.Populations with higher sodium
intakes have higher average blood
pressures than those with lower sodium
intake.
Migration from a rural to an urban environment
is associated with an increase in blood
pressure that is in part related to the amount of
salt in the diet. Studies of the restriction of salt
intake have shown a beneficial effect on blood
pressure in hypertensives. There is some
evidence that a high potassium diet can
protect against the effects of a high sodium
intake.
6.Stress:While acute pain or stress can raise
blood pres-sure, the relationship between
chronic stress and blood pressure is
uncertain.
Secondary hypertension :This is high blood
pressure that is due to a disease or
medical condition. The risk factors
include:
1. - Alcohol, obesity, pregnancy
2. - renal diseases (renal vascular dx,
glomerulonephritis, PKD etc)
3. - Endocrine: thyrotoxicosis,
Cushing's syndrome, Conn's diseases,
secondary hyperaldosteronism,
congenital adrenal hyperplasia,
hyperthyroidism, acromegaly etc
4. - Drugs: OCP, estrogen, anabolic
steroids, corticosteroids,
sympathomimetics, NSAIDs,
Carbenoxolone etc
5. - Coarctation of the aorta
White coat hypertension : This is the
term for when you get a high blood
pressure reading in a doctor’s office and
a normal reading at home. The anxiety
of being around doctors in white coats
can make your blood pressure riseIt can
be ruled out by measuring the BP at
home. Most people don’t need
treatment if their blood pressure is
normal at home.
Resistant hypertension: is poorly
controlled systolic hhypertension despite
patient's compliance with optimum dose
of at least 3 classes of antihypertensives
including diuretics
Malignant Hypertension: is severe HTN
with rapidly progressuve end organ
damage (bilateral retinal hemorrhages
and exudates ± papilledema)

Pathophysiology of Hypertension
The development of hypertension is
multifactorial, involving interactions
between the cardiovascular, renal, and
neurohormonal systems.
1. Increased Peripheral Vascular
Resistance: Caused by narrowing of
arterioles due to vasoconstriction or
structural changes in blood vessel walls.
2. Overactivation of the
Renin-Angiotensin-Aldosterone System
(RAAS): Leads to vasoconstriction and
sodium/water retention.
3. Sympathetic Nervous System
Overactivity: Increases heart rate and
cardiac output, contributing to elevated
BP.
4. Endothelial Dysfunction: Reduced
nitric oxide production leads to impaired
vasodilation.
5. Genetic and Environmental
Factors: Obesity, smoking, high salt
intake, and sedentary lifestyles
contribute to hypertension
development.

Signs and Symptoms of Hypertension

1. Asymptomatic: Often detected
incidentally.
2. Mild Symptoms:
• Headaches, dizziness, and fatigue.
3. Signs of Severe Hypertension:
• Blurred vision, nosebleeds, and
palpitations.
4. Signs of End-organ Damage:
• Retinal changes (e.g.,
arteriovenous nipping, papilledema).
• Left ventricular hypertrophy (on
ECG or echocardiography).
• Renal dysfunction (elevated
creatinine or decreased GFR).

Taking a Proper History in Hypertension

1. Personal History:
• Duration and previous diagnosis of
hypertension.
• Compliance with medications and
lifestyle changes.
2. Risk Factors:
• Smoking, alcohol use, obesity,
physical activity, and salt intake.
• Family history of hypertension,
cardiovascular disease, or kidney
disease.
3. Symptoms of Secondary
Hypertension:
• History of headaches, palpitations,
sweating (pheochromocytoma).
 • History of muscle weakness,
cramps (hyperaldosteronism).
4. Medication History:
• Use of NSAIDs, steroids, or oral
contraceptives.
5. Complications:
• Symptoms of end-organ damage
(e.g., chest pain, dyspnea, or vision
changes).

Complications of Hypertension
1. Cardiovascular Complications:
• Coronary artery disease,
myocardial infarction, and heart failure.
• Aortic dissection and peripheral
artery disease.
2. Cerebrovascular Complications:
• Stroke (ischemic or hemorrhagic)
and transient ischemic attacks.
3. Renal Complications:
• Chronic kidney disease and
hypertensive nephrosclerosis.
4. Ocular Complications:
• Hypertensive retinopathy, leading
to vision loss.
5. Pregnancy-Related Complications:
• Preeclampsia and eclampsia.