Hypertension

Hypertension is directly or indirectly responsible for 10-15 of all deaths. This is uncommon below 20 years.

Hypertension is said to be present when diastolic  pressure is consistently above 90 mm Hg in persons bellow 50 years and above 100 mm of Hg in this above 50 and above 105 mm of hg in this above 70.

Types of hypertension:

1. Benign hypertension: Hypertension without features of malignant       hypertension.

2. Malignant hypertension: A very high diastolic pressure usually more than 130 mm. of hg.

3. Paroxysmal hypertension: The blood pressure remains normal in between

paroxysmal rise.

4. Systolic hypertension: Diastolic pressure is normal and systolic pressure is raised.

Factors unfavourably influencing prognosis:  

(1) Male

(2) Early age of onset

(3) High diastolic and systolic pressure

(4) Positive family history

(5) Level of blood lipids

(6) Glucose intolerance and

(7) Smoking.

Precipitating factor

1. Obesity: This associated with increased intralasenlar  volum and high output.                                                                                                                                                                    

2. Smoking

3. Polycy thaemia

4. NSAIDs

Retinal changes in hypertension:

These are graded as follows.

1. Arterial narrowing with irregularity.

2. More marked narrowing and arteriovenous nicking.

3. Flame shaped (Superficial haemorrhage) or circuler haemorrege and cotton wool exudates.

4. This above and papilloedema.

The indications are:  

1. Hypertension under 30 yrs of age.

2. Accelerated hypertension.

3. Rapidly deteriorating renal function.

4. History of renal pain or renal trauma.

5.Presence of renal bruit.

Malignant hypertension:

Both primary and secondary hypertension may become malignant. Symptoms are almost always present. These are headache, dyspnoea, blurring of vision .

Usually over 40 . Most cases of malignant hypertension below the age of 30 are due to renal parenchymal disease.

This may be lower in children. Without treatment mortality during first year 80% and during second year 100% .

Indication for treatment:

1. Al patients with diastolic pressure above 100 mm Hg.

2. Patients below the age of 65 with diastolic pressure between 90-100 mm

Hg if associated with obesity , smoking .  diabetes , blood lipid abnormality.

3. Patients in category 2 having no risk factor should be kept under observation.

 Treatment:

1. Adequate rest and physical a activity in moderation.

2. Restrict salt, Stop smoking, reduce weihght. Treat associated diseases. Remove removable causes wherever possible. Withdraw oral pills.

3. Drug treatment for the rest of the patients .About half the patient can be controlled with one drug, one phird with two and the rest may require three or more.