This document defines essential hypertension and provides a classification of blood pressure levels according to the JNC-7 report. It also outlines the causes, initial investigations, complications, and treatment of hypertension. Hypertension is classified as normal, prehypertensive, or hypertensive stage 1 or 2 based on systolic and diastolic blood pressure levels. Lifestyle modifications and drug treatments including diuretics, beta-blockers, ACE inhibitors, ARBs, and calcium channel blockers are recommended depending on the hypertension stage. Hypertensive crisis requires urgent treatment with intravenous drugs to lower blood pressure and prevent complications affecting the heart, brain, kidneys, and other organs.

1. Essential Hypertension
Prof. Samir S. al- msalha

2. Definition
Persistent elevation of BP
( ≥ 140/90 mmHg)

3. Classification of BP According to
JNC – 7 report
Normal ≤ 120 mmHg systolic and ≤ 80
mmHg diastolic
 Prehypertention 120 -139 mm Hg systolic
and 80-90mm Hg diastolic
 Stage -1 Hypertension 140-159 mmHg
systolic and 90- 99 mmHg diastolic
 Ssage -2 Hypertention ≥ 160 mmHg
systolic and ≥ 100 mmHg diastolic


4. BP
classification
Life style
Without compelling
modification indication
With
compelling
indication
Normal
encourage
Prehypertension
yes
No anti-HTN drugs
Drug(s) for the
compelling
indication
Stage 1 HTN
yes
Thiazide-diuretics for
most; may consider
ACE,ARB,
B-blockers,CCB,or
combination
Drug(s)for the
compelling
indicatios
( thiazides,
ACEI,CCB,ARB,
B-blocker)
Stage 2 HTN
yes
2-drug combination
for most
(thiazide,ACEI or ARB
or B-blocker or CCB)
Drug(s) for the
compelling
indications
( thiazides,
ACEI, ARB, Bblocker, CCB)
as indicated

5. CAUSES
Essential Hypertention (95 %)
 Secondary ( 5%)
1. DRUGS( steroids , Contraceptive
pills,NSAIDS,carbenoxolone,Liquorice,
sympathomimetics)
2. Cardiovascular (Coarctation of the aorta)
3. Renal (Renovascular i.e RAS and renal
artery occlusion or Parenchymal i.e ch.
Pyelonephritis,acute and
ch.glomeronephritis,obstructive
uropathy,polycystic kidney disease and
hypernephromas.


6. CAUSES
4.Endocrine: ( pheochromocytoma,
1 aldosteronism, cushing’s,acromegaly,
hyperparathyroidism and hypothyroidism).
5.Others
(brain tumors with increased intracranial
pressure,bulbar poliomyelitis,connective tissue
disorders i.e SLE and polyarteriti nodosa,DM
nephropathy,Polycythemia rubra vera)

7. INITIAL or PRIMARY INVESTIGATIONS
in HYPERTENSION









Urinalysis
Renal profile
ECG
Chest x-ray
Plain U-T x-ray or renal ultrasound
Urine culture
HB, PCV
FBS,s.lipids,s.urate
Echocardiography

8. When to investigate for a
secondary cause of hypertension
1.
2.
3.
4.
Clues from the history
Clues from physical examination
Clues from initial investigations
Malignant stage hypertension

9. Complications of hypertension
Cardiovascular(angina,MI,LVH,HF,dissecting
aortic aneurysm)
 Cerebrovascular(TIA,Thrombotic
infarction,intracerebral
hemorrhge,encephalopathy)


Peripheral vascular
disease(atherosclorosis,intermittent
claudication, gangrene)
 Retinopathy(Grades1,2,3,4)
 Nephropathy(nephrosclerosis,fibrinoid necrosis)
 Malignant hypertension

10. Treatment of hypertension
1st. Non-pharmacological measures:
1. Diet
2. Weight reduction
3. Stopping smoking and excess alcohol
consumption
4. Regular exercise ( behavioral,
biofeedback therapy)
5. Treatment of other associated risk
factors

11. B. Antihypertensive medications:
1. Diuretics
Thiazide, loop, K+ sparing
2. B-Blockers
Non-cardioselective
Cardioselective
Drugs with ISA
Alpha and Beta-blockers(labetolol)

12. 3. Alpha-blockers ( prazosin)
4. Central acting drugs (reserpine,
methyldopa,clonidine)
5. vasodilators:
1st. Direct relaxation of arteriolar smooth
muscle:
-Hydralazine
-Minoxidil
-Diazoxide
-Na-nitroprusside

13. 2nd. Calcium-channel blockers:
- Verapamil
- Nifedipine
- Amlodipine
3rd. ACE inhibitors :
- Captopril
- Enalapril
- Lysinopril
- Quinapril

14. 6. ARBs
- Losartan
- Candesartan
- Irbisartan
- Valsartan

15. Hypertensive Crisis:
Severe hypertension with one of the
following:
1. Heart failure
2. MI
3. Renal failure
4. Encephalopathy
5. Dissecting aneurysm
6. Intracerebral hemorrhage
7. Accelerated or malignant hypertension

16. Parentral Drugs Used In
Hypertensive Emergencies:
Na-nitroprusside infusion
2. Diazoxide i.v
3. Hydralazine iv
4. Furosemide i.v
5. Phentolamine i.v
6. Nifedipine s/L
7. Labetolol i.v
( N.B: B.P shouldn’t be reduced to below
diastolic of 100 mmHg )
1.