HYPERTENSION

Case 35

CASE 35
A 56 years old man comes in for routine health maintenance visit. He is saw to your
practice and has no specific complaints today. He has hypertension for which he takes
hydrochlorothiazide, and he occasionally takes an aspirin because someone told him
that it was good for him. He has no other significant medical history. He does not smoke
cigarettes, occasionally drinks alcohol, and does not exercise. His father died of a heart
attack at age 60 years and his mother died at age 72 years of cancer. He has two
younger sisters who are in good health. On examination, his blood pressure is 130/80
mmhg and his pulse is 75 bpm. He is 6 ft tall and weight 200 lb. His complete physical
examination is normal. You order a fasting lipid panel, which subsequently return with
the following result. Total cholesterol 242 mg/dl, triglycerides 138 mg/dl, high-density
lipoprotein (hdl) cholesterol 48 mg/dl, and low-density lipoprotein (ldl) cholesterol 155
mg/dl

TALKING NOTES

SURNAME : NONE

FIRST NAMES : NONE

AGE

MARITAL STATUS : MARRIED

: 56

OCCUPATOIN : NONE
PRESENT COMPLAINT : no specific complaints today
O/E
General condition, 6 ft tall, 200 lb
ENT
NAD
RS
NAD
CVS
Pulse : 75, blood preasure : 130/80
GIS
NAD
GUS
NAD
CNS
NAD

IMMEDIATE PAST HISTORY

no significant medical history
POINT OF NOTE
His father died cause heart attack
His mother died cause cancer
DIAGNOSIS
Hypertension with hypercholesterolemia

KEYWORDS
A 56 years old man
No specific complaints today
He has hypertension
He takes hydroc
He occasionally takes an aspirin
He has no other significant medical history.
He does not smoke cigarettes
Occasionally drinks alcohol
Does not exercise
His father died of a heart attack
And his mother died cause cancer
Complete physical examination is normal
Vital sign : blood pressure is 130/80 mmhg and his pulse is 75 bpm
He is 6 ft tall and weights 200 lb
Total cholesterol 242 mg/dl; triglycerides 138 mg/dl; hight-density lipoprotein (hdl) cholesterol 48 mg/dl; adn low-density lipoprotein

(ldl) cholesterol 155 mg/dl.

DEFINITION
Hypertension was defined as persistent blood pressure
where systolic pressure above 140 mmHg and a diastolic
pressure above 90 mmHg. In the elderly population,
hypertension is defined as systolic pressure of 160 mmHg
and a diastolic pressure of 90 mmHg (Sheps, 2005).

ETIOLOGY
Primary (essential) hypertension
For most adults, there's no identifiable cause of high
blood pressure. This type of high blood pressure, called
essential hypertension or primary hypertension, tends to
develop gradually over many years.

ETIOLOGY
Secondary hypertension
Some people have high blood pressure caused by an underlying condition. This type of high blood pressure, called

secondary hypertension, tends to appear suddenly and cause higher blood pressure than does primary hypertension.
Various conditions and medications can lead to secondary hypertension, including:
Kidney problems
Adrenal gland tumors
Thyroid problems

Certain defects in blood vessels you're born with (congenital)

Certain medications, such as birth control pills, cold remedies, decongestants, over-the-counter pain relievers and some

prescription drugs
Illegal drugs, such as cocaine and amphetamines
Alcohol abuse or chronic alcohol use
Obstructive sleep apnea

RISK FACTOR
Hectic and stress filled life style
Unhealthy food habits
Obesity
Excessive consumption of liquors
Smoking
Over consumption of tea/coffee
Insufficient rest and sleep
Metabolic disorders

Hardening of the arteries

Excessive use of pain killers and other strong medicines
Genetic disorders
Over consumption of oily food and fast food
High salt intake
Emotional and Physical stress
Family history of hypertension

CLINICAL MANFIESTASION
High blood pressure (HBP) it self usually has no signs or symptoms. Rarely, headaches
may occur. You can have HBP for years without knowing it. During this time, the condition
can damage your heart, blood vessels, kidneys, and other parts of your body.
And this clinical manifestasi usually the patient feels :
Fatigue or confusion
Vision problems
Chest pain
Difficulty breathing
Irregular heartbeat
Blood in the urine
Pounding in your chest, neck, or ears

CLASIFICATION OF HIPERTENSION
Classification based of JNC 7 has introduced a new classification
system for hypertension.
1.

Pre Hypertension - Systolic blood pressure (SBP) 120-139 mm Hg or

diastolic blood pressure (DBP) 80-89 mm Hg.

2.

Stage I hypertension - SBP 140-159 mm Hg or DBP 90-99 mm Hg.

3.

Stage II hypertension - SBP >160 mm Hg or DBP > 100 mm Hg.

DIAGNOSIS
1. History
Ask about previous cardiovascular events because they often suggest an increased probability of
future events that can influence the choice of drugs for treating hypertension and will also require more
aggressive treatment of all cardiovascular risk factors. Also ask patients if they have previously been
told that they have hypertension and, if relevant, their responses to any drugs they might have been
given.
Ask about Important previous events include : stroke or transient ischemic attacks or dementia,
coronary artery disease, including myocardial infarctions, angina pectoris, and coronary
revascularizations, Heart failure or symptoms suggesting left ventricular dysfunction (shortness of
breath, edema), Chronic kidney disease, peripheral artery disease, diabetes and sleep apnea.
Ask about other risk factors. Thus, knowing about age, dyslipidemia, microalbuminuria, gout, or family
history of hypertension and diabetes can be valuable. Cigarette smoking is a risk factor that must be
identified so that counseling can be given about stopping this dangerous habit.

DIAGNOSIS
Physical Examination
Measuring blood pressure.
Document the patients weight and height and calculate body mass index.
Waist circumference. Why is this important? Independent of weight, this helps

determine whether a patient has the metabolic syndrome or is at risk for type
2 diabetes. Risk is high when the measurement is >102 cm in men or >88 cm
in women.
Signs of heart failure
Neurologic examination
Eyes examination

DIAGNOSIS
INVESTIGATION
Blood sample:
Electrolytes
Fasting glucose concentration
Serum creatinine and blood urea nitrogen
Lipid
Hemoglobin and hematocrit
Liver function test

Urine sample:
Albuminuria
Red and white cell

Electrocardiography

TREATMENT
Non pharmacologic treatment
Several lifestyle interventions have been shown to reduce blood pressure. Apart from
contributing to the treatment of hypertension, these strategies are beneficial in managing
most of the other cardiovascular risk factors
Weight loss, In patients who are overweight or obese, weight loss is helpful in treating

hypertension, diabetes, and lipid disorders.

Salt reduction: High-salt diets are common in many communities.
Exercise: Regular aerobic exercise can help reduce blood pressure,
Alcohol consumption: Up to 2 drinks a day can be helpful in protecting against

cardiovascular events,
Cigarette smoking: Stopping smoking will not reduce blood pressure, but since smoking

by it self is such a major cardiovascular risk factor,

TREATMENT
Pharmacologic treatment
Angiotensin converting enzyme inhibitor
Angiotensin Receptor Blockers
Thiazide and Thiazide-like Diuretics
Calcium Channel Blockers
Beta blockers
a-Blockers
Mineralocorticoid Receptor Antagonists
Direct Vasodilators
Centrally Acting Agents

EDUCATION
The are other healthy habits, that can help keep your blood pressure under control:

Achieve and maintain a healthy body weight.

Participate in 30 minutes of moderate physical activity on most days of the week.

Eat a healthy diet that is high in fruits and vegetables and low in sodium, saturated fats, trans
fat, and cholesterol.

Manage stress

Limit the amount of alcohol you drink (no more than one drink each day for women and two for
men).

If you have high blood pressure and are prescribed medication, take it as directed.

If you have a family member who has high blood pressure, you can help by taking many of the
steps listed above with them. Go for walks together or cook meals with lower sodium.

Check your blood pressure regularly.

COMPLICATION
Uncontrolled high blood pressure can lead to :

Heart attack or stroke: high blood pressure can cause hardening and thickening of the arteries
(artherosclerosis), which can lead to a heart attack, stroke or other complication.

Aneurysm: increased blood pressure can cause your blood vessels to weaken and bulge, forming an
aneurysm. If an aneurysm ruptures, it can be life-threatening.

Heart failure: to pump blood pressure can cause your blood vessels, your heart muscle thickens. Eventually,
the chickened muscle may have a hard time pumping enough blood to meet you bodys needs, which can
lead to heart failure.

Weakened and narrowed blood vessels in your kidney: this can prevent these organs from functioning
normally.

Thickened, narrowed or torn blood vessels in the eyes: this can result in vision loss.

Metabolic syndrome: this syndrome is a cluster of disorder of your bodys metabolism, including increased
waits circumference, high triglycerides: low high-density lipoprotein (hdl): or good, cholesterol: high blood
pressure: and high insulin levels

CONCLUSION
Hypertension was defined as persistent blood pressure where systolic pressure above 140

mmHg and a diastolic pressure above 90 mmHg.

For most adults, there's no identifiable cause of high blood pressure. This type of high blood

pressure, called essential hypertension. Some people have high blood pressure caused by an
underlying condition. This type of high blood pressure, called secondary hypertension.
Clinical manifestasi usually the patient feels : Fatigue or confusion, vision problems, chest

pain, difficulty breathing, irregular heartbeat, blood in the urine, pounding in chest, neck, or
ears
Like symptoms, physical findings depend on the cause of hypertension, its duration and

severity, and the degree of effect on target organs.

Diagnosis can be estabilished by check medical history, physical examinatior and investigation.

The treatment for Hypertension there is non pharmacologic treatment such us modified daily
life and pharmacologic treatment.

THANK YOU