hypertension : definition, symptom, test, management hypertension : definition, symptom, test, management Doctors media



hypertension : definition, symptom, test, management

hypertension :  definition, symptom, test, management

       How to lower blood pressure or hypertension?

      The most important question of uncontrolled hypertensive patients around the world.  Because this co morbid condition may ruin one's healthy life. Let's discuss this in detail.

Hypertension definition:

 Hypertension or high blood pressure means, increase blood pressure beyond the upper 

level of normal limits. Clinically it may be defined as systolic blood pressure more than 140

 mm Hg and diastolic blood pressure more than 90 mm Hg. Hypertension may only increase 

systolic pressure or maybe diastolic pressure or may both.

Definitions of Hypertension 

Pressure        Systolic    Diastolic
Optimal         120              80
Normal         <  130                  85
High normal  130–139           85–89
Grade 1 (mild)140–159           90–99
Grade 2 (moderate)160–179 100–109
Grade 3 (severe)     ≥ 180   >110
Isolated systolic hypertension
Grade 1             140–159   90
Grade 2            ≥ 160            90

Hypertension symptoms

 Usually, hypertension is symptomless (no feature) until it causes complications. Usually,

 run many years without notice. After years its effects on several target organs. So it mainly

 presents the feature of target organs. Target organs are the Brain, Eye, Heart, Kidney

,  Blood vessels. Occasionally, high-pressure presents with Headache, restlessness,

 drowsiness, and even unconsciousness in hypertensive encephalopathy. Symptoms of

 hypertension are subjective and individualized.patients may present in the emergency

 room with a severe  life-threatening complication.

Hypertension causes

Primary hypertension:

About 95% of cases, there is no cause. Its called Idiopathic or primary or Essential hypertension.

Secondary hypertension:

Only 5% of cases have an underlying cause.




Renal disease

 Parenchymal renal disease, particularly glomerulonephritis

Renal vascular disease

polycystic kidney disease 

Endocrine disease


Cushing’s syndrome

Primary hyperaldosteronism (Conn’s syndrome)

Glucocorticoid-suppressible hyperaldosteronism


Primary hypothyroidism


Congenital adrenal hyperplasia

dehydrogenase deficiency

Drugs: steroids, NSAIDs

Coarctation of the aorta


Test for Hypertension

Urine test, Especially  for blood, protein, and glucose

Blood test for  Blood urea, electrolytes, and creatinine

 Blood glucose

 Lipid Profile (Serum total and HDL cholesterol, LDL) 

 Thyroid function tests (TSH, FT4, FT3)


These are the basic test for detecting the cause of high blood pressure.

Further special tests may be needed.

Hypertension Management

It has two wings.there are non pharmacological and pharmacological management.

Non pharmacological strategies:

Salt restriction: The aim of lowering intake of table salt less than 6 grams/day, ideally 3gram/day. A recent

The study showed that lowering salt intake can have a significant effect on blood pressure. For example, reducing

Salt intake by 6g/day can lower blood pressure by 10 mm Hg.

 Caffeine intake should be reduced.

 Stop smoking

Drink less alcohol

Eat a balanced diet rich in fruit and vegetables

Exercise more

Lose weight

Pharmacological management

 Step 1treatment:

 Patient < 55 years old: ACE inhibitors, b (enalapril, ramipril, lisinopril)

Patient >= 55 years old or Afro-Caribbean

Origin: calcium channel blocker (amlodipine, cildipine, nifedipine)

 Step 2 treatments:

 ACE inhibitors+ calcium channel blockers

 Step 3 treatment:

add a thiazide diuretic with step 1,2.

Step 4 treatment :
consider further diuretic treatment
If potassium <4.5 mmol/l add spironolactone
If potassium >4.5 mmol/l add a higher dose of thiazide-like diuretic treatment.
If blood pressure is not controlled add alpha or beta-blocker. a patient who fails to respond to stage 4 needs further evaluation.

Hypertension in pregnancy:

Alpha methyldopa, labetalol, nifedipine, amlodipine, doxazosin

Hypertension in heart failure/ angina :

ACE inhibitor, beta-blocker 

Hypertension in diabetes

ACE inhibitor, ARB

Hypertension in chronic renal failure

ACE inhibitor, ARB

Hypertension with benign enlargement of the prostate

Alpha-blocker (prazosin, terazosin)

The suitable medicine for controlling high blood pressure varies from person to person. Everybody should follow the local physician's advice.


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