Introduction
The condition is characterised by systemic arterial pressure consistently above 140 mm Hg systolic and 90 mm Hg diastolic.
ETIOLOGY
Primary (essential) hypertension
Idiopathic.
Predisposing causesS moking.
• Mental stress.
Type A personality
Hyperlipidaemia.Excessive intake of salt, fats.
Obesity.
Lack of physical activity.
Secondary hypertension
Renal
Chronic renal disease.
Polycystic kidney disease.
• Hydronephrosis.
• Renal artery stenosis.
Endocrine
Thyrotoxicosis.
Acromegaly.
• Cushing\’s syndrome.
• Hyperaldosteronism.
Phaeochromocytoma.
Neurological
Brain tumour.
• Cerebro-vascular accident.
Psychogenic.
Atherosclerosis.
Polycythaemia.
latrogenic.
Pregnancy.
CLINICAL FEATURES
Symptoms
Asymptomatic during compensatory phase.
Throbbing headache.
Giddiness.
Faintness.
Sleeplessness.
Epistaxis.
Angina pectoris.
Exertional fatigue.
Decreasing exercise tolerance.
Nocturnal cough.
– Oliguria.
Signs
General examination
Age: middle age.
Sex: common in males.
Pulse:
High tension pulse.
• Arterial wall thick.
Blood pressure:
Above 140/90 mm of Hg.
Cardiac examination
On inspection
Apex more down than out.
On palpation
Apical impulse heaving in character.
On percussion
Area of cardiac dullness increased.
On Auscultation
S1 at apex booming.
A2 at base accentuated.
COMPLICATIONS
Cardiovascular
Left Ventricular failure.
Congestive cardiac failure.
Myocardial infarction.
Cerebral
Cerebro-vascular accidents.
– Hypertensive encephalopathy.
Retinal
Hypertensive retinopathy.
Renal
Uraemia.
INVESTIGATIONS
Urinalysis
Albumin: in traces.
Hyaline casts may be present.
Funduscopy
Hypertensive retinopathic changes.
ECG shows features of left ventricular hypertrophy
Left axis deviation.
Large S waves in V1, V2.
Large R waves in V5, V6.
Increased duration of QRS complex (more than 0.11 sec).
Depression of ST segment.
Chest X-Ray
– Left ventricular hypertrophy.
Malignant hypertension
• It may develop as primary presentation in young subjects or as Complication of essential hypertension.
It is characterised by
Very high sustained systolic and diastolic pressure.
Diastolic pressure disproportionately high above 120 mm Hg.
Acute headache.
Acute visual disturbances.
Haematuria.
Proteinuria.
Papilloedema.
Rapid development of cardiac, renal failure.
High blood urea nitrogen and serum creatinine levels.
Lack of response to routine anti-hypertensive therapy.
Rapid course.
Foor prognosis,
Hypertensive encephalopathy
It is a medical emergency.
An acute and transitory disturbances of cere bral function occurring in association with rapid rise of diastolic blood pressure (more than 140 mm Hg).
It is characterised by
Severe headache.
Nausea.
Vomiting.
Drowsiness.
Convulsions.
Transient paresis with disturbances of speech and vision.
Disorientation.
Loss of consciousness.
PROGNOSIS
In majority of cases, disease follows
Slow, benign, progressive course.
Periods of activity alternate with periods of quiescence.
• Prognosis largely depends on:
– Degree of hypertension.
Efficiency of treatment.
• Features indicating adverse Prognosis
Young age.
Persistent diastolic pressure of more than 120 mm Hg.
Smoking.
Diabetes mellitus.
Hyperlipidaemia.
Obesity.
Evidence of end organ damage.
MIASMATIC CLEAVAGE
Mixed miasmatic disorder.
THERAPEUTIC AIM
To detest, evaluate and control predisposing causes at the earliest.
To maintain blood pressure within acceptable range.
To prevent Complications.
GENERAL MANAGEMENT
Treat cause.
Stop smoking.
Mental and physical rest.
Diet:
Salt restricted diet (permissible up to 53/ day).
• Low fat diet.
Reduce weight, if obese.
Regular, moderate exercise.
MEDICAL TREATMENT
Intercurrent anti-miasmatic
Sulphur.
Syphilinum.
Thuja.
Constitutional
Arsenicum album.
Lycopodium.
Nux vomica.
Natrum muriaticum.
Atherosclerosis
Baryta carbonica.
Baryta muriatica.
Psychogenic causes
Argentum nitricum.
Gelsemium.
Ignatia.
Staphysagria.
Palliative
Allium sativum.
Crataegus.
Passiflora.
Rauwolfia serpentina.