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Epidemiology
Definition
Category
(mmHg)
Optimal
<120
< 80
Normal
120129
8084
High normal
130139
8589
Grade 1 hypertension (mild)
140159
90
99
Grade 2 hypertension (moderate)
160179
100109
Grade 3 hypertension (severe)
>180
>110
Isolated systolic hypertension
>140 < 80
90
Normal
< 120
Prehypertension
120139
8089
Stage 1 hypertension
140159
90
99
Stage 2 hypertension
160
100
Hypertensive urgency
Severe hypertension (as defined by a
diastolic blood pressure above 120
mmHg) in asymptomatic patients
Pathogenesis
Pathogenesis
genetic factors,
intrauterine developmental disturbance (eg,
hypoxia, drugs, nutritional deficiency),
Risk factors
A variety of risk factors have been associated with
essential hypertension:
Secondary hypertension
Pheochromocytoma
Renovascular disease
Primary aldosteronism (presence of primary
mineralocorticoid excess)
Secondary hypertension
Measurement
Measurement
Initially, take blood pressure in both arms; if
pressures differ, use the higher arm
Masked hypertension
hypertensive cardiovascular
complications being more closely
correlated with 24-hour or daytime
ambulatory monitoring than with the
Autonomic dysfunction
Diagnostic
History
History
Presence of other risk factors
Smoking
Diabetes
Dyslipidemia
Physical inactivity
Dietary history
Sodium
Alcohol
Saturated fats
Psychosocial factors
Physical examination
Laboratory testing
Electrocardiogram
Additional tests maybe indicated in certain
settings:
Microalbuminuria
Echocardiography is indicated to detect
Hypertension
Treatment
Lifestyle modifications
Dietary sodium reduction (2 to 8 mmHg)
no more than 100 meq/day (2.4 g sodium or 6 g
sodium chloride)
Drug treatment
thiazide diuretics,
long-acting calcium channel blockers (most
Drug treatment
Resistant hypertension
Suboptimal therapy
Extracellular volume expansion
Poor compliance with medical or dietary
therapy
Hypertensive emergencies
Hypertensive encephalopathy
Acute aortic dissection
Acute left ventricular failure
Pheochromocytoma crisis
Eclampsia
Severe epistaxis
Cerebral autoregulation in
hypertension
Clinical manifestations
Treatment
Treatment IV
Treatment PO
Management of severe
preeclampsia
Drugs contraindicated in
pregnancy
Treatment
Treatment
Alpha2-
adrenergic agonist)
Nifedipine
30 to 60 mg once daily as a sustained
release tablet, increase at 7 to 14 day
intervals, maximum dose 120 mg/day
ABPM
Monitorizare ambulatorie a TA
discrepan marcat ntre valorile msurate n cabinet
i la domiciliu
ABPM
60 ani, sex F
Istoric de DZ tip II de 5 ani
Hipertensiune de 9 ani
Hipertrigliceridemie de 3
ani
Microalbuminurie
Examinare fizica :
TA: 152/93 mmHg
Greutate: 87 kg
Circumferinta: 100 cm
IMC: 30 kg/m2
Teste de laborator:
HbA1c: 8,2%
Trigliceride: (253 mg/dl)
Colesterol: (201mg/dl)
Albumina/creatinina: 6,8
Schema de tratament:
Dieta
Metformin 2 x 500 mg
Simvastatin 20 mg
Metoprolol 2 x 50 mg
Perindopril 4 mg