HTN

Joint National Comitee VII
Classification
1)norml systo<120 & diastolic<80
2)preHTN systo120-139 or diastolic80-89
3)stage1HTN systo140-159 or diast90-99
4)stage2HTN systo>160 or dist>100


primary / esential HTN
-acounts for 85% of cases
-not posibl 2 dfine a specific undrlying cause
-70% of dem hav positiv family histry


C/F
majority r asymptomatc
acut HTN causes transient headache & polyuria
long standing HTN leads 2 left ventr hypertrophy & heaving apicl impuls
left atrial hypertrophy & S4
A2 accentuatd
very short early diastolic murmur
fundal changes


Complications
1) CNS
* transient ischaemic attack
* cerebrovascular accidents * subarachinoid haemorrhage * hypertensive encephalopathy * LVF*AORTIC dissection *proteinuria*progressive renal failure *hypertensive retinopathy
Investigation 1- urine analysis  blood glucose, blood urea&creatinine2- serum electrolytes3- serum calcium & uric acid4- ECG 5-chest radiograph


Treatment
1 treatment of underlying cause
2 antihypertensive drug therapy
3 general measures

general measures 1 restriction of salt , control of obesity - restriction of fatty eating



antihypertension
1 diuretics
i)thiazide- chlorthiazide 62.5-500mg BD
ii)loop- furosemide 10-40mg BD
iii)potasium sparing- spirinolact 25-100 OD

2 beta blockers
propranolol 10-40 QID

3 ACE inhibitors
captopril 4.5-50 TDS

4 Calcium chnel blockrs
nifedipine 30-90 OD