Hypertension "A Silent Killer"

Hypertension rightly said "Silent Killer". A symptomless (almost) but fatal , if not properly controlled or managed, a health problem.One of the most important topic of research medicine is hypertension and heart disease.

Hypertension (high blood pressure): A known highly prevalent risk for heart disease and cardiovascular complications.It is a established increasing longevity and prevalence of contributing factors such as obesity. According to research in medicine proves, proper management of hypertension cause a decline in the cases of cardiovascular disease and increase and enhance the quality and span of life.so, heart disease and hypertension are correlated and important area in research medicine

Hypertension simply increase intravascular pressure, defined as a elevated blood pressure exceeding 140 over 90 mm Hg -- a systolic pressure above 140 with a diastolic pressure above 90.

Etiology of Hypertension:
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1. Pri: – 90-95% of cases – also termed “essential” of “idiopathic”
2. Sec: – about 5% of cases
3. Renal or renovascular disease
4. Endocrine disease
5. Phaeochomocytoma
6. Cusings syndrome
7. Conn’s syndrome
8. Acromegaly and hypothyroidism
9. Coarctation of the aorta
10. Iatrogenic
11. Hormonal / oral contraceptive
12. NSAIDs

Few Investigation of the New Hypertensive:
1. History and examination
2. Exclude secondary Hypertension
3. Urea and electrolytes
4. FBP and ESR
5. ECG
6. Lipid profile
7. Chest x-ray no longer routinely indicated

Management:
Monotherapy and Multi drug therapy.


Monotherapy:

(i). Standard initial monotherapy preferences.
(a). Diuretics such as Hydrochlorothiazide.
* Secondly used diuretic if not possible first.
* Excellent adjunct to other antihypertensives.
* Lisinopril and Amlodipine are less effective so they are better.
*Decrease risk of Cardio vascular arythemia , Myocardial Infarction, Congestive heart failure comparitive to other agents.

(b). Beta Blocker (Propanalol, Atenol etc)
(c). Angiotensin Converting Enzyme Inhibitor (ACE)
(c). Angiotensin Receptor Blocker (ARP)

(ii). Reasons compiling for other antihypertensive
(a). AntiHypertensives for Specific Comorbid Diseases
(b). Antihypertensives for Specific Populations

(iii). Avoid the following agents for monotherapy.
(a). Alpha blockers
(b). Hydralazine
(c). Minoxidil
(d). Calcium Channel Blockers

(iv). Avoid in low compliant patients bcoz of rebound Hypertension.
(a). Beta Blockers
(b). Clonidine

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