1. HYPERTENSION

Hypertension means blood pressure that is too high — usually 140/90 mm Hg or more. High blood pressure makes the heart and blood vessels work harder and can slowly damage the heart, brain, kidneys and eyes. Many people have no symptoms, so regular checks are important.

Quick pathophysiology

Blood pressure depends on how much blood the heart pumps and how narrow the small arteries (arterioles) are. When arterioles stay narrowed or the body keeps more fluid, pressure stays high. Hormones (like angiotensin and aldosterone), nerves, the kidneys, salt intake and blood vessel stiffness all play a part.

Common types

  • Primary (essential) — no single cause; most people fall here.
  • Secondary — caused by another problem (kidney disease, hormones, medicines).
  • Isolated systolic — high top number only, common in older adults.
  • Malignant — sudden very high pressure with symptoms; medical emergency.

Signs & symptoms

Most people feel nothing. If blood pressure is very high, there may be headache, dizziness, breathlessness, chest pain, or blurred vision. Long-term untreated hypertension can lead to heart attacks, strokes, kidney failure and vision loss.

How it is diagnosed

  1. Measure BP more than once on different visits — use average of readings.
  2. Look for signs of organ damage (heart, eyes, kidneys).
  3. Basic tests: blood sugar, lipids, kidney tests (BUN/creatinine), electrolytes, urine albumin, and ECG.

Treatment goals

Reduce the risk of heart attack, stroke and kidney disease. Typical targets are <140/90 mm Hg for most people, lower targets for diabetes or significant kidney disease as advised by guidelines.

Non-drug measures

  • Lose weight if overweight.
  • Follow the DASH-style diet and lower salt (aim ~1.5 g sodium/day if possible).
  • Exercise regularly (aerobic activity most days).
  • Limit alcohol, stop smoking and reduce stress.

Drug therapy — main drug classes

Choice depends on patient age, other diseases (diabetes, heart failure, kidney disease), pregnancy status and side-effect profile.

  • Diuretics (thiazide-type) — e.g., hydrochlorothiazide, chlorthalidone. Help remove salt and water. Watch for low potassium, high blood sugar.
  • ACE inhibitors — e.g., lisinopril, enalapril. Lower angiotensin II. Can cause dry cough and raise potassium.
  • ARBs (angiotensin receptor blockers) — e.g., losartan, valsartan. Similar benefits to ACE inhibitors but less cough.
  • Calcium channel blockers (CCBs) — e.g., amlodipine, nifedipine. Work on blood vessel muscle. May cause ankle swelling, flushing, headache.
  • Beta-blockers — e.g., metoprolol, atenolol. Useful with heart disease. Can cause fatigue, bradycardia; avoid sudden stop.
  • Alpha-blockers, vasodilators, centrally acting agents — used in specific situations or when others are not enough; each has distinct side effects.

Common side-effects to watch for

  • Electrolyte changes (low/high potassium) with diuretics and RAAS drugs.
  • Dry cough with ACE inhibitors.
  • Swelling and headache with CCBs.
  • Slow heart rate or tiredness with beta-blockers; avoid abrupt stopping.

Monitoring & follow-up

  • Check BP regularly and adjust medicines until target reached.
  • Monitor kidney function and electrolytes after starting ACE inhibitors/ARBs or diuretics.
  • Review for side effects, adherence and lifestyle changes every visit.

Patient counselling

  • Take medicines every day, even if you feel well.
  • Measure blood pressure at home if possible and bring readings to clinic.
  • Report cough, dizziness, muscle cramps or swelling to the prescriber.
  • Adopt diet and exercise changes — these often reduce the number or dose of pills needed.

Detailed Notes:

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