Hypertension : Types and Clinical Features

Hypertension or High Blood Pressure

Hypertension or high blood pressure is a chronic medical condition of heart in which systemic arterial pressure is increased. Normal blood is below 120/80 mm of Hg. Blood pressure between 120/80 and 139/89 mm of Hg is called Pre-Hypertension and blood pressure of 140/90 mm of Hg and above is considered high blood pressure.

Types of Hypertension:

Hypertension is classified into two types
• Primary or Essential Hypertension
• Secondary Hypertension

Primary or Essential Hypertension : In about 90-95% cases cause of hypertension is obscure. In remaining 5-10% of cases i.e. secondary, is secondary to diseases of kidneys, arteries, heart or endocrine system. Persistent high blood pressure is one the leading cause of stroke, myocardial infarction, cardiac failure and aneurysm of arteries is a major cause of Chr. Renal Failure. Moderate increase in arterial blood pressure reduces the life expectancy. Changes in dietary habit and lifestyle may improve hypertension and reduces the risk of complications. Drug treatment is necessary in patients not responding to changes in dietary habit and lifestyle.

Aetiology of Essential Hypertension:

Aetiology of primary hypertension is unknown. It is most common form of hypertension and affects the both sexes almost equally. It is mostly a serious condition and occurs between the ages of 40-60 years. Patients often show the history of disease i.e. Hereditary. It occurs both in thick & thin build but obesity increases the risk of hypertension.

Clinical features of Essential Hypertension:

Hypertension is often detected during routine medical checkup.Usually essential hypertension is asymptomatic for many years.
Early symptoms of disease are:
• Nervousness
• Irritability
• Loss of energy
• Fatigue
• Insomnia
Late symptoms of disease are:
• Headache
• Dizziness
• Impaired memory & concentration
In early stages, hypertension is not continuous but intermittent. Blood pressure is usually labile and may rise due to anxiety (emotion), exercise & cold etc. and finally resting blood pressure leads to permanent elevation.

In late stages, hypertension may have impaired renal function. Most of the patients of hypertension die due to atherosclerosis in the heart and brain though there renal function is maintained.

Complications of Essential Hypertension:

Complications of hypertension are due to involvement of different organs of the body which are as follows:

Heart manifestation :
• Myocardial enlargement due to hypertrophy of cardiac muscle fibres
• Pulmonary congestion (Breathlessness)
• Atherosclerosis
• Strokes
• Myocardial infarction
• Heart failure

Cerebral manifestations :
• Headache
• Dizziness
• Vertigo
• Hypertensive Encephalopathy
• Cerebral Haemorrhage
• Cerebral Thrombosis
Gradual changes in temperament and mental power are due to defective blood supply,
in case of cerebral atheroma.

Retinal manifestations :
Retinal changes may lead to loss of vision as a result of retinal haemorrhage.

Renal manifestations :
• Renal arteriosclerosis
• Hypertensive renopathy

Malignant Hypertension :
Essential hypertension is sometimes divided into two i.e. Benign and Malignant groups. Malignant hypertension is a clinical syndrome characterised by severe diastolic hypertension, papilloedma and renal failure.

Assessment of a patient with hypertension:

When hypertension is first diagnosed careful assessment of patient is done. Treatment and prognosis depends on the severity and complications of hypertension. Assessment of disease is made on the basis of:
1. History: Family & past history for renal disease is taken.
2. Blood pressure: recorded number of times also in resting state.
3. Examination of cardio vascular system: is done to exclude
• Left ventricular hypertrophy
• Signs of cardiac failure
• Evidence of ischemic heart disease
• Cerebro vascular disease
• Haemorrhage, exudates & papilloedma over fundus of eye
• Femoral pulse is palpated to exclude Coarctation of Aorta.
4. Examination of renal function: is made by routine urine exam. For protein, cells and costs. Urea & creatinine clearance test for glomerular function and specific gravity test for tubular function. Blood urea is raised in case of hypertensive disease without heart failure.
5. Radiology: X-ray examination of heart and lungs to exclude enlargement and congestion respectively.
6. Electrocardiography: show the evidence of left ventricular hypertrophy and myocardial (coronary) disease.
7. Examination of other systems like:
• Central Nervous System
• Careful examination of abdomen to exclude Hydronephrosis & Polycystic Kidney and
• Auscultation may show a bruit due to renal artery stenosis

How Secondary Hypertension occurs:

Manifestations of Secondary hypertension occur due to:

1. Secondary to kidney diseases:
• Acute glomerulo nephritis
• Chronic glomerulo nephritis
• Chronic Pyelo nephritis
• Polycystic kidney
• Unilateral renal disease with renal ischemia
• Prostatic obstruction

2. Secondary endocrinal disorders like Diabetes mellitus
3. Coarctation of the aorta
4. Toxaemia of Pregnancy

Treatment of Hypertension :

Treatment of high blood pressure is done in two parts-
A. Physical factors : are
Rest :
Rest in bed is not so important but slight restriction is beneficial like going to bed early daily and at weekends.
Physical activities :
• Walking and mild exercise within limit of dyspnoea or undue tiredness is encouraged.
• Do exercise regularly for 30 minutes daily
• Reduce weight in obese or over wt. person
• Manage stress by Yoga and Meditation to reduce hypertension

Diet :
• Take green vegetables, fruits & low fat dairy products
• Avoid over eating which is harmful
• Take low common salt diet (Less than 1.5 gms/day) is beneficial
• Stop smoking
• Avoid alcohol in take

Sedatives :
Anti anxiety, Tranquillisers and Sedatives are supporting drugs and are given to minimise anxiety, emotional tension and insomnia.

B. Medical Treatment of Hypertension :
Goal of antihypertensive treatment is to reduce hypertension and its complications. Medicines used to treat hypertension are as follows:
• Beta blockers
• Alpha blockers
• ACE (Angiotensin Covering Enzyme) inhibitors
• Angiotensin Receptor Blockers
• Calcium Channel Blockers
• Diuretics
• Vasodilators

Often, single anti-hypertensive drug is not enough to control hypertension hence more than one drug is required.

Prognosis of Hypertension:

Prognosis is good in case of early diagnosis of disease, medical treatment, change in lifestyle and due precautions.