Dr. Malik Sameeh Ikhraiwesh
Hypertension
Hypertension: sustained elevation in blood pressure (BP) above 140/90
Commonly referred to as "the silent killer" due to its asymptomatic nature.
Most prevalent cardiovascular disease
Significant modifiable risk factor for myocardial infarction, heart failure, and stroke.
Complications are directly correlated with the degree of BP elevation. Sustained
hypertension causes damage to blood vessels in vital organs, leading to increased
incidences of renal failure, coronary disease, heart failure, stroke, and dementia.
Types and Causes of Hypertension:
● Essential Hypertension (Primary): Accounts for 90-95% of cases and lacks a known
cause.
● Secondary Hypertension: Constitutes 5-10% of cases and is attributed to specific
organ pathologies, such as renal artery stenosis or pheochromocytoma.
● Drug-Induced Hypertension: oral contraceptives → NSAIDs → stimulants →
Glucocorticoids → Liquorice → Caffeine
Factors Affecting Blood Pressure:
1. Cardiac Output (CO): The volume of blood pumped by the heart per minute. It is
determined by heart rate (HR) and stroke volume (SV). CO = HR × SV.
2. Peripheral Resistance: resistance to blood flow in the arteries. Increased resistance
leads to higher blood pressure. Arteriolar diameter and blood viscosity affect
resistance.
3. Filling Pressure (Preload): The pressure exerted on the walls of the heart chambers
during diastole (relaxation phase), which determines the amount of blood the heart
can pump during systole (contraction phase).
4. Venous Return and Venous Tone: The rate of blood flow returning to the heart and
the degree of constriction in the veins, respectively. Venous tone influences venous
return and cardiac filling. (Venoconstriction → Higher Venous Return)
5. Contractility: The strength of cardiac muscle contraction → affecting stroke volume
→ Cardiac output.
6. Blood Volume: The total volume of blood in the
circulatory system, which influences cardiac
output and filling pressure.
Regulation of Blood Pressure:
Baroreflexes AND
Renin-angiotensin-aldosterone system
(RAAS)
1
, Dr. Malik Sameeh Ikhraiwesh
General Treatment Strategy:
1. Diagnosis: Accurate diagnosis requires
multiple measurements.
2. Determination of Primary vs. Secondary
Hypertension: Secondary hypertension
should prompt treatment of underlying
pathology.
3. Lifestyle Changes: Initiating lifestyle
modifications such as smoking cessation,
weight loss, and stress reduction.
4. Pharmacological Treatment: When
necessary, pharmacological intervention is initiated.
Classes of Antihypertensive Agents:
1. Diuretics (Natriuretics)
Increase urine flow → Reducing blood volume → Excretion of sodium and water
Types of Diuretics:
1. Thiazide Diuretics (Potassium-depleting Diuretics):
● Examples → Hydrochlorothiazide.
● Moderate efficacy in reducing blood pressure.
● Commonly used as Initial therapy for mild to moderate hypertension.
● Side effects: Hypokalemia (Higher Doses Increase Risk of Arrhythmia) →
Hypercalcemia → Hyperuricemia (High Dose) → Hyperglycemia(High Doses)
2. Loop Diuretics (Potassium-depleting Diuretics):
● Examples → Furosemide (Lasix).
● High efficacy → Reserved for patients with heart failure, pulmonary edema,
or mild renal insufficiency.
● Side effects: Hypokalemia → Hypocalcemia (C/I in Osteoporosis) →
Ototoxicity.
● Used with caution
3- Potassium-sparing Diuretics (Low efficacy):
● Examples → Spironolactone.
● Lower efficacy → Often used in combination with other diuretics
to counteract potassium loss.
● Spironolactone is an aldosterone antagonist and is
cardioprotective → Given in Chronic Heart Failure
● Side effects: Hyperkalemia → Gynecomastia in males →
Menstrual irregularities in females → Gastrointestinal symptoms.
2
Hypertension
Hypertension: sustained elevation in blood pressure (BP) above 140/90
Commonly referred to as "the silent killer" due to its asymptomatic nature.
Most prevalent cardiovascular disease
Significant modifiable risk factor for myocardial infarction, heart failure, and stroke.
Complications are directly correlated with the degree of BP elevation. Sustained
hypertension causes damage to blood vessels in vital organs, leading to increased
incidences of renal failure, coronary disease, heart failure, stroke, and dementia.
Types and Causes of Hypertension:
● Essential Hypertension (Primary): Accounts for 90-95% of cases and lacks a known
cause.
● Secondary Hypertension: Constitutes 5-10% of cases and is attributed to specific
organ pathologies, such as renal artery stenosis or pheochromocytoma.
● Drug-Induced Hypertension: oral contraceptives → NSAIDs → stimulants →
Glucocorticoids → Liquorice → Caffeine
Factors Affecting Blood Pressure:
1. Cardiac Output (CO): The volume of blood pumped by the heart per minute. It is
determined by heart rate (HR) and stroke volume (SV). CO = HR × SV.
2. Peripheral Resistance: resistance to blood flow in the arteries. Increased resistance
leads to higher blood pressure. Arteriolar diameter and blood viscosity affect
resistance.
3. Filling Pressure (Preload): The pressure exerted on the walls of the heart chambers
during diastole (relaxation phase), which determines the amount of blood the heart
can pump during systole (contraction phase).
4. Venous Return and Venous Tone: The rate of blood flow returning to the heart and
the degree of constriction in the veins, respectively. Venous tone influences venous
return and cardiac filling. (Venoconstriction → Higher Venous Return)
5. Contractility: The strength of cardiac muscle contraction → affecting stroke volume
→ Cardiac output.
6. Blood Volume: The total volume of blood in the
circulatory system, which influences cardiac
output and filling pressure.
Regulation of Blood Pressure:
Baroreflexes AND
Renin-angiotensin-aldosterone system
(RAAS)
1
, Dr. Malik Sameeh Ikhraiwesh
General Treatment Strategy:
1. Diagnosis: Accurate diagnosis requires
multiple measurements.
2. Determination of Primary vs. Secondary
Hypertension: Secondary hypertension
should prompt treatment of underlying
pathology.
3. Lifestyle Changes: Initiating lifestyle
modifications such as smoking cessation,
weight loss, and stress reduction.
4. Pharmacological Treatment: When
necessary, pharmacological intervention is initiated.
Classes of Antihypertensive Agents:
1. Diuretics (Natriuretics)
Increase urine flow → Reducing blood volume → Excretion of sodium and water
Types of Diuretics:
1. Thiazide Diuretics (Potassium-depleting Diuretics):
● Examples → Hydrochlorothiazide.
● Moderate efficacy in reducing blood pressure.
● Commonly used as Initial therapy for mild to moderate hypertension.
● Side effects: Hypokalemia (Higher Doses Increase Risk of Arrhythmia) →
Hypercalcemia → Hyperuricemia (High Dose) → Hyperglycemia(High Doses)
2. Loop Diuretics (Potassium-depleting Diuretics):
● Examples → Furosemide (Lasix).
● High efficacy → Reserved for patients with heart failure, pulmonary edema,
or mild renal insufficiency.
● Side effects: Hypokalemia → Hypocalcemia (C/I in Osteoporosis) →
Ototoxicity.
● Used with caution
3- Potassium-sparing Diuretics (Low efficacy):
● Examples → Spironolactone.
● Lower efficacy → Often used in combination with other diuretics
to counteract potassium loss.
● Spironolactone is an aldosterone antagonist and is
cardioprotective → Given in Chronic Heart Failure
● Side effects: Hyperkalemia → Gynecomastia in males →
Menstrual irregularities in females → Gastrointestinal symptoms.
2
