Is Hypertension A Syndrome???

Hypertension is one of the most common worldwide diseases afflicting humans. Why can’t it be called a syndrome(association of several clinically recognizable features, signs, symptoms that occur often)??? It is the most important modifiable risk factor coronary heart disease, stroke, peripheral vascular disease, end stage renal failure. According to what I have seen in clinics, out of every 100 patients visiting a doctor 70 of them are hypertensive.


Hypertension

Actually what is hypertension??? Before knowing it you have to know what blood pressure is, it is the pressure exerted by blood flowing in the blood vessels on the walls of the blood vessels. It is determined by certain factors like peripheral vascular resistance, kidney function, sympathetic nervous system activity and endocrinal activity. Any alteration in the normal physiology of these factors leading to elevation in the blood pressure above 140/90 mm of Hg(according to BHS classification) is termed as hypertension and people with blood pressure of 130/85 mm of Hg (high normal blood pressure) are at higher risks of developing hypertension.


Classifications & Causes

Depending on the cause of hypertension it can be classified as essential (the most common type of hypertension with around 95% of hypertensive cases to its credit) with no identifiable cause (idiopathic) and secondary hypertension (with about 5% of hypertensive patients) with an underlying pathology leading to hypertension

Sometimes in pregnant women hypertension develops which can be either pre-eclampsia or eclampsia.

The causes for secondary hypertension may be underlying
•Renal pathology: Renal Vascular disease, Polycystic kidney disease, Renin producing tumor(some segment of people have low rennin hypertension), Glomerulo nephritis
•Endocrinal derangements: Phaeochromocytoma, Cushing syndrome, Conn’s syndrome, Congenital Adrenal Hyperplasia, Acromegaly, Hyperthyroidism, Liddle’s syndrome, diabetes mellitus
•Cardiovascular causes: Corctation of aorta, Polyarteritis nodosa
•Neurogenic causes: psychogenic, increased intra-cranial pressure, acute stress
•Drugs: monoamine oxidase inhibitors, tyramine containing food, oral contraceptive pills, NSAID’s(non steroidal anti inflammatory drugs)




Risk Factors

Risk factors for hypertension are male sex, persistent diastolic blood pressure of >115mm of Hg, smoking, diabetes mellitus, hypercholesterolemia, obesity, alcohol abuse and evidence of end organ damage


Signs and Symptoms

Mostly a hypertensive person is asymptomatic or may present with features ranging from headache, breathlessness, angina, palpitations, sweating to features of end organ damage

After recording the blood pressure with a sphygmomanometer (in a very relaxed state of the patient the blood pressure is recorded as the patient blood pressure may go up in a stressful state after seeing a doctor which is called white collar hypertension) and diagnosing as hypertensive the doctor will be conducting a series of examinations (fundoscopy, ECG, urine stir test for blood and glucose, levels of glucose and lipids in blood, serum creatinine , urea ,electrolytes etc.,) to rule out various causes of secondary hypertension.



Treatment

Treatment strategies depends on the intensity of hypertension (presentation)

But treatment actually starts with non-pharmacological modalities i.e, diet modification, exercise, smoking and alcohol restriction and avoiding stressful conditions etc.

The pharmacological treatment is indicated if the person has following
•If person has blood pressure greater than or equal to 160/100 mm of Hg
•In case of diabetic person it should be started if blood pressure is greater than or equal to 140/90 mm of Hg

The regimen for pharmacological treatment varies with age of the person and health status. The drugs used in the treatment of hypertension are Angiotensin antagonists or ACE inhibitors (A), beta blockers (B), Calcium channel blockers(C), Diuretics (D).

The treatment regimen goes this way: link (press the link to see the regimen)


Complications

The complications of hypertension are end organ damage which can become fatal.
Hypertension can cause damage to various organs

Central Nervous System
Stroke is the common complication of hypertension caused by either cerebral hemorrhage or cerebral infarction. Subarachnoid hemorrhage is also quite common
Retina
Retinal ischemia associated with “cotton wool” exudates, central retinal vein thrombosis
Heart
Hypertension leads to increase in the after load which causes the left ventricular hypertrophy leading to the dilatation of the left atrium and atrial fibrillation (inappropriate contraction of the heart wall).the most common complication of hypertension in heart is coronary artery disease (CAD)
Kidney
Long standing hypertension can lead to renal vasculature damage leading to renal failure
Blood vessels
With hypertension the integrity of the vessel is lost and becomes weak and prone to aneurysms. There also a chance for developing coronary or cerebro vascular disease if hypertension is further added up with factors like smoking, alcohol abuse and hyperlipidemia

Leaving these aside there also are conditions like malignant hypertension (diastolic blood pressure>130mm of Hg + papilloedema + retinal hemorrhage) is medical as well as hypertensive emergencies and accelerated hypertension (diastolic blood pressure>130 mm of Hg without any evidence of papilloedema) which is a hypertensive emergencies

So hypertension is always associated with one or the other conditions listed above so in our opinion we can call hypertension a syndrome

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