Signs and Symptoms of & rsquo; hypertension (HTA)

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I/- INTRODUCTION :

A/- Definitions and classifications :

Hypertension is defined as any abnormal elevation of blood pressure above normal values ​​considered.

Classification table blood pressure values (in mmHg)

B/- Interests :

  • It is a common disease that poses a public health problem (35% adults in Algeria).
  • Serious in its repercussions on the heart, kidney and brain and retina.
  • Two etiological entities : HTA most common essential, and & rsquo; secondary hypertension which may be treatable.
  • Hypertension is a cardiovascular risk factor.

C/- pathophysiology :

Blood pressure (PA) Cardiac output is the product (QC) by systemic arterial resistance (RAS) :

PA = QC X Alert [Law mile Poise)

The heart rate is the heart rate product (FC) by the stroke volume (VES).

The increase is due either PA :

  • The increase in QC
  • The increase in RAS ++++

II/- SIGNS :

A/- The discoveries of circumstances :

Hypertension can be revealed before :

1/- Neurosensory signs Dieulafoy : headaches, dizziness, feeling phosphene (sensation of seeing a light or by the & rsquo; appearance of spots in the visual field), sensation of floaters, fog before the eyes sensation, scotomes, tinnitus (auditory sensation unrelated to a sound generated by vibration d & rsquo; external origin to the & rsquo; organization and inaudible by & rsquo; entourage) ringing in & rsquo; s ear, founnillements…

2/- complications : épistaxis, stroke, renal failure, heart failure.

The discovery of Y hypertension may be fortuitous in a systematic management of TA.

B/- Taking BP and precautionary measure : (See clinical examination courses)

C/- The clinical forms :

  • The permanent HTA, persists at any time of day.
  • Hypertension paroxysmal is an acute elevation of BP may be associated with signs of adrenergic (phéochromocytome ++).
  • The systolic hypertension, interest only SBP.
  • The diastolic hypertension defined by an isolated elevation in DBP.
  • L'HTA maligne is a medical emergency that combines PAD > 120mmHg with signs of threatening visceral involvement that are acute pulmonary edema, myocardial infarction, acute renal failure, hypertensive encephalopathy and edema papillary.
  • Hypertension in pregnancy :

Hypertension blood during pregnancy or in the immediate postpartum period (period covering the 6 weeks following the & rsquo; childbirth) is defined as follows :

Definitions of hypertension during pregnancy
Hypertension during pregnancy PAS with 140 mm Hg

or PAD s 90 mm Hg

Mild to moderate hypertension NOT = 140-159 mm Hg

or PAD = 90-109 mm Hg

severe hypertension PAS with 160 mm Hg

or PAD s 110 mm Hg

On distingue :

  • Chronic high blood pressure (existing pregnancy or seen before 20th TO).
  • gestational hypertension without proteinuria pathological elevation (observed after the 20ERAE TO).
  • Pre-eclampsia defined by a HTA (controlled or not) associated with a pathological proteinuria discovered after the 20th SA.
  • Eclampsia is defined as a seizure in a context of hypertensive disorder of pregnancy.

III/- BALANCE PARACLINIQUE :

A/- The minimum balance of called before any HTA :

  • Serum electrolytes,
  • Creatinine with GFR estimated,
  • Fasting glucose,
  • Lipid profile,
  • proteinuria.

B/- The balance of visceral impact :

Hypertension is a major risk factor for atherosclerosis, which is directly responsible for cardiovascular complications, renal and neurological :

  • Cardiac echo is wanted by ECG and Doppler echocardiography.
  • The ophthalmologic impact is appreciated by the fundus.
  • Renal impact of hypertension is towards chronic renal failure (creatinine and proteinuria).
  • The neurological assessment done before the call signs such as stroke and transient deficits : CT scan.

C/- Results parallel of vascular risk factors :

Diabetes Research, hypercholesterolemia.

IV/- etiologies :

A/- essential hypertension :

Especially in elderly patients over 50 years, with a notion of family hypertension. Represented 95% HTA of

B/- secondary hypertension :

Occurs in young patients age < 50 years. It represents 5% HTA of.

1/- The endocrine causes :

  • Phéochromocytome : paroxysmal hypertension, alternating with periods of hypotension by elevation of catecholamines and metabolites.
  • primary aldosteronism (syndrome de Conn) : It is due to inappropriate secretion of aldosterone by an adenoma adrenal cortex or bilateral adrenal hyperplasia. It is the association of hypertension and hypokalemia.
  • Syndrome de Cushing : inappropriate secretion of cortisol (associated with stretch marks).
  • hyperthyroidism : palpitation, tachycardia, HTA, diarrhea, elevated thyroid hormones.
  • Other : acromegaly, hyperparathyroïdie

2/- The renal causes :

  • The renal artery stenosis : atheromatous or fibrodysplasique.
  • Unilateral and bilateral renal.

3/- Vascular causes :

  • Coarctation of the aorta : the femoral pulses are reduced or abolished. There are a para systolic murmur left sternal, intense, irradiating the back.
  • Aortic Aneurysm.
  • Disease Takayasu : Women pulseless disease,

4/- The causes iatrogenic :

drug : oestroprogestive, corticosteroids, nasal vasoconstrictor, cyclosporine, erythropoietin…

Course of Dr H Foudad – Faculty of Constantine