I/- INTRODUCTION :
A/- Definitions and classifications :
Hypertension is defined as any abnormal elevation of blood pressure above normal values considered.
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,
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