Types of Hypertension

Rejekine. Resistant hypertension is the failure to achieve the desired target BP in hypertensive patients by using three kinds of full-dose medications, including diuretics. Settled in diastolic BP above 90 mmHg at least twice the measurement practices in place at different times and one time measurement at home with tools pengukurTD home or ambulatory blood pressure monitoring (ABPM) 24 hours. Nearly 40% of patients treated by general practitioners or specialists indicate therapeutic resistance.
Resistant hypertension is more often found in patients aged over 60 years than the younger ones. The use of inadequate doses of diuretics are often the cause.

Resistant hypertension is caused by among others.

1. BP measurement is not precise. This can cause high intra-arterial pressure on the measurement results. Readings are too high can also occur in patients with arteriosclerosis in the classification or brachial artery that can not be fully compressed. May also occur in white-coat hypertension. This problem can be resolved by measurement of BP at home or with ABPM readings.

2. Excess liquids: excess intake of sodium / salt, fluid retention due to kidney disease and diuretic therapy is inadequate. Thiazide diuretics are recommended for most patients with hypertension, whereas loop diuretics are needed in patients with decreased glomerular filtration rate (LFG) or heart failure.

3. Drug-induced or other causes: non-adherence, inadequate dosage, inappropriate combinations, interactions with other drugs such as non-steroidal anti-inflammatory Drugs (NSAIDs), inhibitors of cyclooxygenase-2 (COX-2), cocaine, amphetamines, phenothiazines, sympathomimetic (decongestants, anorektik), tobacco, caffeine, corticosteroids, oral contraceptive hormones, adrenal steroid hormones, cyclosporine and tacrolimus, erythropoietin, licorice (including chewing tobacco), supplements and certain medications (eg, ephedra, mahaung, orange bitted).

4. Related conditions: obesity, excessive alcohol drinking.

5. Secondary causes: renal parenchymal disease, renal artery disease, aldosteronism, phaeochromocytoma, Gushing syndrome, hypo or hyperthyroidism, sleep apnea, and coarctation of the aorta.

Also known condition called hypertensive crisis. The state is divided
into two types:
1. Hypertensive emergency, an emergency hypertension, where BP exceeded 180/120 mm Hg accompanied by a threat of organ dysfunction, such as the brain (cerebral hemorrhage / stroke, hypertensive encephalopathy), heart (acute left heart failure, acute coronary heart disease), lung ( dam in the lung), and eclampsia; or TD may be lower than 180/120 mmHg but with one organ disorder symptoms over the obvious arise. If TD is not immediately derived can lead to complications that persisted. Therefore it should be lowered with medication intravenously (injections), which works faster in a few minutes at most one hour. These patients should be taken to the intensive care unit (ICU) to monitored his TD and parenterally administered drugs. Target reduction in mean arterial pressure (MAP) does not exceed 25% in a matter of minutes to 1 hour and if stable, can be reached TD 160/100-110 mmHg within 2-6 hours, due to a faster decline will lead to coronary ischemia, brain and the kidney. Initial therapy is right for the state is short-acting nifedipine provide. If the level of TD can be tolerated and the patient is stable, normal BP can be accomplished within the next 24-48 hours.

2. Hypertensive urgency: TD is very high (> 180/120 mmHg), but there are no symptoms as above. TD does not have to be reduced rapidly (in minutes}, but can in a matter of hours up to days with oral medication. Symptoms include severe headache / spinning (vertigo), nausea, vomiting, dizziness / drifting, blurred vision, nosebleeds, shortness of breath , severe anxiety disorders, but there is no target organ damage. Patients with hypertension urgency may also be given an oral therapy that works like a short-acting captopril, labetalol or Clonidine with strict observation.

The division of hypertension based on the cause:

1. Primary hypertension is hypertension with no known cause (essential hypertension). An increase in cardiac work due to narrowing of peripheral blood vessels. The majority (90-95%) patients including primary hypertension.

2. Secondary hypertension is hypertension caused by other systemic diseases, such as hormonal disorders (Gushing), narrowing of major blood vessels of kidney (renal artery stenosis, renal disease (glomerulonephritis)}, and other systemic diseases (lupus nephritis). The number of secondary hypertension is less than 5% of the adult population in America.