Hypertension can be classified in two different ways. One is according to severity and second according to the cause.
Mild HT- When Diastolic pressure is less than 100mm
Moderate HT - Diastolic pressure between 100 - 120mm
Severe HT - Diastolic pressure between 120 - 140 mm
Gross or Malignant HT - Diastolic pressure more than 140 mm of Hg.
Another way of classifying the HT is Causes , which can be either Primary or Secondary. Primary Hypertension : Also known as Essential hypertension with obscure cause or where No cause can be found. Blood pressure is high without any physical complaints and has to be treated on the basis of constitution. It is the most common type and it affects both sexes.
Secondary Hypertension - Where there is a demonstrable cause for the HT and treatment of the same cures the patient of HT.
     Hypertension is said to be the disease of modern urbanisation and fast life. as a matter of fact hypertension itself is not a disease in itself but it is one of the indicators alarming a person to take care of probable emergency. An enzyme called RENIN in the kidneys is responsible for control of Blood Pressure. When there is a fall in volume of blood flowing through the kidneys, kidneys secrete Renin. This Renin cause formation of a substance called Angiotensin which leads to constriction of arteries thus raising the Blood Pressure. Angiotensin also causes excess of Aldosterone, a harmone from Adrenal Glands. This Aldosterone causes sodium retention in the body, we all know that water follows sodium, hence sodium retention leads to water retention causing volume overload thereby raising the BP even further. Here I must make a mention about the stress also. HT is sad to be the outcome or a derivative of fast life, people always rushing against time, trying to realize their ambitions, setting up newer goals , intensely competitive nature all take their toll. This permanent stance of fight leads to increased secretion of Adrenaline, which causes Hypertension.
Complications which can arise :
1. ARTERIOSCLEROSIS
2. ARTERIOLAR INFLAMMATION
3. HEART FAILURE
4. ANGINA PECTORIS
5. CEREBRO-VASCULAR ACCIDENT- CEREBRAL HAEMORRHAGE
6. THROMBOSIS AND SUBARACHNOID HAEMORRHAGE
7. HYPERTENSIVE ENCEPHALOPATHY
8. MALIGNANT HYPERTENSION
9. RENAL DAMAGE
10. HAEMORRHAGES - EPISTAXIS,HAEMATAMESIS, HAEMOPTYSIS
11. REDUCED LIFE EXPECTANCY OR DEATH
On examination and Investigating a patient of HT , we must obeserve following :
a) Blood Pressure level of Diastolic Pressure is important and according to its level the patient is put into the category of Mild, Moderate, Severe and Gross HT
b) Pulse - Radial pulse bounding and hard. Femoral pulse also must be palpated.
c) CVS - Heaving cardiac impulse.
d) Eye Fundus - Arteriolar narrowing, compression, haemorrhage or oedema of disc may be seen.
e) ECG - Left Ventricular enlargement with or without T wave inversion in Lead I, AVL,V5 and V6.
f) X-Ray Chest - Left Ventricle is dense, It's left border is rounded. Hyperaemic lung, prominent hilar shadow.
Usually the same format is useful to investigate a newly detected case or follow up of case under going treatment . A routine package is generally recomended which gives an insight into important organ systems. In case a particular organ system showing signs of damage, detailed investigations of that system becomes mandatory.
In addition to the complete Blood Count the basic investigations should be ;
1)Urine routine - To look for the presence of Albumin and Casts ,which indicate Renal involvement., presence of Occult Blood indicate Calculus.
2)Blood Sugar - Diabetes and HT if presnt togather becomes all the more important for management as chances of Target Organ damage increase.
( Normal Fasting 70-100 and P/P. 100-140 mg )
3)Serum Creatinine - elevated Creatinine suggests early renal Failure, and in absence of another cause, indicates that HT may be of long standing in that patient ( Normal 0.6 - 1.4 mg/dl)
4) Serum Cholestrol - Hyperlipidaemia can both be a cause and effect of HT. If present unless treated will not let BP come under control.Preferably 12hrs. fasting should be observed for this test. Lipid Profile should be carried out if Myocardial involvement is suspected, as it tells more about blood lipids i.e. HDL, the good friendly Cholestrol(Normal M 35-45,F 45-65mg/dl) and LDL, the bad and unfriendly Cholestrol(Normal upto 150mg/dl).
5)Serum Uric Acid - Hyperuricemia is one of the most common cause for HT not responding to the treatment.
6)X-Ray Chest PA view - For Cardiomegaly sply. LVH.indicates that HT is chronic and has been present for some time. Since LVH is reversible with very good control of BP ,X-Ray should be repeated to see the progress and control of BP.
7)E.C.G.- Tells about Myocardial involvent and Ischaemic changes in the heart.
8)Fundoscopy - To see the Retinal Haemorrhage and Papilloedema which again indindicaensive Emergencies:
Diastolic BP more than 120mm of Hg with major organ damage i.e.
CNS/Kidney/Cardio Vascular.
Intracranial/subarachnoid Haemorrhage.
CVA, Hypertensive Encephalopathy.
Acute Aortic dissection, Pulmonary Oedema.
Myocardial Infarction,Unstable Angina.
Eclampsia.
Phaeochromocytoma.(Tumour of Adrenal Medulla)
Grade III or IV K.W. fundoscopic changes.
     During management: Interestingly having enemized BP and linking it to the ills of the Heart,the Brain,the Kidneys and the Blood vessels- without of course reliable proof or data for anyone! Not knowing how exactly the God's great creation of body computer controls blood pressure every second so thoughtfully and dynamically, modern medicine has chosen to control some facets of the physiology, with inevitable train of side effects ranging from increased mortality to humiliating Impotence. In a study of celebrated multi-blind trial on antihypertensives in UK, 90% of the physicians declared that their patients were doing well, 80% of the relations of the patients said that the patients were far from happy, and 100% of the patients felt they were worse off than before. Still if HT is treated before becoming chronic, complicated and without pathological cause can be treated better and it shoulld be patient oriented rather than disease oriented. The basic guideline remains as following ;
     Weight reduction in obese patients.
     Low Sodium diet. Salt restriction.(Sodium transport hypothesis is commonly accepted. Stress and more -Low Sodium diet. Salt restriction.(Sodium transport hypothesis is commonly accepted. Stress and more ccepted. Stress and more -Low Sodium diet. Salt restriction.(Sodium transport hypothesis is commonly accepted. Stress and more ccepted. Stress and more -Low Sodium diet. Salt restriction.(Sodium transport hypothesis is commonly accepted. Stress and more ccepted. Stress and more -Low Sodium diet. Salt restriction.(Sodium trans-Low Sodium diet. Salt restriction.(Sodium transpor-Low Sodium diet. -Low Sodie or moderation of Alcohol and Smoking.
     Psychological factors should be looked into and treated first.
     Avoidance of Physical Strain. Rest and Relaxation. Moderation of physical activity.Sternuous exertions, sudden and prolonged stress should be restricted or stopped.
     Change in the outlook and life style. Inclusion of Yogasnas ,prefereably under the guidence of an expert ( Padmasana, Dhanurasna, Matsyasana and Shavasana are supposed to be the best for the HT patients. Here one should caution the patient also regarding the Shirshasana and Sarvangasana are strictly contraindicated in which the body is held upside down.)