 Hello all, in this video we are going to discuss about common viber questions in clinical social case of hypertension. Now the first question is what is the value of blood pressure to be called hypertension. So here you need to refer the JNC criteria or joint national committee criteria which classifies hypertension based on the stage. According to that hypertension is above 139. So you can call 140 and above and 90 and above in systolic and diastolic respectively for hypertension. So the optimal pressure is in systolic it is less than 120, 120 to 129 is normal, 80 to 84 is normal, high normal is 130 to 139 of systolic and 85 to 89 diastolic. We need to increase 20 millimeter of mercury in systolic blood pressure for different grades and 10 millimeter of mercury in diastolic blood pressure. So if we increase we get grade 1 hypertension, grade 2 hypertension and grade 3 hypertension. If the systolic blood pressure is alone greater than 140 millimeter of mercury but still the diastolic blood pressure is less than 90 then you call that condition as isolated systolic hypertension. So this point can be asked as classify hypertension based on the stage or severity. So when they use this term classify hypertension based on the stage and severity you can use this table to answer the question. When a question is asked classify hypertension based on the cause or classify hypertension simply you can classify hypertension into primary otherwise called as essential or idiopathic 90 percent of the hypertension cases are primary and the rest 10 percentage will be secondary that is due to secondary causes such as renal causes like chronic phyloenopritis, glomerular enopritis and hormonal causes especially thyroid and tumors in adrenal and peripheral vascular diseases all can cause hypertension but these secondary causes comprises of 10 percentage and most common presentation of hypertension is primary or otherwise called as idiopathic. We move on to the next question what are the errors in recording of blood pressure? We have three errors possible that is the variations number one is the observer error which is due to the error practiced by the person who is performing the recording of blood pressure and there may be error due to the instrument that is the VB apparatus or the stratoscope and there may be error due to the subject that is biological changes in the subject may cause subject error. Next is explain the rule of halves the rule of halves for hypertension states that half the people with high blood pressure are known that is out of the people high blood pressure only half know that they have blood pressure out of the people who know that they have high blood pressure only half are treated and out of the people who got treatment for high blood pressure half of them are controlled. So this is community this is normal this is hypertensive out of which this is diagnosed this circle is treated this circle is effectively treated so we need to be very careful that out of the total population hypertension is not of that we need to remember. Next commonly asked question is explain the tracking of blood pressure we need to understand the fact that if blood pressure levels of individuals were followed up over a period of time that is from early childhood to the adult life then these individuals whose pressure were initially high in the distribution will tend to remain high in other words low blood pressure levels tend to remain low when they become adult high blood pressure levels tend to become higher as their age progresses. This phenomenon of persistence of rank order of hypertension or rank order of blood pressure over age is described as tracking this is over the age so over the age lower one remains and the higher one increases with maintaining the rank order. So this phenomenon is called as tracking or the persistence of rank order of blood pressure. Now the next question is what are the non-modifiable and modifiable risk factors in hypertension these are the non-modifiable risk factors that is age, gender, genetic factors and ethnicity that is increase in age increases blood pressure males have higher blood pressure and there are certain exceptions that is post menopausal women have high blood pressure genetic factors family history of high potential will have an impact on the blood pressure same way ethnicity certain race are prone to get high blood pressure then modifiable risk factors include obesity salt intake more than 5 grams per day saturated fat intake increases blood pressure dietary fiber alcohol intake also increases blood pressure increased heart rate also increases blood pressure decreased physical activity stress and socioeconomic status are included under modifiable risk factors for hypertension. Now what is the primary prevention of hypertension all measures taken to reduce the incidence of hypertension in population by reducing the risk of onset will be considered as primary prevention so we have two strategies for that that is population strategy and high risk strategy population strategy includes proper nutrition weight reduction exercise behavioral changes such as reduction of alcohol and smoking health education high risk strategy through tracking of blood pressure we can identify the people who are at risk or high risk so we can effectively implement the control strategies in them so the primary prevention of hypertension in aims at reducing the risk of onset of the disease it includes population strategy and high risk strategy now what is the secondary prevention of hypertension the goal of secondary prevention is to detect and control high blood pressure in affected individuals we have three strategies for that one is early case detection second one is treatment and patient compliance under early case detection we need to screen the population effectively and under treatment the effective treatment means the aim of the treatment is to bring down the BP to less than 120 bar 80 millimeter of mercury the extent to which the patient behavior coincides with the clinical prescription that is called as patient compliance so early case detection treatment patient compliance all are included under secondary prevention now the next question is what is non-pharmacological or lifestyle approach for hypertension number one is the weight reduction the most effective method and we need to adapt dash heating program that is dietary approach to stop hypertension eating plan then dietary sodium reduction is also important physical activity moderate consumption of alcohol all are included under lifestyle approach or non-pharmacological approach for management of hypertension now what are the common drugs available for treatment of hypertension mostly they will ask about the first line drug so the first line drug will be ac inhibitors or angiotensin receptor blockers or ARBs all prills are ac inhibitors all sawtons are angiotensin receptor blockers so we have angiotensin converting enzyme inhibitors or ARBs and we have beta blockers calcium channel blockers and diuretics so A, B, C, D will be the acronym to remember the common drugs used for the treatment of hypertension A stands for angiotensin antagonists B stands for beta blockers example latinal l C stands for calcium channel blockers example amnodipine D stands for diuretics example chlor thalidone now what are all the complications of hypertension we have macro vascular and micro vascular complications macro vascular complications include the atherosclerotic complications which leads to the coronary heart disease or ischemic heart disease stroke and peripheral vascular diseases we have micro vascular complications that include renal failure retinal damage and neuropathies these are all the common micro vascular and macro vascular complications of hypertension now what is syndrome X or metabolic syndrome syndrome X is a clustering of problems associated with resistance to insulin thereby causing hyper insulinemia which also includes obesity high central S so the distribution of fat is intra and periabdominal associated with hypertension dyslipidemia and also sometimes hyper muricemia so the insulin resistance predisposes to hyperglycemia thereby resulting in hyper insulinemia hyper triglycidemia and increased sodium retention thereby causing hypertension that is the mechanism of hypertension in syndrome X or metabolic syndrome high levels of insulin can stimulate endothelial proliferation to initiate atherosclerosis also what are the dietary approaches for treatment for hypertension what is dash therapy dash therapy means dietary approaches to stop hypertension which is the diet rich in fiber whole grain cereals fruits and vegetables low in dairy products fried foods unsaturated and trans fats intake of not more than 5 grams per day of salt avoid eating salty foods like puppet pickles avoid sprinkling extra salt over food and avoidance of smoking and alcohol all are included under dash therapy so you can refer this image you can read so thanks for watching this video if you like this video please click on the like button share it to your friends if you haven't subscribed the channel please subscribe to it thanks again