JNTU Pharm. D II Year PHARMACOTHERAPEUTICS-I Previous Question Paper (November/December - 2021 - R08)

Hypertension, if left uncontrolled, leads to significant end-organ damage due to sustained high pressure on the arterial walls. The primary complications include:

• Cardiovascular complications: Left ventricular hypertrophy, which progresses to heart failure, coronary artery disease, myocardial infarction, and sudden cardiac death.
• Cerebrovascular complications: Increased risk of ischemic or hemorrhagic stroke and transient ischemic attacks. Chronic hypertension can also lead to vascular dementia.
• Renal complications: Hypertensive nephrosclerosis, which causes chronic kidney disease and can eventually progress to end-stage renal disease.
• Ocular complications: Hypertensive retinopathy, characterized by retinal hemorrhages, exudates, and papilledema, which can lead to vision loss.
• Peripheral artery disease: Damage to the peripheral vasculature leading to intermittent claudication and aortic dissection.

Hypertension is categorized into two main types based on its etiology:

• Primary (Essential) Hypertension: This accounts for 90-95% of cases. The exact cause is idiopathic, but it is strongly associated with a combination of genetic factors and lifestyle influences, including high sodium intake, obesity, physical inactivity, excessive alcohol consumption, and chronic stress.
• Secondary Hypertension: This accounts for 5-10% of cases and results from an identifiable underlying medical condition, such as:
  • Renal diseases: Chronic kidney disease, renal artery stenosis, or polycystic kidney disease.
  • Endocrine disorders: Primary aldosteronism (Conn's syndrome), Cushing's syndrome, pheochromocytoma, or thyroid dysfunction.
  • Drug-induced: Use of oral contraceptives, NSAIDs, corticosteroids, or sympathomimetics.
  • Structural/Other: Coarctation of the aorta, obstructive sleep apnea, or pregnancy-induced hypertension.