Orris

Create a super aesthetic, handwritten-style revision note page for the topic: [Hypertension]. Make it look like neat exam notes written on a page (top view, clean layout, colorful headings, underlines, boxes). Keep it crisp, high-yield, and exam-oriented. Use clear headings and organize content like this (modify if needed for topic): Definition Etiology Pathogenesis (flow/arrow style) Clinical features Key features Differential diagnosis Management Complications Key points / last-minute revision box Add simple diagrams or labeled sketches wherever helpful. Highlight important keywords. Include one memory trick / one-line summary Keep handwriting-style fonts, pastel colors, and clean spacing

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Running Command

mkdir -p /home/daytona/workspace/hypertension-notes && ls /home/daytona/workspace/hypertension-notes/

Writing File

~/hypertension-notes/hypertension_notes.html

<!DOCTYPE html>
<html lang="en">
<head>
<meta charset="UTF-8">
<meta name="viewport" content="width=device-width, initial-scale=1.0">
<title>Hypertension – Revision Notes</title>
<link href="https://fonts.googleapis.com/css2?family=Caveat:wght@400;500;600;700&family=Patrick+Hand&family=Kalam:wght@300;400;700&display=swap" rel="stylesheet">
<style>
  :root {
    --paper: #FFFEF5;
    --line: #e8e0d5;
    --pink:   #FF6B8A;
    --blue:   #4A90D9;
    --green:  #52B788;
    --orange: #F4845F;
    --purple: #9B72CF;
    --yellow: #FFD166;
    --red:    #EF476F;
    --teal:   #06D6A0;
    --ink:    #2d2d2d;

    --bg-pink:   #FFF0F3;
    --bg-blue:   #EFF6FF;
    --bg-green:  #EEFAF4;
    --bg-orange: #FFF4F0;
    --bg-purple: #F6F0FF;
    --bg-yellow: #FFFAE8;
    --bg-teal:   #EDFAF6;
  }

  * { box-sizing: border-box; margin: 0; padding: 0; }

  body {
    background: #e9e5de;
    font-family: 'Kalam', cursive;
    color: var(--ink);
    padding: 30px 20px 60px;
  }

  .page {
    max-width: 880px;
    margin: 0 auto;
    background: var(--paper);
    border-radius: 4px;
    box-shadow: 0 4px 24px rgba(0,0,0,0.18), 0 1px 4px rgba(0,0,0,0.12);
    padding: 48px 52px 60px;
    position: relative;
    /* lined paper effect */
    background-image:
      repeating-linear-gradient(
        transparent,
        transparent 31px,
        var(--line) 31px,
        var(--line) 32px
      );
    background-size: 100% 32px;
    background-attachment: local;
  }

  /* Red margin line */
  .page::before {
    content: '';
    position: absolute;
    left: 88px;
    top: 0; bottom: 0;
    width: 2px;
    background: rgba(255,100,100,0.22);
    border-radius: 1px;
  }

  /* Spiral holes */
  .holes {
    position: absolute;
    left: 16px;
    top: 60px;
    display: flex;
    flex-direction: column;
    gap: 54px;
  }
  .hole {
    width: 18px; height: 18px;
    border-radius: 50%;
    background: #e9e5de;
    border: 1.5px solid #c9c2b8;
    box-shadow: inset 0 1px 3px rgba(0,0,0,0.15);
  }

  /* ── Title ── */
  .title-block {
    text-align: center;
    margin-bottom: 28px;
    padding-bottom: 10px;
  }
  .subject-tag {
    font-family: 'Caveat', cursive;
    font-size: 13px;
    letter-spacing: 3px;
    text-transform: uppercase;
    color: var(--purple);
    background: var(--bg-purple);
    display: inline-block;
    padding: 2px 14px;
    border-radius: 20px;
    margin-bottom: 6px;
  }
  .main-title {
    font-family: 'Caveat', cursive;
    font-size: 52px;
    font-weight: 700;
    color: var(--red);
    letter-spacing: -1px;
    line-height: 1.1;
    text-decoration: underline;
    text-underline-offset: 6px;
    text-decoration-color: var(--pink);
  }
  .subtitle {
    font-family: 'Patrick Hand', cursive;
    font-size: 15px;
    color: #888;
    margin-top: 4px;
  }

  /* ── Section Cards ── */
  .section {
    margin-bottom: 26px;
    border-radius: 12px;
    padding: 16px 20px 14px;
    position: relative;
  }

  .section-heading {
    font-family: 'Caveat', cursive;
    font-size: 24px;
    font-weight: 700;
    margin-bottom: 10px;
    display: flex;
    align-items: center;
    gap: 8px;
  }

  .section-heading::after {
    content: '';
    flex: 1;
    height: 2px;
    border-radius: 2px;
    opacity: 0.5;
    margin-left: 6px;
  }

  /* Color themes per section */
  .def    { background: var(--bg-blue);   border-left: 5px solid var(--blue);   }
  .def   .section-heading { color: var(--blue); }
  .def   .section-heading::after { background: var(--blue); }

  .etio   { background: var(--bg-orange); border-left: 5px solid var(--orange); }
  .etio  .section-heading { color: var(--orange); }
  .etio  .section-heading::after { background: var(--orange); }

  .patho  { background: var(--bg-purple); border-left: 5px solid var(--purple); }
  .patho .section-heading { color: var(--purple); }
  .patho .section-heading::after { background: var(--purple); }

  .clin   { background: var(--bg-pink);   border-left: 5px solid var(--pink);   }
  .clin  .section-heading { color: var(--pink); }
  .clin  .section-heading::after { background: var(--pink); }

  .ddx    { background: var(--bg-teal);   border-left: 5px solid var(--teal);   }
  .ddx   .section-heading { color: #00a083); }
  .ddx   .section-heading { color: var(--teal); }
  .ddx   .section-heading::after { background: var(--teal); }

  .mgmt   { background: var(--bg-green);  border-left: 5px solid var(--green);  }
  .mgmt  .section-heading { color: var(--green); }
  .mgmt  .section-heading::after { background: var(--green); }

  .comp   { background: var(--bg-orange); border-left: 5px solid var(--red);    }
  .comp  .section-heading { color: var(--red); }
  .comp  .section-heading::after { background: var(--red); }

  .keybox { background: #FFFAE8; border: 2.5px dashed var(--yellow); }
  .keybox .section-heading { color: #c98b00; }
  .keybox .section-heading::after { background: var(--yellow); }

  /* ── Text Elements ── */
  ul { padding-left: 20px; }
  li {
    font-family: 'Kalam', cursive;
    font-size: 15.5px;
    line-height: 1.75;
    list-style: none;
    padding-left: 4px;
  }
  li::before {
    content: '→  ';
    font-weight: 700;
    opacity: 0.7;
  }

  .hl-pink   { background: #FFD6E0; border-radius: 3px; padding: 1px 4px; font-weight: 700; }
  .hl-yellow { background: #FFF4A8; border-radius: 3px; padding: 1px 4px; font-weight: 700; }
  .hl-green  { background: #C8F5DF; border-radius: 3px; padding: 1px 4px; font-weight: 700; }
  .hl-blue   { background: #C8E4FF; border-radius: 3px; padding: 1px 4px; font-weight: 700; }
  .hl-purple { background: #E5D5FF; border-radius: 3px; padding: 1px 4px; font-weight: 700; }
  .hl-orange { background: #FFE0CC; border-radius: 3px; padding: 1px 4px; font-weight: 700; }
  .hl-red    { background: #FFCCD6; border-radius: 3px; padding: 1px 4px; font-weight: 700; }

  .underline { text-decoration: underline; text-underline-offset: 3px; }

  /* ── Classification Table ── */
  .class-table {
    width: 100%;
    border-collapse: collapse;
    font-family: 'Kalam', cursive;
    font-size: 14.5px;
    margin-top: 8px;
    border-radius: 8px;
    overflow: hidden;
  }
  .class-table th {
    background: var(--blue);
    color: white;
    padding: 6px 10px;
    text-align: left;
    font-family: 'Caveat', cursive;
    font-size: 16px;
    font-weight: 700;
  }
  .class-table td {
    padding: 5px 10px;
    border-bottom: 1px dashed #ccc;
  }
  .class-table tr:nth-child(even) td { background: rgba(74,144,217,0.08); }
  .class-table tr:last-child td { border-bottom: none; }
  .normal-row td { color: var(--green); font-weight: 700; }
  .elevated-row td { color: #E09830; font-weight: 700; }
  .stage1-row td { color: var(--orange); font-weight: 700; }
  .stage2-row td { color: var(--red); font-weight: 700; }
  .crisis-row td { color: var(--red); font-weight: 700; background: #FFEEF1 !important; }

  /* ── Flow Diagram ── */
  .flow {
    display: flex;
    flex-direction: column;
    align-items: flex-start;
    gap: 2px;
    margin-top: 6px;
    font-family: 'Kalam', cursive;
    font-size: 14.5px;
  }
  .flow-step {
    display: flex;
    align-items: center;
    gap: 8px;
  }
  .flow-box {
    padding: 5px 14px;
    border-radius: 20px;
    font-weight: 600;
    white-space: nowrap;
  }
  .flow-arrow {
    font-size: 22px;
    color: var(--purple);
    line-height: 1;
    margin: 0 4px;
    font-weight: 700;
  }
  .flow-label {
    font-size: 12px;
    color: #888;
    font-style: italic;
    margin-left: 6px;
  }
  .fb1 { background: #E5D5FF; color: #6B3DC8; }
  .fb2 { background: #C8E4FF; color: #1E6FAA; }
  .fb3 { background: #FFE0CC; color: #B85C1A; }
  .fb4 { background: #FFD6E0; color: #C02050; }
  .fb5 { background: #C8F5DF; color: #1A7A4A; }
  .fb6 { background: #FFF4A8; color: #8A6800; }

  /* Two-column layout */
  .two-col {
    display: grid;
    grid-template-columns: 1fr 1fr;
    gap: 16px;
  }

  /* ── Sketch Diagram ── */
  .sketch-area {
    background: white;
    border: 2px dashed #ccc;
    border-radius: 10px;
    padding: 14px;
    margin-top: 10px;
    font-family: 'Kalam', cursive;
    font-size: 13.5px;
    color: #555;
  }

  /* ── Organs diagram ── */
  .organs-grid {
    display: grid;
    grid-template-columns: repeat(3, 1fr);
    gap: 10px;
    margin-top: 8px;
  }
  .organ-box {
    border-radius: 10px;
    padding: 10px 12px;
    font-family: 'Kalam', cursive;
    font-size: 13.5px;
    line-height: 1.5;
  }
  .organ-box .organ-name {
    font-family: 'Caveat', cursive;
    font-size: 17px;
    font-weight: 700;
    margin-bottom: 3px;
    display: flex;
    align-items: center;
    gap: 5px;
  }
  .ob-brain  { background: #F0E8FF; border: 2px solid var(--purple); }
  .ob-heart  { background: #FFE8EC; border: 2px solid var(--pink);   }
  .ob-kidney { background: #E8F4FF; border: 2px solid var(--blue);   }
  .ob-eye    { background: #E8FFF4; border: 2px solid var(--green);  }
  .ob-vessel { background: #FFF4E0; border: 2px solid var(--orange); }
  .ob-brain  .organ-name { color: var(--purple); }
  .ob-heart  .organ-name { color: var(--pink);   }
  .ob-kidney .organ-name { color: var(--blue);   }
  .ob-eye    .organ-name { color: var(--green);  }
  .ob-vessel .organ-name { color: var(--orange); }

  /* Drug boxes */
  .drug-grid {
    display: grid;
    grid-template-columns: repeat(2, 1fr);
    gap: 10px;
    margin-top: 8px;
  }
  .drug-box {
    border-radius: 10px;
    padding: 10px 14px;
    font-family: 'Kalam', cursive;
    font-size: 14px;
    line-height: 1.6;
  }
  .drug-box .drug-class {
    font-family: 'Caveat', cursive;
    font-size: 18px;
    font-weight: 700;
    margin-bottom: 4px;
  }
  .db1 { background: #E8FFF4; border: 2px solid var(--green);  }
  .db2 { background: #C8E4FF; border: 2px solid var(--blue);   }
  .db3 { background: #F0E8FF; border: 2px solid var(--purple); }
  .db4 { background: #FFE0CC; border: 2px solid var(--orange); }
  .db5 { background: #FFD6E0; border: 2px solid var(--pink);   }
  .db6 { background: #FFF4A8; border: 2px solid #c9a400;       }
  .db1 .drug-class { color: var(--green);  }
  .db2 .drug-class { color: var(--blue);   }
  .db3 .drug-class { color: var(--purple); }
  .db4 .drug-class { color: var(--orange); }
  .db5 .drug-class { color: var(--pink);   }
  .db6 .drug-class { color: #9A7000;       }

  /* Memory trick */
  .memory-trick {
    background: linear-gradient(135deg, #FFF9E6, #FFECB3);
    border: 2.5px solid var(--yellow);
    border-radius: 14px;
    padding: 16px 20px;
    margin-top: 12px;
    font-family: 'Caveat', cursive;
    font-size: 20px;
    color: #7A5800;
    text-align: center;
    box-shadow: 0 2px 8px rgba(255,209,0,0.2);
  }
  .memory-trick .label {
    font-size: 13px;
    letter-spacing: 2px;
    text-transform: uppercase;
    color: #c98b00;
    margin-bottom: 4px;
    font-family: 'Patrick Hand', cursive;
  }

  /* ── Stars / bullet deco ── */
  .star::before { content: '★ '; color: var(--yellow); }
  .check::before { content: '✓ '; color: var(--green); font-weight: 700; }
  .warn::before { content: '⚠ '; color: var(--orange); }
  .cross::before { content: '✕ '; color: var(--red); }
  .pin::before { content: '📌 '; }

  /* ── One-line summary banner ── */
  .summary-banner {
    background: linear-gradient(90deg, var(--red), var(--pink));
    color: white;
    border-radius: 10px;
    padding: 12px 20px;
    font-family: 'Caveat', cursive;
    font-size: 21px;
    font-weight: 700;
    margin: 20px 0 8px;
    text-align: center;
    box-shadow: 0 3px 10px rgba(239,71,111,0.3);
  }
  .summary-banner span { opacity: 0.85; font-size: 14px; font-family: 'Patrick Hand', cursive; display: block; margin-top: 2px; }

  /* Small note text */
  .note-text {
    font-family: 'Patrick Hand', cursive;
    font-size: 13px;
    color: #888;
    margin-top: 6px;
    font-style: italic;
  }

  /* Divider */
  .divider {
    border: none;
    border-top: 2px dashed var(--line);
    margin: 20px 0;
  }

  /* Corner stamp */
  .date-stamp {
    position: absolute;
    top: 20px;
    right: 52px;
    font-family: 'Caveat', cursive;
    font-size: 13px;
    color: #bbb;
    text-align: right;
  }

  /* SVG inline diagrams */
  svg.diagram {
    display: block;
    max-width: 100%;
    margin: 10px auto;
  }

  .raas-flow {
    display: flex;
    align-items: center;
    flex-wrap: wrap;
    gap: 0;
    margin: 10px 0;
    font-family: 'Kalam', cursive;
    font-size: 13px;
  }
  .raas-box {
    background: white;
    border: 2px solid var(--purple);
    border-radius: 8px;
    padding: 5px 10px;
    color: #6B3DC8;
    font-weight: 700;
    white-space: nowrap;
  }
  .raas-arrow {
    color: var(--purple);
    font-size: 18px;
    padding: 0 4px;
    font-weight: 700;
  }
  .raas-label {
    font-size: 11px;
    color: #888;
    display: block;
    text-align: center;
    font-style: italic;
  }

  .indent { margin-left: 22px; }

  @media print {
    body { background: white; padding: 0; }
    .page { box-shadow: none; }
  }
</style>
</head>
<body>

<div class="page">

  <!-- Spiral holes decoration -->
  <div class="holes">
    <div class="hole"></div><div class="hole"></div><div class="hole"></div>
    <div class="hole"></div><div class="hole"></div><div class="hole"></div>
    <div class="hole"></div><div class="hole"></div><div class="hole"></div>
    <div class="hole"></div><div class="hole"></div>
  </div>

  <!-- Date stamp -->
  <div class="date-stamp">📅 May 2026<br>Cardiology · Medicine</div>

  <!-- ══════════════════════════════════ TITLE ══════════════════════════════════ -->
  <div class="title-block">
    <div class="subject-tag">📋 High-Yield Revision Notes</div>
    <div class="main-title">🩺 HYPERTENSION</div>
    <div class="subtitle">Harrison's 22e · Brenner & Rector · Fuster's Heart · JNC / ACC-AHA 2017</div>
  </div>

  <!-- ONE-LINE SUMMARY BANNER -->
  <div class="summary-banner">
    💡 "BP ≥ 130/80 mmHg = HTN → Silent killer → ABCD drugs → prevent CHKRE damage"
    <span>Cardiac Output × Peripheral Resistance = Blood Pressure</span>
  </div>

  <!-- ══════════════════════════════ DEFINITION ══════════════════════════════ -->
  <div class="section def">
    <div class="section-heading">📖 Definition &amp; Classification</div>

    <p style="font-size:15.5px; margin-bottom:10px;">
      <span class="hl-blue">Hypertension</span> = sustained elevation of systemic arterial blood pressure above normal thresholds, 
      associated with increased risk of <span class="hl-pink">CVD, stroke, CKD, and death</span>.
    </p>

    <table class="class-table">
      <thead>
        <tr><th>Category (ACC/AHA 2017)</th><th>SBP (mmHg)</th><th>DBP (mmHg)</th></tr>
      </thead>
      <tbody>
        <tr class="normal-row"><td>Normal</td><td>&lt; 120</td><td>&lt; 80</td></tr>
        <tr class="elevated-row"><td>Elevated</td><td>120 – 129</td><td>&lt; 80</td></tr>
        <tr class="stage1-row"><td>Stage 1 HTN</td><td>130 – 139</td><td>80 – 89</td></tr>
        <tr class="stage2-row"><td>Stage 2 HTN</td><td>≥ 140</td><td>≥ 90</td></tr>
        <tr class="crisis-row"><td>⚡ Hypertensive Crisis</td><td>≥ 180</td><td>≥ 120</td></tr>
      </tbody>
    </table>

    <p class="note-text">* Old JNC 7: Stage 1 ≥ 140/90. ACC/AHA 2017 lowered threshold to 130/80 ← often tested!</p>

    <ul style="margin-top:8px;">
      <li><span class="hl-yellow">Hypertensive Urgency</span> — BP ≥ 180/120, <span class="underline">no</span> acute target-organ damage</li>
      <li><span class="hl-red">Hypertensive Emergency</span> — BP ≥ 180/120 <span class="underline">WITH</span> acute end-organ damage → ICU</li>
      <li>Isolated Systolic HTN (ISH) — SBP ≥ 130, DBP &lt; 80 → most common in elderly</li>
    </ul>
  </div>

  <!-- ══════════════════════════════ ETIOLOGY ══════════════════════════════ -->
  <div class="section etio">
    <div class="section-heading">🔍 Etiology</div>
    <div class="two-col">
      <div>
        <p style="font-family:'Caveat',cursive; font-size:18px; font-weight:700; color:var(--orange); margin-bottom:5px;">Primary (Essential) HTN — 90–95%</p>
        <ul>
          <li class="check">Genetic predisposition (polygenic)</li>
          <li class="check">High <span class="hl-yellow">salt &amp; sodium</span> intake</li>
          <li class="check">Obesity / central adiposity</li>
          <li class="check">Physical inactivity</li>
          <li class="check">Chronic stress / psychosocial</li>
          <li class="check">Alcohol excess (≥3 drinks/day)</li>
          <li class="check">Ageing → ↑ arterial stiffness</li>
        </ul>
      </div>
      <div>
        <p style="font-family:'Caveat',cursive; font-size:18px; font-weight:700; color:var(--red); margin-bottom:5px;">Secondary HTN — 5–10% ⚠</p>
        <ul>
          <li class="warn"><span class="hl-pink">Renovascular</span> — renal artery stenosis</li>
          <li class="warn"><span class="hl-blue">CKD</span> / parenchymal renal disease</li>
          <li class="warn"><span class="hl-purple">Hyperaldosteronism</span> (Conn's)</li>
          <li class="warn">Phaeochromocytoma (paroxysmal!)</li>
          <li class="warn">Cushing's syndrome</li>
          <li class="warn">Obstructive sleep apnoea (OSA)</li>
          <li class="warn">Coarctation of aorta (young)</li>
          <li class="warn">Drugs: NSAIDs, OCP, steroids, cocaine</li>
        </ul>
      </div>
    </div>
    <div class="memory-trick" style="margin-top:10px; font-size:16px; padding:10px 16px;">
      <div class="label">🧠 Mnemonic — Secondary HTN causes</div>
      <strong>"ABCDE"</strong> → <span style="color:var(--orange);">A</span>ldosteronism · <span style="color:var(--orange);">B</span>P drugs / OSA · <span style="color:var(--orange);">C</span>oarctation / Cushing's · <span style="color:var(--orange);">D</span>iabetes / renal · <span style="color:var(--orange);">E</span>ndocrine (Pheo, thyroid)
    </div>
  </div>

  <!-- ══════════════════════════════ PATHOGENESIS ══════════════════════════════ -->
  <div class="section patho">
    <div class="section-heading">⚙️ Pathogenesis</div>

    <p style="font-family:'Caveat',cursive; font-size:16px; color:var(--purple); font-weight:700; margin-bottom:6px;">🔵 BP = Cardiac Output × Total Peripheral Resistance</p>

    <!-- RAAS Cascade -->
    <p style="font-family:'Caveat',cursive; font-size:15px; color:#6B3DC8; font-weight:600; margin-bottom:6px;">① RAAS Activation Cascade:</p>
    <div class="raas-flow">
      <div>
        <div class="raas-box">Angiotensinogen<br><span class="raas-label">liver</span></div>
      </div>
      <span class="raas-arrow">→<br><span style="font-size:10px; color:#888;">Renin<br>(kidney)</span></span>
      <div>
        <div class="raas-box">Angiotensin I<br><span class="raas-label">inactive</span></div>
      </div>
      <span class="raas-arrow">→<br><span style="font-size:10px; color:#888;">ACE<br>(lung)</span></span>
      <div>
        <div class="raas-box" style="border-color:var(--red); color:var(--red);">Angiotensin II<br><span class="raas-label" style="color:var(--red);">ACTIVE ⚡</span></div>
      </div>
      <span class="raas-arrow" style="color:var(--red);">→</span>
      <div style="font-family:'Kalam',cursive; font-size:12.5px; color:#555; line-height:1.6; max-width:130px;">
        ↑ Vasoconstriction<br>
        ↑ Aldosterone → Na⁺ retention<br>
        ↑ ADH → H₂O retention<br>
        → ↑ BP 📈
      </div>
    </div>

    <!-- Flow chart style -->
    <p style="font-family:'Caveat',cursive; font-size:15px; color:#6B3DC8; font-weight:600; margin: 10px 0 6px;">② Sympathetic Nervous System:</p>
    <div class="flow">
      <div class="flow-step">
        <div class="flow-box fb1">Stress / Pain / Catecholamines</div>
        <span class="flow-arrow">↓</span>
        <div class="flow-box fb2">↑ HR &amp; contractility (↑ CO)</div>
        <span class="flow-arrow">+</span>
        <div class="flow-box fb3">↑ Arteriolar tone (↑ TPR)</div>
        <span class="flow-arrow">→</span>
        <div class="flow-box fb4">↑ BP</div>
      </div>
    </div>

    <p style="font-family:'Caveat',cursive; font-size:15px; color:#6B3DC8; font-weight:600; margin: 10px 0 6px;">③ Endothelial Dysfunction:</p>
    <div class="flow">
      <div class="flow-step">
        <div class="flow-box fb2">↓ Nitric Oxide (NO)</div>
        <span class="flow-arrow">+</span>
        <div class="flow-box fb3">↑ Endothelin-1</div>
        <span class="flow-arrow">+</span>
        <div class="flow-box fb4">↑ ROS / inflammation</div>
        <span class="flow-arrow">→</span>
        <div class="flow-box fb4">Vascular remodelling</div>
      </div>
    </div>

    <div class="sketch-area" style="margin-top:10px;">
      <!-- SVG BP control diagram -->
      <svg class="diagram" width="600" height="130" viewBox="0 0 600 130">
        <!-- Central BP box -->
        <rect x="230" y="45" width="140" height="44" rx="12" fill="#E5D5FF" stroke="#9B72CF" stroke-width="2.5"/>
        <text x="300" y="64" text-anchor="middle" font-family="Kalam, cursive" font-size="15" fill="#6B3DC8" font-weight="700">Blood Pressure</text>
        <text x="300" y="82" text-anchor="middle" font-family="Kalam, cursive" font-size="13" fill="#9B72CF">= CO × TPR</text>

        <!-- Left: Cardiac Output -->
        <rect x="20" y="45" width="140" height="44" rx="12" fill="#C8E4FF" stroke="#4A90D9" stroke-width="2.5"/>
        <text x="90" y="64" text-anchor="middle" font-family="Kalam, cursive" font-size="14" fill="#1E6FAA" font-weight="700">Cardiac Output</text>
        <text x="90" y="82" text-anchor="middle" font-family="Kalam, cursive" font-size="12" fill="#4A90D9">HR × Stroke Volume</text>
        <line x1="160" y1="67" x2="228" y2="67" stroke="#4A90D9" stroke-width="2" marker-end="url(#arrowB)"/>
        <text x="194" y="60" text-anchor="middle" font-family="Kalam, cursive" font-size="12" fill="#888">×</text>

        <!-- Right: TPR -->
        <rect x="440" y="45" width="150" height="44" rx="12" fill="#FFE0CC" stroke="#F4845F" stroke-width="2.5"/>
        <text x="515" y="64" text-anchor="middle" font-family="Kalam, cursive" font-size="14" fill="#B85C1A" font-weight="700">Total Periph. R</text>
        <text x="515" y="82" text-anchor="middle" font-family="Kalam, cursive" font-size="12" fill="#F4845F">arteriole tone</text>
        <line x1="370" y1="67" x2="438" y2="67" stroke="#F4845F" stroke-width="2"/>
        <text x="404" y="60" text-anchor="middle" font-family="Kalam, cursive" font-size="12" fill="#888">×</text>

        <!-- Top: RAAS -->
        <rect x="200" y="0" width="200" height="34" rx="10" fill="#C8F5DF" stroke="#52B788" stroke-width="2"/>
        <text x="300" y="22" text-anchor="middle" font-family="Kalam, cursive" font-size="14" fill="#1A7A4A" font-weight="700">RAAS / SNS activation</text>
        <line x1="300" y1="34" x2="300" y2="44" stroke="#52B788" stroke-width="2"/>

        <!-- Bottom: End organ -->
        <rect x="190" y="100" width="220" height="28" rx="10" fill="#FFCCD6" stroke="#EF476F" stroke-width="2"/>
        <text x="300" y="119" text-anchor="middle" font-family="Kalam, cursive" font-size="14" fill="#C02050" font-weight="700">⚡ Target Organ Damage</text>
        <line x1="300" y1="89" x2="300" y2="99" stroke="#EF476F" stroke-width="2"/>

        <!-- Arrow markers -->
        <defs>
          <marker id="arrowB" markerWidth="8" markerHeight="8" refX="6" refY="3" orient="auto">
            <path d="M0,0 L0,6 L8,3 z" fill="#4A90D9"/>
          </marker>
        </defs>
      </svg>
    </div>
  </div>

  <!-- ══════════════════════════════ CLINICAL FEATURES ══════════════════════════════ -->
  <div class="section clin">
    <div class="section-heading">🩻 Clinical Features</div>
    <div class="two-col">
      <div>
        <p style="font-family:'Caveat',cursive; font-size:17px; font-weight:700; color:var(--pink); margin-bottom:6px;">Symptoms <span style="font-size:13px; color:#888;">(often NONE — "silent killer")</span></p>
        <ul>
          <li class="star"><span class="hl-pink">Headache</span> — occipital, worse on waking</li>
          <li>Dizziness / vertigo</li>
          <li>Tinnitus</li>
          <li>Epistaxis (nosebleeds)</li>
          <li>Visual blurring / spots</li>
          <li>Palpitations / chest discomfort</li>
          <li>Dyspnoea on exertion</li>
          <li class="warn">Hypertensive emergency: <span class="hl-red">confusion, seizures, papilloedema</span></li>
        </ul>
      </div>
      <div>
        <p style="font-family:'Caveat',cursive; font-size:17px; font-weight:700; color:var(--pink); margin-bottom:6px;">Examination Signs</p>
        <ul>
          <li class="star">Elevated BP on ≥ 2 occasions</li>
          <li><span class="hl-yellow">Fundoscopy</span> — AV nipping, flame haemorrhages, papilloedema (Keith-Wagener grading)</li>
          <li>Displaced apex beat (LVH)</li>
          <li>S4 gallop (non-compliant LV)</li>
          <li>Bruit — renal artery stenosis</li>
          <li>Radio-femoral delay → coarctation</li>
          <li><span class="hl-blue">Ankle-brachial index</span> → PAD</li>
        </ul>

        <div class="sketch-area" style="margin-top:10px; padding:10px 12px;">
          <p style="font-family:'Caveat',cursive; font-size:15px; font-weight:700; color:#C02050; margin-bottom:5px;">✏ KW Fundoscopic Grading:</p>
          <div style="font-size:13px; line-height:1.8; color:#444;">
            <b>Grade I</b> — Silver wiring (↑ light reflex)<br>
            <b>Grade II</b> — AV nipping / nicking<br>
            <b>Grade III</b> — Flame haemorrhages + exudates<br>
            <b style="color:var(--red);">Grade IV</b> — Papilloedema ← Hypertensive Emergency!
          </div>
        </div>
      </div>
    </div>
  </div>

  <!-- ══════════════════════════════ KEY FEATURES ══════════════════════════════ -->
  <div class="section" style="background:var(--bg-yellow); border-left:5px solid #c9a400;">
    <div class="section-heading" style="color:#9A7000;">🔑 Key Features / Exam Facts</div>
    <div class="two-col">
      <ul>
        <li class="star">Leading cause of CVD globally</li>
        <li class="star">Most common reason for primary care visits worldwide</li>
        <li class="pin">Whites: RAAS-mediated → ACEi/ARB best</li>
        <li class="pin">Black patients: salt-sensitive → <span class="hl-green">Thiazides + CCBs best</span></li>
        <li>Resistant HTN = BP uncontrolled on ≥ 3 drugs (incl. diuretic)</li>
        <li>White coat HTN → ambulatory monitoring to exclude</li>
      </ul>
      <ul>
        <li class="star">Treat BP goal: <span class="hl-pink">&lt; 130/80 mmHg</span> (ACC/AHA 2017)</li>
        <li class="check">CKD + proteinuria → ACEI/ARB mandatory</li>
        <li class="check">Pregnancy HTN → <span class="hl-blue">Labetalol / Methyldopa / Nifedipine</span></li>
        <li class="warn">ACEi + ARB combination = <span class="hl-red">CONTRAINDICATED</span></li>
        <li class="warn">Beta-blockers avoided in asthma / COPD</li>
        <li>Isolated SBP rise in elderly → ↑ pulse pressure → atherosclerosis</li>
      </ul>
    </div>
  </div>

  <!-- ══════════════════════════════ DIFFERENTIAL DIAGNOSIS ══════════════════════════════ -->
  <div class="section ddx">
    <div class="section-heading">🔎 Differential Diagnosis</div>
    <div class="two-col">
      <ul>
        <li>White coat hypertension</li>
        <li><span class="hl-green">Phaeochromocytoma</span> — paroxysmal HTN + palpitations + diaphoresis</li>
        <li>Renovascular HTN — flank bruit, young female / smoker</li>
        <li>Primary hyperaldosteronism (Conn's) — hypokalaemia + HTN</li>
      </ul>
      <ul>
        <li>Cushing's — central obesity + striae</li>
        <li>Coarctation of aorta — radio-femoral delay, young</li>
        <li>Hyperthyroidism — systolic HTN + ↑ pulse pressure</li>
        <li>OSA — morning headaches + snoring + resistant HTN</li>
      </ul>
    </div>
    <div class="sketch-area" style="margin-top:8px;">
      <p style="font-family:'Caveat',cursive; font-size:14px; color:#888; margin-bottom:5px;">🔬 Screening Tests for Secondary HTN:</p>
      <div style="font-size:13.5px; line-height:1.8; color:#444;">
        <b>Renal artery stenosis</b> → Renal duplex ultrasound / MRA<br>
        <b>Phaeochromocytoma</b> → 24h urine metanephrines / plasma fractionated metanephrines<br>
        <b>Conn's syndrome</b> → Aldosterone:Renin ratio (ARR) > 30<br>
        <b>Cushing's</b> → 24h urinary cortisol / overnight dexamethasone suppression test<br>
        <b>CKD</b> → eGFR, serum creatinine, urine ACR
      </div>
    </div>
  </div>

  <!-- ══════════════════════════════ MANAGEMENT ══════════════════════════════ -->
  <div class="section mgmt">
    <div class="section-heading">💊 Management</div>

    <p style="font-family:'Caveat',cursive; font-size:17px; font-weight:700; color:var(--green); margin-bottom:6px;">① Non-Pharmacological (all patients)</p>
    <ul>
      <li class="check"><span class="hl-green">DASH diet</span> — rich in fruits, veg, low-fat dairy, ↓ sodium</li>
      <li class="check">Na⁺ restriction &lt; 2.3g/day (↓ SBP ~5 mmHg)</li>
      <li class="check">Weight loss: every 1kg lost → ↓ ~1 mmHg SBP</li>
      <li class="check">Aerobic exercise ≥ 30 min, 5× per week</li>
      <li class="check">Limit alcohol: ≤ 2 drinks/day (men), ≤ 1 (women)</li>
      <li class="check">Smoking cessation (CVD risk, not direct BP)</li>
    </ul>

    <p style="font-family:'Caveat',cursive; font-size:17px; font-weight:700; color:var(--green); margin: 10px 0 6px;">② Pharmacological — First-line Drugs: <span class="hl-green">"ABCD"</span></p>

    <div class="drug-grid">
      <div class="drug-box db1">
        <div class="drug-class">A — ACE Inhibitors / ARBs</div>
        Ramipril, Lisinopril / Losartan, Valsartan<br>
        <span style="color:#888; font-size:12.5px;">↓ Ang II → vasodilation + ↓ aldosterone<br>
        Best: CKD, diabetes, HF, post-MI<br>
        ⚠ Avoid in pregnancy, bilateral RAS</span>
      </div>
      <div class="drug-box db2">
        <div class="drug-class">B — Beta-Blockers</div>
        Metoprolol, Carvedilol, Bisoprolol<br>
        <span style="color:#888; font-size:12.5px;">↓ HR + ↓ CO → ↓ BP<br>
        Best: post-MI, HF with ↓ EF, AF<br>
        ⚠ Avoid: asthma, heart block, Raynaud's</span>
      </div>
      <div class="drug-box db3">
        <div class="drug-class">C — Calcium Channel Blockers</div>
        Amlodipine (DHP), Verapamil (non-DHP)<br>
        <span style="color:#888; font-size:12.5px;">↓ Vascular smooth muscle tone<br>
        Best: elderly, Black patients, angina<br>
        ⚠ Non-DHP: avoid in HF + ↓ EF</span>
      </div>
      <div class="drug-box db4">
        <div class="drug-class">D — Diuretics (Thiazide-type)</div>
        Chlorthalidone (preferred), HCTZ, Indapamide<br>
        <span style="color:#888; font-size:12.5px;">↓ Na⁺/H₂O → ↓ plasma volume<br>
        Best: Black patients, elderly, ISH<br>
        ⚠ Hypo K⁺, hyperuricaemia, glucose ↑</span>
      </div>
      <div class="drug-box db5">
        <div class="drug-class">➕ Loop Diuretics</div>
        Furosemide, Torsemide<br>
        <span style="color:#888; font-size:12.5px;">For CKD (eGFR &lt;30), HF with fluid overload<br>Replace thiazide when GFR falls</span>
      </div>
      <div class="drug-box db6">
        <div class="drug-class">➕ MRAs / Others</div>
        Spironolactone, Eplerenone<br>
        <span style="color:#888; font-size:12.5px;">Resistant HTN (4th agent) ← most effective add-on<br>Also: Hydralazine, Minoxidil, Clonidine (2nd line)</span>
      </div>
    </div>

    <div class="sketch-area" style="margin-top:12px;">
      <p style="font-family:'Caveat',cursive; font-size:15px; font-weight:700; color:#1A7A4A; margin-bottom:6px;">📋 Compelling Indications Cheat Sheet:</p>
      <div style="font-size:13.5px; line-height:1.9; color:#333;">
        <b>Post-MI / IHD</b> → BB + ACEI/ARB ± Diuretic<br>
        <b>Heart Failure ↓ EF</b> → ACEI/ARB + BB + Spironolactone (+ SGLT2i if DM)<br>
        <b>Diabetes + CKD</b> → <span class="hl-green">ACEI or ARB mandatory</span> (renoprotection)<br>
        <b>Pregnancy</b> → <span class="hl-blue">Labetalol (1st) / Methyldopa / Nifedipine</span> — NO ACEI/ARB<br>
        <b>Stroke prevention</b> → Thiazide + ACEI (PROGRESS trial)<br>
        <b>Black patients</b> → Thiazide + CCB (first); ACEI less effective as monotherapy
      </div>
    </div>
  </div>

  <!-- ══════════════════════════════ COMPLICATIONS ══════════════════════════════ -->
  <div class="section comp">
    <div class="section-heading">💥 Complications — Target Organ Damage</div>

    <div class="organs-grid">
      <div class="organ-box ob-brain">
        <div class="organ-name">🧠 Brain</div>
        Ischaemic stroke<br>
        Haemorrhagic stroke<br>
        Hypertensive encephalopathy<br>
        <span class="hl-purple">Dementia</span> / cognitive decline
      </div>
      <div class="organ-box ob-heart">
        <div class="organ-name">❤️ Heart</div>
        <span class="hl-pink">LVH</span> → diastolic dysfunction<br>
        Coronary artery disease<br>
        Heart failure (systolic + diastolic)<br>
        Atrial fibrillation
      </div>
      <div class="organ-box ob-kidney">
        <div class="organ-name">🫘 Kidney</div>
        <span class="hl-blue">Hypertensive nephrosclerosis</span><br>
        Proteinuria → CKD → ESKD<br>
        ↓ eGFR (80–85% of advanced CKD)
      </div>
      <div class="organ-box ob-eye">
        <div class="organ-name">👁️ Eye</div>
        Hypertensive retinopathy<br>
        Grade III–IV changes<br>
        Visual loss, retinal detachment<br>
        <span class="hl-green">Papilloedema</span> (emergency)
      </div>
      <div class="organ-box ob-vessel">
        <div class="organ-name">🩸 Vessels</div>
        Aortic dissection<br>
        <span class="hl-orange">PAD</span> (2.5× ↑ risk men, 3.9× women)<br>
        Aortic aneurysm<br>
        Arterial stiffness ↑ PWV
      </div>
      <div class="organ-box" style="background:#FFF4E0; border:2px solid #c9a400;">
        <div class="organ-name" style="color:#9A7000;">⚡ HTN Emergency</div>
        <span style="font-size:12.5px; color:#555;">
        Malignant HTN<br>
        Acute pulmonary oedema<br>
        Acute MI / ACS<br>
        HELLP syndrome<br>
        Acute intracranial events<br>
        → IV sodium nitroprusside /<br>&nbsp;&nbsp; IV labetalol / nicardipine
        </span>
      </div>
    </div>

    <p class="note-text" style="margin-top:8px;">* HTN emergency: aim to ↓ BP by 25% in first hour, then gradually over 24h — NOT abrupt normalisation!</p>
  </div>

  <!-- ══════════════════════════════ LAST-MINUTE KEY POINTS BOX ══════════════════════════════ -->
  <div class="section keybox">
    <div class="section-heading">⭐ Last-Minute Revision Box</div>
    <div class="two-col">
      <ul>
        <li class="star"><span class="hl-yellow">HTN threshold</span> = ≥ 130/80 (ACC/AHA 2017)</li>
        <li class="star">BP = CO × TPR — know this cold</li>
        <li class="star">Primary HTN = 90–95%; secondary = 5–10%</li>
        <li class="star">Most common cause of secondary = <span class="hl-pink">CKD / renovascular</span></li>
        <li class="star">Paroxysmal HTN + sweating + palpitations = rule out <span class="hl-purple">Pheo</span></li>
        <li class="star">HTN + hypokalaemia = rule out <span class="hl-green">Conn's syndrome</span></li>
        <li class="star">Radio-femoral delay → <span class="hl-blue">Coarctation of aorta</span></li>
      </ul>
      <ul>
        <li class="star">ACEI + ARB together = <span class="hl-red">CONTRAINDICATED</span> (↑ AKI risk)</li>
        <li class="star">Best diuretic in advanced CKD = <span class="hl-orange">Loop diuretic</span></li>
        <li class="star">Spironolactone = best 4th agent in resistant HTN</li>
        <li class="star">Chlorthalidone > HCTZ (longer half-life, ↓ events)</li>
        <li class="star">Pregnancy: Labetalol/Methyldopa/Nifedipine. NO ACEI</li>
        <li class="star">HTN emergency: IV drugs, target ↓ 25% SBP in 1h</li>
        <li class="star">Grade IV retinopathy + HTN = hypertensive emergency</li>
      </ul>
    </div>
  </div>

  <!-- ══════════════════════════════ MEMORY TRICK ══════════════════════════════ -->
  <div class="memory-trick">
    <div class="label">✨ One-Line Summary + Memory Trick</div>
    <div style="font-size:22px; margin-bottom:6px;">"BP ≥ 130/80 → silent killer → ABCD drugs → target &lt; 130/80 → protect CHKRE"</div>
    <div style="font-size:16px; color:#9A6800;">
      <b>CHKRE</b> = <span style="color:var(--purple);">C</span>erebrovascular · <span style="color:var(--pink);">H</span>eart · <span style="color:var(--blue);">K</span>idney · <span style="color:var(--green);">R</span>etina · <span style="color:var(--orange);">E</span>ndarteries (vessels)
    </div>
    <div style="font-size:15px; color:#999; margin-top:5px;">
      Drug mnemonic: <b>A</b>CE/ARB · <b>B</b>eta-blocker · <b>C</b>CB · <b>D</b>iuretic (thiazide)
    </div>
  </div>

  <div style="text-align:center; margin-top:20px; font-family:'Patrick Hand',cursive; font-size:12px; color:#bbb;">
    Sources: Harrison's Principles 22e (2025) · Brenner &amp; Rector's The Kidney · Fuster's The Heart 15e · ACC/AHA 2017 HTN Guidelines
  </div>

</div><!-- end .page -->

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