02 Systemic Hypertension

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SYSTEMICSYSTEMICHYPERTENSIONHYPERTENSION



SYSTEMIC HYPERTENSIONSYSTEMIC HYPERTENSION

Definitions of hypertension

Elevated arterial blood pressureis a major cause of prematurevascular disease leading to

cerebrovascular eventsischaemic heart disease and peripheral vascular disease



Blood pressure is the pressure exerted bythe blood against the walls of the bloodvessels especially the arteries

It varies with the strength of the heartbeatthe elasticity of the arterial walls thevolume and viscosity of the blood

and a persons health age and physical

condition



Age

onset between $ years of age

increases over $ years of age

sex males in young adulthood and early

middle age

females after the age of $$ years



The prevalence

hypertensions is higher among blacamps and

older persons especially older women

Hypertension increased with age and is

higher in young men than in young

women

although the reverse is true in older

adults



Hypertension - IntroductionHypertension - Introduction

Silent Killer ndash painless complications

It is the leading risk factor ndashMI HF CRF

Stroke

Responsible for the majority of office isits

mber one reason for drg prescription

$amp of poplation Complications bring to diagnosis bt latehellip



his re(uires the heart to woramp harder than

normal to circulate blood through the blood

vessels

Blood pressure is summarised by two

measurements systolic and diastolic

which depend on whether the heart muscle

is contracting systole) or relaxed between

beats diastole)



ormal blood pressure at rest is within therange of ++mm-g systolic top

reading) and mm-g diastolic bottom

reading)

-igh blood pressure is said to be present if

it is persistently at or above + mm-g



Ideal Mean Aterial Pressure

012) is defined as mm of mercury

which corresponds to +34 and can be

calculated by 012 5 D2 6 + 72D2)0ean 1rterial blood pressure depends on

the flow of blood from the heart cardiac

output) and the resistance to flow in thesmall arteries and microscopic resistance

vessels arterioles)



Regulation of BPRegulation of BP

BP = Cardiac Output x Peripheral Resistance

Endocrine actors

8 Renin ngiotensin P H ldosterone

eural actors

8 $ympathetic Parasympathetic

Blood ampolume

8 $odium ineralocorticoids P

Cardiac actors

8 Heart rate Contractility



Classification of blood

of blood pressure



(ou Have)) iastolicampalue)

$ystolic

ampalue)

ormal lood pressure +ess than - +ess than 0

High1normal loodpressure

+ess than - 012or

$tage 3mild4hypertension

20122 501-2

$tage 6 3moderate4hypertension

00102 70182

$tage 3severe4

hypertension

012 01602

$tage 5 3very severe4

hypertension

60 orhigher

60 or higher



Signs and symptoms

Hypertension is rarely accompanied yany symptoms and its identi9ication isusually through screening or when

seeing healthcare 9or an unrelatedprolem proportion o9 people withhigh lood pressure reports

headaches 3particularly at theac o9 the head and in the morning4



lightheadedness

vertigo

tinnitus

3uing or hissing in the ears4

altered vision or 9ainting episodes

lthese symptoms however are more liely

to e related to associated anxiety thanthe high lood pressure itsel9



Control of Blood PressureControl of Blood Pressure

B29ardiac

utput

2eripheral

esistance

Blood ltolume

a6 1ldosterone

ltasoconstrictors1ngiotensin II

9atecholaminesltasodilators

2g = gtinins

ocal actors

p- -ypoxia eural actors

α1drenergic 8 9ons

A 1drenergic Dil

9ardiac actorsate = 9ontract

-umoral actors



Pea blood pressure

2eaamp blood pressure levels in humans occur

during the mid morning at about +

10) then decrease progressivelythroughout the remainder of the day to

reach a trough value the following morning

at around 10



efinition of Circadian Rytm

9ircadian rhythms are daily cycles of

physiology and behavior that are driven by

an endogenous oscillator with a period of

approximately one day



Norally circadian rhyths

are synchroniCed with the 3 h

environment by stimuli which alter the

phase of the underlying brain circadian pacemaamper

or most organisms including mammalsthe primary phaseshifting stimulus is light



hese processes include

sleepwaampe cycles

body temperature

blood pressure

release of hormones

his activity is controlled by the biologicalclocamp which is located in the suprachiasmtic nuclei of the hypothalamus inhuman brains

It is highly influenced by natural daramplightcycles but will persist under constantenvironmental conditions ExamplesDisruptions to the circadian rhythm cancause problems with the sleepwaampe cycle



9ircadian rhythms are regulated by threecomponents

+) the circadian pacemaamper or clocamp

3) an input mechanism which allows theclocamp to be reset by environmental stimuliand

)an output mechanism which regulates physiological and behavioral 2rocesses



Hypertension types

Primary Hypertension -igh blood pressure ofunidentified cause 1ccounts for of cases of

high blood pressure he identified risamp factors in

primary hypertension are as follows age onset

between $ years of age increases over $years of age sex males in young adulthood and

early middle age females after the age of $$ years

$econdary Hypertension is -igh blood

pressure in which the cause can be identified



EtiologyEtiology

+ EssentialIn more than $ of cases an underlying

cause cannot be found 2roposed mechanisms

includeExcess renal sodium retention

ver activity of sympathetic nervous system

enin angiotensin excess-yperinsulinemia

1lterations in vascular endothelium



actors contriuting to the development o9 Essential

hypertension

FGenetic actors

hypertension is more

common in some familiesand in some ethnic groups

liampe 1frican 1mericans

FEnvironmental factors

include obesity alcohollacamp of exercise and excess

salt



Emotional stress can cause uite large

increases in blood pressure$ Prominent amongst te pysiological

responses to stress is an increase in actiity

in te sympatetic neres Postural canges eampert stresses on te

cardioascular system reuiring effectie

refleamp responses to constrict arteries and

eins and stimulate te eart to controlblood pressure maintain brain blood flo(

and preent loss of consciousness



Regular oer)consumption of alcool can

raise blood pressure dramatically as (ell as

cause an eleation upon (itdra(al

Te seerity of obstructie sleep apnea

syndrome OSS is an independent factorcorrelated to diurnal ypertension



pathophysiology

here is some evidence that supports a

hypothesis that the primary fault in the

pathophysiology of hypertension is adefect in the

calcium binding of the plasma membrane of

the cells of a pressureregulating center inthe nervous system



+) Secondary ypertension+) Secondary ypertension

Renal hese account for over 4 of the cases ofsecondary hypertension he common causes arediabetic nephropathy chronic glomerulonephritisadult polycystic disease chronic tubulointerstitialnephritis and renovascular disease

Endocrinal hese include 9onns syndrome adrenal hyperplasia

acromegaly

2haeochromocytoma 9ushings syndromerugs and toxins Pregnancy1induced hypertension

ampascular coarctation of aorta vasculitis

Cildren



Cildren

Hypertension in neonates is rare occurring inaround 06 to gt o9 neonates

lood pressure is not measured routinely in the

healthy newornHypertension is more common in high ris

neworns

variety o9 9actors such as gestational age

postconceptional age and irth weight needs to

e taen into account when deciding i9 a lood

pressure is normal in a neonate

Hypertensie crises



Hypertensie crises

7everely elevated blood pressure e(ual toor greater than a systolic +4 or diastolic of++ H sometime termed malignant oraccelerated hypertension) is referred to as a

hypertensive crisis as blood pressuresabove these levels are ampnown to confer ahigh risamp of complications

2eople with blood pressures in this rangemay have no symptoms but are more liampelyto report headaches 33 of cases)and diCCiness than the general population

th t i



ther symptoms accompanying a

hypertensive crisis may include

+visual deterioration

3breathlessness due to heart failure

general feeling of malaise due to renal

failure0ost people with a hypertensive crisis are

ampnown to have elevated blood pressure but

additional triggers may have led to a sudden

rise



eergency hypertensivemalignant hypertension is diagnosed

when there is evidence of + direct damage to one or more organs as a

result of the severely elevated blood pressure

+his may includehypertensive encephalopathy caused by brain swelling and dysfunction



characteriCed by

headaches

altered level of consciousness

confusion or drowsiness)etinal papilloedema

fundal hemorrhages



1exudates are another sign o9 target organ

damage

1Chest pain may indicate heart muscle

damage 3which may progress to myocardial

in9arction4 or sometimes aortic dissection

1tearing o9 the inner wall o9 the aorta

1Breathlessness cough and the

expectoration o9 lood1stained sputum are

characteristic signs o9 pulmonary edemathe swelling o9 lung tissue due to le9t

ventricular 9ailure



1inaility o9 the le9t ventricle o9 the

heart to adeuately pump lood

9rom the lungs into the arterial

system



In pregnancy

Hypertension occurs in approximately 10gt o9pregnancies

ost women with hypertension in pregnancyhave pre1existing primary hypertension uthigh lood pressure in pregnancy may e

the 9irst sign o9 pre1eclampsia a seriouscondition o9 the second hal9 o9 pregnancy andpuerperium



Pre1eclampsia is characterised yincreased lood pressurethe presence o9 protein in the urineIt occurs in about $ of pregnancies and is

responsible for approximately + of all

maternal deaths globally2reeclampsia also doubles the risamp of

perinatal mortality Jsually there are no symptoms in pre

eclampsia and it is detected by routinescreening



ComplicationsComplications

Cererovasculardisease

coronary artery disease

are the most commoncauses o9 death

although hypertensive

patients are also prone

to renal 9ailureperipheral vascular

disease

HYPERTENSIONHYPERTENSION




9lassification of blood pressure levelsaccording to the British -ypertension 7ociety)

9ategory 7ystolic blood pressure Diastolic blood pressure

ptimal K +3 K 4

ormal K + K 4$-igh normal ++ 4$4

Hypertension

Grade I mild) ++$

Grade 3 moderate) ++L ++Grade severe) M+4 M++

Asolated systolic hypertension

Grade + ++ K

Grade 3 M+ K

HISTORYHISTORY



HISTORYHISTORY

he patient with mild hypertension is

usually asymptomatic

1ttacamps of sweating

headaches

palpitations

-igher levels of blood pressure may be

associated with epitasis or nocturnalBreathlessness may be present owing to left

ventricular hypertrophy or cardiac failure

INESTI-TIONSINESTI-TIONS




outine investigation of the hypertensive

patient should include

E9GJrine stix test for protein and blood

asting blood for lipids total and high

density lipoprotein cholesterol) and glucose7erum urea creatinine and electrolytes

I ti ti f l t dI ti ti f l t d



Inestigation of selected casesInestigation of selected cases

9hest Nray

1mbulatory B2 recording

Echocardiogram

enal ultrasound

enal angiography

Jrinary catecholamines

Jrinary cortisol and dexamethasonesuppression test

2lasma renin activity and aldosterone

Preention



Preention

0uch of the disease burden of high blood

pressure is experienced by people who arenot labelled as hypertensive

population strategies are re(uired to reducethe conse(uences of high blood pressureand reduce the need for antihypertensivedrug therapy

ifestyle changes are recommended to lower blood pressure before starting drug therapy



maintain normal body weightfor adults eg body massindex 383$ ampgm3)

reduce dietary sodium intaampeto K+ mmol day K g of

sodium chloride or K3 g ofsodium per day)



Engage in regular aerobic physical activity such as brisampwalamping M min per day most days of the weeamp)

limit alcohol consumption to no more than unitsday inmen and no more than 3 unitsday in women

consume a diet rich in fruit and vegetables eg at leastfive portions per day)

Effective lifestyle modification may lower blood

pressure as much an individual antihypertensive drug 9ombinations of two or more lifestyle modifications can

achieve even better results

M t



Management

+i9estyle modi9ications includes

dietary changes physical exerciseweight loss

If hypertension is high enough to justifyimmediate use of medications lifestylechanges conjunction with medication

1ntiinflammatory approaches should be a promising strategy for treating bothhypertension and atherosclerosis



Different programs aimed to

reduce

psychological stresssuch as biofeedbacamp

relaxation or meditation



Dietary change such as a low sodium diet is

beneficial 1 long term more than weeamps)low sodium diet in

1lso the D17- diet a diet rich in nutswhole grains fish poultry fruits and

vegetables

diet is also rich in potassium magnesium

calcium as well as protein

N l i lN l i l



Non)parmacologicalNon)parmacological

treatmenttreatment eight reduction 1 BA should e 6- gDm6+ow19at and saturated 9at diet+ow1sodium diet 1 7 g sodium chloride per day+imited alcohol consumption 1 6 unitsDwee 9or

men and 5 unitsDwee 9or women eating plan which is rich in potassium and

calcium Chronic intae o9 diets rich in pomace olive oil

improves endothelial dys9unction in spontaneouslyhypertensive

iets rich in 9ruits and vegetales reduce loodpressure



Dynamic exercise 8

1t least minutes brisamp walamp per day

Increased fruit and vegetable consumption

educe cardiovascular risamp by stopping

smoampingincreasing oily fish consumption

Parmacological treatment sould beParmacological treatment sould be




based on te follo(ingbased on te follo(ing

lthe initiation o9 antihypertensive therapy insuFects with sustained systolic loodpressure 3BP4 G 70 mmHg or sustained

diastolic BP G 00 mmHg

An patients with diaetes mellitus theinitiation o9 antihypertensive drug therapyi9 systolic BP is sustained G 50 mmHg ordiastolic BP is sustained G 20 mmHg

An non1diaetic hypertensive suFects treatment goals BP



yp F g50D- mmHg An some hypertensive suFects these levels maye di99icult to achieve

ost hypertensive patients will reuire a comination o9antihypertensive drugs to achieve the recommended targets

An most hypertensive patients therapy with statins and

aspirin to reduce the overall cardiovascular ris urden

lycaemic control should e optimied in diaetics 3Hc 8gt4



1ntihypertensive medications are not

effective for everyonecostly and result in adverse effects that

impair (uality of life and reduce adherence

0oreover abnormalities associated with

high B2 such as insulin resistance and

hyperlipidaemia may persist or may even be exacerbated by some antihypertensive

medications

Parmacological TreatmentParmacological Treatment




$everal classes o9 drugs are availale to treat

hypertension lthe usual are

3a4 CE inhiitors or ngiotensin receptor

antagonists

34 Beta1locers

3c4 Calcium1channel locers

3d4 iuretics

3e4 Other drugs as I1locer direct

vasodilator or centrally acting drugs



Choice o9 antihypertensive

therapy

he choice of antihypertensive therapy is

usually dictated bycost convenience the response to treatment

and freedom of

side effects

Co morid conditions may have an



y

important in9luence on

initial drug selection eg

J1locer in angina

lthiaide diuretics and calcium

antagonists in elderly people

CE in heart 9ailure post A type

diaetic nephropathy

RBs in type 6 diaetic nephropathy

intolerance to CE

I1locer in enign prostatic hypertrophy



Aeroic e$ercises

eroic exercises may play an important

role in the treatment o9 lood pressure o9hypertensive individuals treated in the

long run



Eampercises

or many years physical inactivity has

been recogniCed as a risamp factor for

coronary heart disease 9-D) and mostrecommendations suggest regular physical

activity as a part of the strategy in

preventingreducing 9-D



Physical Activity

Regular physical activity is the 9irst treatmentrecommended

to lower BP and improve cardiovascular health

lthe e99ect o9 physical activity on $BP and BPis uneual ith increased levels o9 activity

there is an almost linear increase in $BPwhereas BP tends to decrease



oderate1intensity 350K80gt ampO6 max4

aeroic exercise is associated with asigni9icant reduction o9 lood pressure in

hypertensive and normotensives

participants and in overweight as well as

normal1weight participants

reducing L

1regional sympathetic out9low61 total peripheral resistance

1 heart rate



1 exercise has een shown to augment

vagal tone endothelium1mediatedvasodilatation

1 insulin sensitivity and mood

1 and to lower cholestero



1Resistive exercise training has een shownto decrease $$ activity

1increase arore9lex sensitivity 3an index o9re9lex vagal control o9 the heart which

carries relevant patho physiological

1High intensity training may paradoxicallyincrease arterial sti99ness in healthy

middle1aged

An hypertension sympathetic activation




represents a mechanism potentially

responsile 9or the day1night lood

pressure di99erence

evening exercise signi9icantly reduced the

nighttime lood pressure Arrespective o9a morning exercise period

nitric oxides release y moderate

exercises as a vasodilator on endotheliumcell o9 lood vessels that increases lood

9low while lowering lood pressure



ecreases in catecholamine and totalperipheral resistance

improved insulin sensitivity

and alterations in vasodilators and

vasoconstrictors are some o9 thepostulated explanations 9or the

antihypertensive e99ects o9 exercise

sympathy inhiition and enhanced vagalactivity



increase in diastolic blood pressure of more

than + mm-g during or after exercise

represents a coronary artery disease

uaryuary



uaryuary

Hypertension is te commonest cause of maor morbidity

but less tan a uarter of patients are adeuately treated$

reduction in cardioascular disease mortality and

morbidity can be acieed troug improed treatment and

control of ypertension$

greater coice of drugs are aailable for ypertension

tan for oter cronic diseases$

Rational coice of single and combination drugs facilitated

by understanding teir effects on te renin system but

systematic trial and error may still be necessary$





SYSTEMICSYSTEMICHYPERTENSIONHYPERTENSION












condition



Age




middle age




The prevalence





women


adults






Stroke








vessels





beats diastole)





reading)











vessels arterioles)





Endocrine actors


eural actors


Blood ampolume


Cardiac actors





of blood pressure




$ystolic

ampalue)



+ess than - 012or


20122 501-2


00102 70182

$tage 3severe4

hypertension

012 01602


hypertension

60 orhigher

60 or higher



Signs and symptoms






lightheadedness

vertigo

tinnitus








B29ardiac

utput

2eripheral

esistance

Blood ltolume

a6 1ldosterone



2g = gtinins

ocal actors


α1drenergic 8 9ons

A 1drenergic Dil


-umoral actors



Pea blood pressure





at around 10


















sleepwaampe cycles

body temperature

blood pressure

release of hormones











Hypertension types










EtiologyEtiology










hypertension

FGenetic actors






salt




















pathophysiology











acromegaly



Cildren



Cildren




neworns





Hypertensie crises



Hypertensie crises




th t i











rise









characteriCed by

headaches



fundal hemorrhages




damage








ventricular 9ailure






system



In pregnancy




















disease







ptimal K +3 K 4


Hypertension

Grade I mild) ++$



Grade + ++ K

Grade 3 M+ K

HISTORYHISTORY



HISTORYHISTORY




headaches

palpitations

















9hest Nray


Echocardiogram

enal ultrasound

enal angiography




Preention



Preention


















M t



Management








reduce








vegetables



N l i lN l i l











Dynamic exercise 8





























medications








antagonists

34 Beta1locers


3d4 iuretics






therapy



and freedom of

side effects




y



J1locer in angina




diaetic nephropathy


intolerance to CE




Aeroic e$ercises



long run



Eampercises








Physical Activity












reducing L


1 heart rate













middle1aged







pressure di99erence



















uaryuary



uaryuary
























condition



Age




middle age




The prevalence





women


adults






Stroke








vessels





beats diastole)





reading)











vessels arterioles)





Endocrine actors


eural actors


Blood ampolume


Cardiac actors





of blood pressure




$ystolic

ampalue)



+ess than - 012or


20122 501-2


00102 70182

$tage 3severe4

hypertension

012 01602


hypertension

60 orhigher

60 or higher



Signs and symptoms






lightheadedness

vertigo

tinnitus








B29ardiac

utput

2eripheral

esistance

Blood ltolume

a6 1ldosterone



2g = gtinins

ocal actors


α1drenergic 8 9ons

A 1drenergic Dil


-umoral actors



Pea blood pressure





at around 10


















sleepwaampe cycles

body temperature

blood pressure

release of hormones











Hypertension types










EtiologyEtiology










hypertension

FGenetic actors






salt




















pathophysiology











acromegaly



Cildren



Cildren




neworns





Hypertensie crises



Hypertensie crises




th t i











rise









characteriCed by

headaches



fundal hemorrhages




damage








ventricular 9ailure






system



In pregnancy




















disease







ptimal K +3 K 4


Hypertension

Grade I mild) ++$



Grade + ++ K

Grade 3 M+ K

HISTORYHISTORY



HISTORYHISTORY




headaches

palpitations

















9hest Nray


Echocardiogram

enal ultrasound

enal angiography




Preention



Preention


















M t



Management








reduce








vegetables



N l i lN l i l











Dynamic exercise 8





























medications








antagonists

34 Beta1locers


3d4 iuretics






therapy



and freedom of

side effects




y



J1locer in angina




diaetic nephropathy


intolerance to CE




Aeroic e$ercises



long run



Eampercises








Physical Activity












reducing L


1 heart rate













middle1aged







pressure di99erence



















uaryuary



uaryuary















Age




middle age




The prevalence





women


adults






Stroke








vessels





beats diastole)





reading)











vessels arterioles)





Endocrine actors


eural actors


Blood ampolume


Cardiac actors





of blood pressure




$ystolic

ampalue)



+ess than - 012or


20122 501-2


00102 70182

$tage 3severe4

hypertension

012 01602


hypertension

60 orhigher

60 or higher



Signs and symptoms






lightheadedness

vertigo

tinnitus








B29ardiac

utput

2eripheral

esistance

Blood ltolume

a6 1ldosterone



2g = gtinins

ocal actors


α1drenergic 8 9ons

A 1drenergic Dil


-umoral actors



Pea blood pressure





at around 10


















sleepwaampe cycles

body temperature

blood pressure

release of hormones











Hypertension types










EtiologyEtiology










hypertension

FGenetic actors






salt




















pathophysiology











acromegaly



Cildren



Cildren




neworns





Hypertensie crises



Hypertensie crises




th t i











rise









characteriCed by

headaches



fundal hemorrhages




damage








ventricular 9ailure






system



In pregnancy




















disease







ptimal K +3 K 4


Hypertension

Grade I mild) ++$



Grade + ++ K

Grade 3 M+ K

HISTORYHISTORY



HISTORYHISTORY




headaches

palpitations

















9hest Nray


Echocardiogram

enal ultrasound

enal angiography




Preention



Preention


















M t



Management








reduce








vegetables



N l i lN l i l











Dynamic exercise 8





























medications








antagonists

34 Beta1locers


3d4 iuretics






therapy



and freedom of

side effects




y



J1locer in angina




diaetic nephropathy


intolerance to CE




Aeroic e$ercises



long run



Eampercises








Physical Activity












reducing L


1 heart rate













middle1aged







pressure di99erence



















uaryuary



uaryuary















The prevalence





women


adults






Stroke








vessels





beats diastole)





reading)











vessels arterioles)





Endocrine actors


eural actors


Blood ampolume


Cardiac actors





of blood pressure




$ystolic

ampalue)



+ess than - 012or


20122 501-2


00102 70182

$tage 3severe4

hypertension

012 01602


hypertension

60 orhigher

60 or higher



Signs and symptoms






lightheadedness

vertigo

tinnitus








B29ardiac

utput

2eripheral

esistance

Blood ltolume

a6 1ldosterone



2g = gtinins

ocal actors


α1drenergic 8 9ons

A 1drenergic Dil


-umoral actors



Pea blood pressure





at around 10


















sleepwaampe cycles

body temperature

blood pressure

release of hormones











Hypertension types










EtiologyEtiology










hypertension

FGenetic actors






salt




















pathophysiology











acromegaly



Cildren



Cildren




neworns





Hypertensie crises



Hypertensie crises




th t i











rise









characteriCed by

headaches



fundal hemorrhages




damage








ventricular 9ailure






system



In pregnancy




















disease







ptimal K +3 K 4


Hypertension

Grade I mild) ++$



Grade + ++ K

Grade 3 M+ K

HISTORYHISTORY



HISTORYHISTORY




headaches

palpitations

















9hest Nray


Echocardiogram

enal ultrasound

enal angiography




Preention



Preention


















M t



Management








reduce








vegetables



N l i lN l i l











Dynamic exercise 8





























medications








antagonists

34 Beta1locers


3d4 iuretics






therapy



and freedom of

side effects




y



J1locer in angina




diaetic nephropathy


intolerance to CE




Aeroic e$ercises



long run



Eampercises








Physical Activity












reducing L


1 heart rate













middle1aged







pressure di99erence



















uaryuary



uaryuary


















Stroke








vessels





beats diastole)





reading)











vessels arterioles)





Endocrine actors


eural actors


Blood ampolume


Cardiac actors





of blood pressure




$ystolic

ampalue)



+ess than - 012or


20122 501-2


00102 70182

$tage 3severe4

hypertension

012 01602


hypertension

60 orhigher

60 or higher



Signs and symptoms






lightheadedness

vertigo

tinnitus








B29ardiac

utput

2eripheral

esistance

Blood ltolume

a6 1ldosterone



2g = gtinins

ocal actors


α1drenergic 8 9ons

A 1drenergic Dil


-umoral actors



Pea blood pressure





at around 10


















sleepwaampe cycles

body temperature

blood pressure

release of hormones











Hypertension types










EtiologyEtiology










hypertension

FGenetic actors






salt




















pathophysiology











acromegaly



Cildren



Cildren




neworns





Hypertensie crises



Hypertensie crises




th t i











rise









characteriCed by

headaches



fundal hemorrhages




damage








ventricular 9ailure






system



In pregnancy




















disease







ptimal K +3 K 4


Hypertension

Grade I mild) ++$



Grade + ++ K

Grade 3 M+ K

HISTORYHISTORY



HISTORYHISTORY




headaches

palpitations

















9hest Nray


Echocardiogram

enal ultrasound

enal angiography




Preention



Preention


















M t



Management








reduce








vegetables



N l i lN l i l











Dynamic exercise 8





























medications








antagonists

34 Beta1locers


3d4 iuretics






therapy



and freedom of

side effects




y



J1locer in angina




diaetic nephropathy


intolerance to CE




Aeroic e$ercises



long run



Eampercises








Physical Activity












reducing L


1 heart rate













middle1aged







pressure di99erence



















uaryuary



uaryuary

















vessels





beats diastole)





reading)











vessels arterioles)





Endocrine actors


eural actors


Blood ampolume


Cardiac actors





of blood pressure




$ystolic

ampalue)



+ess than - 012or


20122 501-2


00102 70182

$tage 3severe4

hypertension

012 01602


hypertension

60 orhigher

60 or higher



Signs and symptoms






lightheadedness

vertigo

tinnitus








B29ardiac

utput

2eripheral

esistance

Blood ltolume

a6 1ldosterone



2g = gtinins

ocal actors


α1drenergic 8 9ons

A 1drenergic Dil


-umoral actors



Pea blood pressure





at around 10


















sleepwaampe cycles

body temperature

blood pressure

release of hormones











Hypertension types










EtiologyEtiology










hypertension

FGenetic actors






salt




















pathophysiology











acromegaly



Cildren



Cildren




neworns





Hypertensie crises



Hypertensie crises




th t i











rise









characteriCed by

headaches



fundal hemorrhages




damage








ventricular 9ailure






system



In pregnancy




















disease







ptimal K +3 K 4


Hypertension

Grade I mild) ++$



Grade + ++ K

Grade 3 M+ K

HISTORYHISTORY



HISTORYHISTORY




headaches

palpitations

















9hest Nray


Echocardiogram

enal ultrasound

enal angiography




Preention



Preention


















M t



Management








reduce








vegetables



N l i lN l i l











Dynamic exercise 8





























medications








antagonists

34 Beta1locers


3d4 iuretics






therapy



and freedom of

side effects




y



J1locer in angina




diaetic nephropathy


intolerance to CE




Aeroic e$ercises



long run



Eampercises








Physical Activity












reducing L


1 heart rate













middle1aged







pressure di99erence



















uaryuary



uaryuary

















reading)











vessels arterioles)





Endocrine actors


eural actors


Blood ampolume


Cardiac actors





of blood pressure




$ystolic

ampalue)



+ess than - 012or


20122 501-2


00102 70182

$tage 3severe4

hypertension

012 01602


hypertension

60 orhigher

60 or higher



Signs and symptoms






lightheadedness

vertigo

tinnitus








B29ardiac

utput

2eripheral

esistance

Blood ltolume

a6 1ldosterone



2g = gtinins

ocal actors


α1drenergic 8 9ons

A 1drenergic Dil


-umoral actors



Pea blood pressure





at around 10


















sleepwaampe cycles

body temperature

blood pressure

release of hormones











Hypertension types










EtiologyEtiology










hypertension

FGenetic actors






salt




















pathophysiology











acromegaly



Cildren



Cildren




neworns





Hypertensie crises



Hypertensie crises




th t i











rise









characteriCed by

headaches



fundal hemorrhages




damage








ventricular 9ailure






system



In pregnancy




















disease







ptimal K +3 K 4


Hypertension

Grade I mild) ++$



Grade + ++ K

Grade 3 M+ K

HISTORYHISTORY



HISTORYHISTORY




headaches

palpitations

















9hest Nray


Echocardiogram

enal ultrasound

enal angiography




Preention



Preention


















M t



Management








reduce








vegetables



N l i lN l i l











Dynamic exercise 8





























medications








antagonists

34 Beta1locers


3d4 iuretics






therapy



and freedom of

side effects




y



J1locer in angina




diaetic nephropathy


intolerance to CE




Aeroic e$ercises



long run



Eampercises








Physical Activity












reducing L


1 heart rate













middle1aged







pressure di99erence



















uaryuary



uaryuary





















vessels arterioles)





Endocrine actors


eural actors


Blood ampolume


Cardiac actors





of blood pressure




$ystolic

ampalue)



+ess than - 012or


20122 501-2


00102 70182

$tage 3severe4

hypertension

012 01602


hypertension

60 orhigher

60 or higher



Signs and symptoms






lightheadedness

vertigo

tinnitus








B29ardiac

utput

2eripheral

esistance

Blood ltolume

a6 1ldosterone



2g = gtinins

ocal actors


α1drenergic 8 9ons

A 1drenergic Dil


-umoral actors



Pea blood pressure





at around 10


















sleepwaampe cycles

body temperature

blood pressure

release of hormones











Hypertension types










EtiologyEtiology










hypertension

FGenetic actors






salt




















pathophysiology











acromegaly



Cildren



Cildren




neworns





Hypertensie crises



Hypertensie crises




th t i











rise









characteriCed by

headaches



fundal hemorrhages




damage








ventricular 9ailure






system



In pregnancy




















disease







ptimal K +3 K 4


Hypertension

Grade I mild) ++$



Grade + ++ K

Grade 3 M+ K

HISTORYHISTORY



HISTORYHISTORY




headaches

palpitations

















9hest Nray


Echocardiogram

enal ultrasound

enal angiography




Preention



Preention


















M t



Management








reduce








vegetables



N l i lN l i l











Dynamic exercise 8





























medications








antagonists

34 Beta1locers


3d4 iuretics






therapy



and freedom of

side effects




y



J1locer in angina




diaetic nephropathy


intolerance to CE




Aeroic e$ercises



long run



Eampercises








Physical Activity












reducing L


1 heart rate













middle1aged







pressure di99erence



















uaryuary



uaryuary

















Endocrine actors


eural actors


Blood ampolume


Cardiac actors





of blood pressure




$ystolic

ampalue)



+ess than - 012or


20122 501-2


00102 70182

$tage 3severe4

hypertension

012 01602


hypertension

60 orhigher

60 or higher



Signs and symptoms






lightheadedness

vertigo

tinnitus








B29ardiac

utput

2eripheral

esistance

Blood ltolume

a6 1ldosterone



2g = gtinins

ocal actors


α1drenergic 8 9ons

A 1drenergic Dil


-umoral actors



Pea blood pressure





at around 10


















sleepwaampe cycles

body temperature

blood pressure

release of hormones











Hypertension types










EtiologyEtiology










hypertension

FGenetic actors






salt




















pathophysiology











acromegaly



Cildren



Cildren




neworns





Hypertensie crises



Hypertensie crises




th t i











rise









characteriCed by

headaches



fundal hemorrhages




damage








ventricular 9ailure






system



In pregnancy




















disease







ptimal K +3 K 4


Hypertension

Grade I mild) ++$



Grade + ++ K

Grade 3 M+ K

HISTORYHISTORY



HISTORYHISTORY




headaches

palpitations

















9hest Nray


Echocardiogram

enal ultrasound

enal angiography




Preention



Preention


















M t



Management








reduce








vegetables



N l i lN l i l











Dynamic exercise 8





























medications








antagonists

34 Beta1locers


3d4 iuretics






therapy



and freedom of

side effects




y



J1locer in angina




diaetic nephropathy


intolerance to CE




Aeroic e$ercises



long run



Eampercises








Physical Activity












reducing L


1 heart rate













middle1aged







pressure di99erence



















uaryuary



uaryuary
















of blood pressure




$ystolic

ampalue)



+ess than - 012or


20122 501-2


00102 70182

$tage 3severe4

hypertension

012 01602


hypertension

60 orhigher

60 or higher



Signs and symptoms






lightheadedness

vertigo

tinnitus








B29ardiac

utput

2eripheral

esistance

Blood ltolume

a6 1ldosterone



2g = gtinins

ocal actors


α1drenergic 8 9ons

A 1drenergic Dil


-umoral actors



Pea blood pressure





at around 10


















sleepwaampe cycles

body temperature

blood pressure

release of hormones











Hypertension types










EtiologyEtiology










hypertension

FGenetic actors






salt




















pathophysiology











acromegaly



Cildren



Cildren




neworns





Hypertensie crises



Hypertensie crises




th t i











rise









characteriCed by

headaches



fundal hemorrhages




damage








ventricular 9ailure






system



In pregnancy




















disease







ptimal K +3 K 4


Hypertension

Grade I mild) ++$



Grade + ++ K

Grade 3 M+ K

HISTORYHISTORY



HISTORYHISTORY




headaches

palpitations

















9hest Nray


Echocardiogram

enal ultrasound

enal angiography




Preention



Preention


















M t



Management








reduce








vegetables



N l i lN l i l











Dynamic exercise 8





























medications








antagonists

34 Beta1locers


3d4 iuretics






therapy



and freedom of

side effects




y



J1locer in angina




diaetic nephropathy


intolerance to CE




Aeroic e$ercises



long run



Eampercises








Physical Activity












reducing L


1 heart rate













middle1aged







pressure di99erence



















uaryuary



uaryuary
















$ystolic

ampalue)



+ess than - 012or


20122 501-2


00102 70182

$tage 3severe4

hypertension

012 01602


hypertension

60 orhigher

60 or higher



Signs and symptoms






lightheadedness

vertigo

tinnitus








B29ardiac

utput

2eripheral

esistance

Blood ltolume

a6 1ldosterone



2g = gtinins

ocal actors


α1drenergic 8 9ons

A 1drenergic Dil


-umoral actors



Pea blood pressure





at around 10


















sleepwaampe cycles

body temperature

blood pressure

release of hormones











Hypertension types










EtiologyEtiology










hypertension

FGenetic actors






salt




















pathophysiology











acromegaly



Cildren



Cildren




neworns





Hypertensie crises



Hypertensie crises




th t i











rise









characteriCed by

headaches



fundal hemorrhages




damage








ventricular 9ailure






system



In pregnancy




















disease







ptimal K +3 K 4


Hypertension

Grade I mild) ++$



Grade + ++ K

Grade 3 M+ K

HISTORYHISTORY



HISTORYHISTORY




headaches

palpitations

















9hest Nray


Echocardiogram

enal ultrasound

enal angiography




Preention



Preention


















M t



Management








reduce








vegetables



N l i lN l i l











Dynamic exercise 8





























medications








antagonists

34 Beta1locers


3d4 iuretics






therapy



and freedom of

side effects




y



J1locer in angina




diaetic nephropathy


intolerance to CE




Aeroic e$ercises



long run



Eampercises








Physical Activity












reducing L


1 heart rate













middle1aged







pressure di99erence



















uaryuary



uaryuary















Signs and symptoms






lightheadedness

vertigo

tinnitus








B29ardiac

utput

2eripheral

esistance

Blood ltolume

a6 1ldosterone



2g = gtinins

ocal actors


α1drenergic 8 9ons

A 1drenergic Dil


-umoral actors



Pea blood pressure





at around 10


















sleepwaampe cycles

body temperature

blood pressure

release of hormones











Hypertension types










EtiologyEtiology










hypertension

FGenetic actors






salt




















pathophysiology











acromegaly



Cildren



Cildren




neworns





Hypertensie crises



Hypertensie crises




th t i











rise









characteriCed by

headaches



fundal hemorrhages




damage








ventricular 9ailure






system



In pregnancy




















disease







ptimal K +3 K 4


Hypertension

Grade I mild) ++$



Grade + ++ K

Grade 3 M+ K

HISTORYHISTORY



HISTORYHISTORY




headaches

palpitations

















9hest Nray


Echocardiogram

enal ultrasound

enal angiography




Preention



Preention


















M t



Management








reduce








vegetables



N l i lN l i l











Dynamic exercise 8





























medications








antagonists

34 Beta1locers


3d4 iuretics






therapy



and freedom of

side effects




y



J1locer in angina




diaetic nephropathy


intolerance to CE




Aeroic e$ercises



long run



Eampercises








Physical Activity












reducing L


1 heart rate













middle1aged







pressure di99erence



















uaryuary



uaryuary















lightheadedness

vertigo

tinnitus








B29ardiac

utput

2eripheral

esistance

Blood ltolume

a6 1ldosterone



2g = gtinins

ocal actors


α1drenergic 8 9ons

A 1drenergic Dil


-umoral actors



Pea blood pressure





at around 10


















sleepwaampe cycles

body temperature

blood pressure

release of hormones











Hypertension types










EtiologyEtiology










hypertension

FGenetic actors






salt




















pathophysiology











acromegaly



Cildren



Cildren




neworns





Hypertensie crises



Hypertensie crises




th t i











rise









characteriCed by

headaches



fundal hemorrhages




damage








ventricular 9ailure






system



In pregnancy




















disease







ptimal K +3 K 4


Hypertension

Grade I mild) ++$



Grade + ++ K

Grade 3 M+ K

HISTORYHISTORY



HISTORYHISTORY




headaches

palpitations

















9hest Nray


Echocardiogram

enal ultrasound

enal angiography




Preention



Preention


















M t



Management








reduce








vegetables



N l i lN l i l











Dynamic exercise 8





























medications








antagonists

34 Beta1locers


3d4 iuretics






therapy



and freedom of

side effects




y



J1locer in angina




diaetic nephropathy


intolerance to CE




Aeroic e$ercises



long run



Eampercises








Physical Activity












reducing L


1 heart rate













middle1aged







pressure di99erence



















uaryuary



uaryuary
















B29ardiac

utput

2eripheral

esistance

Blood ltolume

a6 1ldosterone



2g = gtinins

ocal actors


α1drenergic 8 9ons

A 1drenergic Dil


-umoral actors



Pea blood pressure





at around 10


















sleepwaampe cycles

body temperature

blood pressure

release of hormones











Hypertension types










EtiologyEtiology










hypertension

FGenetic actors






salt




















pathophysiology











acromegaly



Cildren



Cildren




neworns





Hypertensie crises



Hypertensie crises




th t i











rise









characteriCed by

headaches



fundal hemorrhages




damage








ventricular 9ailure






system



In pregnancy




















disease







ptimal K +3 K 4


Hypertension

Grade I mild) ++$



Grade + ++ K

Grade 3 M+ K

HISTORYHISTORY



HISTORYHISTORY




headaches

palpitations

















9hest Nray


Echocardiogram

enal ultrasound

enal angiography




Preention



Preention


















M t



Management








reduce








vegetables



N l i lN l i l











Dynamic exercise 8





























medications








antagonists

34 Beta1locers


3d4 iuretics






therapy



and freedom of

side effects




y



J1locer in angina




diaetic nephropathy


intolerance to CE




Aeroic e$ercises



long run



Eampercises








Physical Activity












reducing L


1 heart rate













middle1aged







pressure di99erence



















uaryuary



uaryuary















Pea blood pressure





at around 10


















sleepwaampe cycles

body temperature

blood pressure

release of hormones











Hypertension types










EtiologyEtiology










hypertension

FGenetic actors






salt




















pathophysiology











acromegaly



Cildren



Cildren




neworns





Hypertensie crises



Hypertensie crises




th t i











rise









characteriCed by

headaches



fundal hemorrhages




damage








ventricular 9ailure






system



In pregnancy




















disease







ptimal K +3 K 4


Hypertension

Grade I mild) ++$



Grade + ++ K

Grade 3 M+ K

HISTORYHISTORY



HISTORYHISTORY




headaches

palpitations

















9hest Nray


Echocardiogram

enal ultrasound

enal angiography




Preention



Preention


















M t



Management








reduce








vegetables



N l i lN l i l











Dynamic exercise 8





























medications








antagonists

34 Beta1locers


3d4 iuretics






therapy



and freedom of

side effects




y



J1locer in angina




diaetic nephropathy


intolerance to CE




Aeroic e$ercises



long run



Eampercises








Physical Activity












reducing L


1 heart rate













middle1aged







pressure di99erence



















uaryuary



uaryuary






























sleepwaampe cycles

body temperature

blood pressure

release of hormones











Hypertension types










EtiologyEtiology










hypertension

FGenetic actors






salt




















pathophysiology











acromegaly



Cildren



Cildren




neworns





Hypertensie crises



Hypertensie crises




th t i











rise









characteriCed by

headaches



fundal hemorrhages




damage








ventricular 9ailure






system



In pregnancy




















disease







ptimal K +3 K 4


Hypertension

Grade I mild) ++$



Grade + ++ K

Grade 3 M+ K

HISTORYHISTORY



HISTORYHISTORY




headaches

palpitations

















9hest Nray


Echocardiogram

enal ultrasound

enal angiography




Preention



Preention


















M t



Management








reduce








vegetables



N l i lN l i l











Dynamic exercise 8





























medications








antagonists

34 Beta1locers


3d4 iuretics






therapy



and freedom of

side effects




y



J1locer in angina




diaetic nephropathy


intolerance to CE




Aeroic e$ercises



long run



Eampercises








Physical Activity












reducing L


1 heart rate













middle1aged







pressure di99erence



















uaryuary



uaryuary





















Hypertension types










EtiologyEtiology










hypertension

FGenetic actors






salt




















pathophysiology











acromegaly



Cildren



Cildren




neworns





Hypertensie crises



Hypertensie crises




th t i











rise









characteriCed by

headaches



fundal hemorrhages




damage








ventricular 9ailure






system



In pregnancy




















disease







ptimal K +3 K 4


Hypertension

Grade I mild) ++$



Grade + ++ K

Grade 3 M+ K

HISTORYHISTORY



HISTORYHISTORY




headaches

palpitations

















9hest Nray


Echocardiogram

enal ultrasound

enal angiography




Preention



Preention


















M t



Management








reduce








vegetables



N l i lN l i l











Dynamic exercise 8





























medications








antagonists

34 Beta1locers


3d4 iuretics






therapy



and freedom of

side effects




y



J1locer in angina




diaetic nephropathy


intolerance to CE




Aeroic e$ercises



long run



Eampercises








Physical Activity












reducing L


1 heart rate













middle1aged







pressure di99erence



















uaryuary



uaryuary















EtiologyEtiology










hypertension

FGenetic actors






salt




















pathophysiology











acromegaly



Cildren



Cildren




neworns





Hypertensie crises



Hypertensie crises




th t i











rise









characteriCed by

headaches



fundal hemorrhages




damage








ventricular 9ailure






system



In pregnancy




















disease







ptimal K +3 K 4


Hypertension

Grade I mild) ++$



Grade + ++ K

Grade 3 M+ K

HISTORYHISTORY



HISTORYHISTORY




headaches

palpitations

















9hest Nray


Echocardiogram

enal ultrasound

enal angiography




Preention



Preention


















M t



Management








reduce








vegetables



N l i lN l i l











Dynamic exercise 8





























medications








antagonists

34 Beta1locers


3d4 iuretics






therapy



and freedom of

side effects




y



J1locer in angina




diaetic nephropathy


intolerance to CE




Aeroic e$ercises



long run



Eampercises








Physical Activity












reducing L


1 heart rate













middle1aged







pressure di99erence



















uaryuary



uaryuary
















hypertension

FGenetic actors






salt




















pathophysiology











acromegaly



Cildren



Cildren




neworns





Hypertensie crises



Hypertensie crises




th t i











rise









characteriCed by

headaches



fundal hemorrhages




damage








ventricular 9ailure






system



In pregnancy




















disease







ptimal K +3 K 4


Hypertension

Grade I mild) ++$



Grade + ++ K

Grade 3 M+ K

HISTORYHISTORY



HISTORYHISTORY




headaches

palpitations

















9hest Nray


Echocardiogram

enal ultrasound

enal angiography




Preention



Preention


















M t



Management








reduce








vegetables



N l i lN l i l











Dynamic exercise 8





























medications








antagonists

34 Beta1locers


3d4 iuretics






therapy



and freedom of

side effects




y



J1locer in angina




diaetic nephropathy


intolerance to CE




Aeroic e$ercises



long run



Eampercises








Physical Activity












reducing L


1 heart rate













middle1aged







pressure di99erence



















uaryuary



uaryuary
































pathophysiology











acromegaly



Cildren



Cildren




neworns





Hypertensie crises



Hypertensie crises




th t i











rise









characteriCed by

headaches



fundal hemorrhages




damage








ventricular 9ailure






system



In pregnancy




















disease







ptimal K +3 K 4


Hypertension

Grade I mild) ++$



Grade + ++ K

Grade 3 M+ K

HISTORYHISTORY



HISTORYHISTORY




headaches

palpitations

















9hest Nray


Echocardiogram

enal ultrasound

enal angiography




Preention



Preention


















M t



Management








reduce








vegetables



N l i lN l i l











Dynamic exercise 8





























medications








antagonists

34 Beta1locers


3d4 iuretics






therapy



and freedom of

side effects




y



J1locer in angina




diaetic nephropathy


intolerance to CE




Aeroic e$ercises



long run



Eampercises








Physical Activity












reducing L


1 heart rate













middle1aged







pressure di99erence



















uaryuary



uaryuary


















acromegaly



Cildren



Cildren




neworns





Hypertensie crises



Hypertensie crises




th t i











rise









characteriCed by

headaches



fundal hemorrhages




damage








ventricular 9ailure






system



In pregnancy




















disease







ptimal K +3 K 4


Hypertension

Grade I mild) ++$



Grade + ++ K

Grade 3 M+ K

HISTORYHISTORY



HISTORYHISTORY




headaches

palpitations

















9hest Nray


Echocardiogram

enal ultrasound

enal angiography




Preention



Preention


















M t



Management








reduce








vegetables



N l i lN l i l











Dynamic exercise 8





























medications








antagonists

34 Beta1locers


3d4 iuretics






therapy



and freedom of

side effects




y



J1locer in angina




diaetic nephropathy


intolerance to CE




Aeroic e$ercises



long run



Eampercises








Physical Activity












reducing L


1 heart rate













middle1aged







pressure di99erence



















uaryuary



uaryuary















Cildren




neworns





Hypertensie crises



Hypertensie crises




th t i











rise









characteriCed by

headaches



fundal hemorrhages




damage








ventricular 9ailure






system



In pregnancy




















disease







ptimal K +3 K 4


Hypertension

Grade I mild) ++$



Grade + ++ K

Grade 3 M+ K

HISTORYHISTORY



HISTORYHISTORY




headaches

palpitations

















9hest Nray


Echocardiogram

enal ultrasound

enal angiography




Preention



Preention


















M t



Management








reduce








vegetables



N l i lN l i l











Dynamic exercise 8





























medications








antagonists

34 Beta1locers


3d4 iuretics






therapy



and freedom of

side effects




y



J1locer in angina




diaetic nephropathy


intolerance to CE




Aeroic e$ercises



long run



Eampercises








Physical Activity












reducing L


1 heart rate













middle1aged







pressure di99erence



















uaryuary



uaryuary















Hypertensie crises




th t i











rise









characteriCed by

headaches



fundal hemorrhages




damage








ventricular 9ailure






system



In pregnancy




















disease







ptimal K +3 K 4


Hypertension

Grade I mild) ++$



Grade + ++ K

Grade 3 M+ K

HISTORYHISTORY



HISTORYHISTORY




headaches

palpitations

















9hest Nray


Echocardiogram

enal ultrasound

enal angiography




Preention



Preention


















M t



Management








reduce








vegetables



N l i lN l i l











Dynamic exercise 8





























medications








antagonists

34 Beta1locers


3d4 iuretics






therapy



and freedom of

side effects




y



J1locer in angina




diaetic nephropathy


intolerance to CE




Aeroic e$ercises



long run



Eampercises








Physical Activity












reducing L


1 heart rate













middle1aged







pressure di99erence



















uaryuary



uaryuary























rise









characteriCed by

headaches



fundal hemorrhages




damage








ventricular 9ailure






system



In pregnancy




















disease







ptimal K +3 K 4


Hypertension

Grade I mild) ++$



Grade + ++ K

Grade 3 M+ K

HISTORYHISTORY



HISTORYHISTORY




headaches

palpitations

















9hest Nray


Echocardiogram

enal ultrasound

enal angiography




Preention



Preention


















M t



Management








reduce








vegetables



N l i lN l i l











Dynamic exercise 8





























medications








antagonists

34 Beta1locers


3d4 iuretics






therapy



and freedom of

side effects




y



J1locer in angina




diaetic nephropathy


intolerance to CE




Aeroic e$ercises



long run



Eampercises








Physical Activity












reducing L


1 heart rate













middle1aged







pressure di99erence



















uaryuary



uaryuary





















characteriCed by

headaches



fundal hemorrhages




damage








ventricular 9ailure






system



In pregnancy




















disease







ptimal K +3 K 4


Hypertension

Grade I mild) ++$



Grade + ++ K

Grade 3 M+ K

HISTORYHISTORY



HISTORYHISTORY




headaches

palpitations

















9hest Nray


Echocardiogram

enal ultrasound

enal angiography




Preention



Preention


















M t



Management








reduce








vegetables



N l i lN l i l











Dynamic exercise 8





























medications








antagonists

34 Beta1locers


3d4 iuretics






therapy



and freedom of

side effects




y



J1locer in angina




diaetic nephropathy


intolerance to CE




Aeroic e$ercises



long run



Eampercises








Physical Activity












reducing L


1 heart rate













middle1aged







pressure di99erence



















uaryuary



uaryuary
















damage








ventricular 9ailure






system



In pregnancy




















disease







ptimal K +3 K 4


Hypertension

Grade I mild) ++$



Grade + ++ K

Grade 3 M+ K

HISTORYHISTORY



HISTORYHISTORY




headaches

palpitations

















9hest Nray


Echocardiogram

enal ultrasound

enal angiography




Preention



Preention


















M t



Management








reduce








vegetables



N l i lN l i l











Dynamic exercise 8





























medications








antagonists

34 Beta1locers


3d4 iuretics






therapy



and freedom of

side effects




y



J1locer in angina




diaetic nephropathy


intolerance to CE




Aeroic e$ercises



long run



Eampercises








Physical Activity












reducing L


1 heart rate













middle1aged







pressure di99erence



















uaryuary



uaryuary


















system



In pregnancy




















disease







ptimal K +3 K 4


Hypertension

Grade I mild) ++$



Grade + ++ K

Grade 3 M+ K

HISTORYHISTORY



HISTORYHISTORY




headaches

palpitations

















9hest Nray


Echocardiogram

enal ultrasound

enal angiography




Preention



Preention


















M t



Management








reduce








vegetables



N l i lN l i l











Dynamic exercise 8





























medications








antagonists

34 Beta1locers


3d4 iuretics






therapy



and freedom of

side effects




y



J1locer in angina




diaetic nephropathy


intolerance to CE




Aeroic e$ercises



long run



Eampercises








Physical Activity












reducing L


1 heart rate













middle1aged







pressure di99erence



















uaryuary



uaryuary















In pregnancy




















disease







ptimal K +3 K 4


Hypertension

Grade I mild) ++$



Grade + ++ K

Grade 3 M+ K

HISTORYHISTORY



HISTORYHISTORY




headaches

palpitations

















9hest Nray


Echocardiogram

enal ultrasound

enal angiography




Preention



Preention


















M t



Management








reduce








vegetables



N l i lN l i l











Dynamic exercise 8





























medications








antagonists

34 Beta1locers


3d4 iuretics






therapy



and freedom of

side effects




y



J1locer in angina




diaetic nephropathy


intolerance to CE




Aeroic e$ercises



long run



Eampercises








Physical Activity












reducing L


1 heart rate













middle1aged







pressure di99erence



















uaryuary



uaryuary





























disease







ptimal K +3 K 4


Hypertension

Grade I mild) ++$



Grade + ++ K

Grade 3 M+ K

HISTORYHISTORY



HISTORYHISTORY




headaches

palpitations

















9hest Nray


Echocardiogram

enal ultrasound

enal angiography




Preention



Preention


















M t



Management








reduce








vegetables



N l i lN l i l











Dynamic exercise 8





























medications








antagonists

34 Beta1locers


3d4 iuretics






therapy



and freedom of

side effects




y



J1locer in angina




diaetic nephropathy


intolerance to CE




Aeroic e$ercises



long run



Eampercises








Physical Activity












reducing L


1 heart rate













middle1aged







pressure di99erence



















uaryuary



uaryuary


















ptimal K +3 K 4


Hypertension

Grade I mild) ++$



Grade + ++ K

Grade 3 M+ K

HISTORYHISTORY



HISTORYHISTORY




headaches

palpitations

















9hest Nray


Echocardiogram

enal ultrasound

enal angiography




Preention



Preention


















M t



Management








reduce








vegetables



N l i lN l i l











Dynamic exercise 8





























medications








antagonists

34 Beta1locers


3d4 iuretics






therapy



and freedom of

side effects




y



J1locer in angina




diaetic nephropathy


intolerance to CE




Aeroic e$ercises



long run



Eampercises








Physical Activity












reducing L


1 heart rate













middle1aged







pressure di99erence



















uaryuary



uaryuary















HISTORYHISTORY




headaches

palpitations

















9hest Nray


Echocardiogram

enal ultrasound

enal angiography




Preention



Preention


















M t



Management








reduce








vegetables



N l i lN l i l











Dynamic exercise 8





























medications








antagonists

34 Beta1locers


3d4 iuretics






therapy



and freedom of

side effects




y



J1locer in angina




diaetic nephropathy


intolerance to CE




Aeroic e$ercises



long run



Eampercises








Physical Activity












reducing L


1 heart rate













middle1aged







pressure di99erence



















uaryuary



uaryuary

























9hest Nray


Echocardiogram

enal ultrasound

enal angiography




Preention



Preention


















M t



Management








reduce








vegetables



N l i lN l i l











Dynamic exercise 8





























medications








antagonists

34 Beta1locers


3d4 iuretics






therapy



and freedom of

side effects




y



J1locer in angina




diaetic nephropathy


intolerance to CE




Aeroic e$ercises



long run



Eampercises








Physical Activity












reducing L


1 heart rate













middle1aged







pressure di99erence



















uaryuary



uaryuary















Preention


















M t



Management








reduce








vegetables



N l i lN l i l











Dynamic exercise 8





























medications








antagonists

34 Beta1locers


3d4 iuretics






therapy



and freedom of

side effects




y



J1locer in angina




diaetic nephropathy


intolerance to CE




Aeroic e$ercises



long run



Eampercises








Physical Activity












reducing L


1 heart rate













middle1aged







pressure di99erence



















uaryuary



uaryuary


























M t



Management








reduce








vegetables



N l i lN l i l











Dynamic exercise 8





























medications








antagonists

34 Beta1locers


3d4 iuretics






therapy



and freedom of

side effects




y



J1locer in angina




diaetic nephropathy


intolerance to CE




Aeroic e$ercises



long run



Eampercises








Physical Activity












reducing L


1 heart rate













middle1aged







pressure di99erence



















uaryuary



uaryuary















Management








reduce








vegetables



N l i lN l i l











Dynamic exercise 8





























medications








antagonists

34 Beta1locers


3d4 iuretics






therapy



and freedom of

side effects




y



J1locer in angina




diaetic nephropathy


intolerance to CE




Aeroic e$ercises



long run



Eampercises








Physical Activity












reducing L


1 heart rate













middle1aged







pressure di99erence



















uaryuary



uaryuary
















reduce








vegetables



N l i lN l i l











Dynamic exercise 8





























medications








antagonists

34 Beta1locers


3d4 iuretics






therapy



and freedom of

side effects




y



J1locer in angina




diaetic nephropathy


intolerance to CE




Aeroic e$ercises



long run



Eampercises








Physical Activity












reducing L


1 heart rate













middle1aged







pressure di99erence



















uaryuary



uaryuary


















vegetables



N l i lN l i l











Dynamic exercise 8





























medications








antagonists

34 Beta1locers


3d4 iuretics






therapy



and freedom of

side effects




y



J1locer in angina




diaetic nephropathy


intolerance to CE




Aeroic e$ercises



long run



Eampercises








Physical Activity












reducing L


1 heart rate













middle1aged







pressure di99erence



















uaryuary



uaryuary























Dynamic exercise 8





























medications








antagonists

34 Beta1locers


3d4 iuretics






therapy



and freedom of

side effects




y



J1locer in angina




diaetic nephropathy


intolerance to CE




Aeroic e$ercises



long run



Eampercises








Physical Activity












reducing L


1 heart rate













middle1aged







pressure di99erence



















uaryuary



uaryuary




































medications








antagonists

34 Beta1locers


3d4 iuretics






therapy



and freedom of

side effects




y



J1locer in angina




diaetic nephropathy


intolerance to CE




Aeroic e$ercises



long run



Eampercises








Physical Activity












reducing L


1 heart rate













middle1aged







pressure di99erence



















uaryuary



uaryuary



















antagonists

34 Beta1locers


3d4 iuretics






therapy



and freedom of

side effects




y



J1locer in angina




diaetic nephropathy


intolerance to CE




Aeroic e$ercises



long run



Eampercises








Physical Activity












reducing L


1 heart rate













middle1aged







pressure di99erence



















uaryuary



uaryuary
















therapy



and freedom of

side effects




y



J1locer in angina




diaetic nephropathy


intolerance to CE




Aeroic e$ercises



long run



Eampercises








Physical Activity












reducing L


1 heart rate













middle1aged







pressure di99erence



















uaryuary



uaryuary















y



J1locer in angina




diaetic nephropathy


intolerance to CE




Aeroic e$ercises



long run



Eampercises








Physical Activity












reducing L


1 heart rate













middle1aged







pressure di99erence



















uaryuary



uaryuary















Aeroic e$ercises



long run



Eampercises








Physical Activity












reducing L


1 heart rate













middle1aged







pressure di99erence



















uaryuary



uaryuary















Eampercises








Physical Activity












reducing L


1 heart rate













middle1aged







pressure di99erence



















uaryuary



uaryuary















Physical Activity












reducing L


1 heart rate













middle1aged







pressure di99erence



















uaryuary



uaryuary




















reducing L


1 heart rate













middle1aged







pressure di99erence



















uaryuary



uaryuary

























middle1aged







pressure di99erence



















uaryuary



uaryuary


















pressure di99erence



















uaryuary



uaryuary


























uaryuary



uaryuary















uaryuary













02 Systemic Hypertension

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Transcript of 02 Systemic Hypertension