Hypertension lecture
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Transcript of Hypertension lecture
Hypertension
Each time the heart beats (about 60-70 times a minute at rest), it pumps out blood into
the arteries.
What Is Blood Pressure?Your blood pressure is at its
highest when the heart beats, pumping the blood.
When the heart is at rest, between beats, your blood pressure
falls.
Your blood pressure is always given as these two numbers with one above or before the other.
This is called SYSTOLIC pressure. 120/To
p num
ber
80This is called DIASTOLIC pressure.
Bottom number
CategorySystolic
(Top Number)Diastolic
(Bottom Number)
Normal Less than 120 Less than 80
What Is Normal Blood Pressure?
“Normal” blood pressure is when both numbers are lower than 120/80.
If your blood pressure is in the prehypertensive range:
It means that you don’t have high blood pressure now, but you are likely to develop it in the future.
Unless you take ACTION to prevent it!
“Prehypertension”
Prehypertension 120-139 80-89
Medical Education & Information – for all Media, all Disciplines, from all over the World Powered by
2013 ESH/ESC Guidelines for the management of arterial hypertension
The Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC) - J Hypertension 2013;31:1281-1357
Definitions and classification of office BP levels (mmHg)*
Category Systolic Diastolic
Optimal <120 and <80
Normal 120–129 and/or 80–84
High normal 130–139 and/or 85–89
Grade 1 hypertension 140–159 and/or 90–99
Grade 2 hypertension 160–179 and/or 100–109
Grade 3 hypertension ≥180 and/or ≥110
Isolated systolic hypertension ≥140 and <90
* The blood pressure (BP) category is defined by the highest level of BP, whether systolic or diastolic. Isolated systolic hypertension should be graded 1, 2, or 3 according to systolic BP values in the ranges indicated.
Hypertension:SBP >140 mmHg ± DBP >90 mmHg
What Is High Blood Pressure?
A blood pressure of 140/90 is considered high blood pressure.
High Blood Pressure Systolic Diastolic
Stage 1 140-159 90-99
Stage 2 160 or higher 100 or higher
“Hypertension”
Kieran McGlade Nov 2001 Department of General Practice QUB
Aetiology of Hypertension• Primary – 90-95% of cases – also termed “essential” of “idiopathic”• Secondary – about 5% of cases
– Renal or renovascular disease– Endocrine disease
• Phaeochomocytoma• Cusings syndrome• Conn’s syndrome (hyperaldosteronism)• Acromegaly and hypothyroidism
– Coarctation of the aorta– Iatrogenic
• Hormonal / oral contraceptive• NSAIDs
• Renovascular disease is a progressive condition that causes narrowing or blockage of the renal arteries or veins. These are the blood vessels that take blood to and from the kidneys. It's the general term used for three disorders: renal artery occlusion, renal vein thrombosis, and renal atheroembolism.
• Phaeochomocytoma is a small vascular tumor of the adrenal medulla, causing irregular secretion of epinephrine and norepinephrine, leading to attacks of raised blood pressure, palpitations, and headache.
• Cusings syndrome is a metabolic disorder caused by overproduction of corticosteroid hormones by the adrenal cortex and often involving obesity and high blood pressure.
Coarctation of the aorta
• Coarctation
Hypertension: Predisposing factors
• Advancing Age • Sex (men and postmenopausal women)• Family history of cardiovascular disease• Sedentary life style & psycho-social stress• Smoking ,High cholesterol diet, Low fruit
consumption• Obesity & wt. gain• Co-existing disorders such as diabetes, and
hyperlipidaemia• High intake of alcohol
Haemodynamic Pattern in
Hypertension
Young : BP = CO X TPR
Elderly : BP = CO X TPR
What can high blood pressure do to your body?
Heart Attack
High blood pressure is a major risk factor for heart attack. The arteries bring
oxygen-carrying blood to the heart muscle. If the heart
cannot get enough oxygen, chest pain, can occur. If the flow of blood is blocked, a
heart attack results.
BlindnessHigh blood pressure can eventually
cause blood vessels in the eye to burst or bleed. Vision may become blurred or otherwise impaired and
can result in blindness.
Kidney diseaseKidneys act as filters to rid the
body of waste. High blood pressure can narrow and
thicken the blood vessels of the kidneys. The kidneys filter less fluid and waste
builds up in the blood. The kidneys may fail altogether.
High blood pressure is the most important risk factor for stroke. Very high pressure can cause a break in a weakened blood vessel,
which then bleeds in the brain. This can cause a stroke. If a blood clot blocks one of the narrowed arteries, it can also cause a
stroke.
Stroke
As people get older, arteries throughout the body
"harden," especially those in the heart, brain, and
kidneys. High blood pressure is associated with these "stiffer" arteries. This, in
turn, causes the heart and kidneys to work harder.
Arteries
Heart failureThe heart is unable to
pump enough blood to supply the body's needs.
Diagnosis
Clinical manifestations
• No specific complains or manifestations other than elevated systolic and/or diastolic BP (Silent Killer )
• Morning occipital headache• Dizziness• Fatigue• In severe hypertension, epistaxis or blurred vision
Self-Measurement of BP
Provides information on:1. Response to antihypertensive therapy2. Improving adherence with therapy 3. Evaluating white-coat HTN
Home measurement of >135/85 mmHg is generally considered to be hypertensive.
Home measurement devices should be checked regularly.
Measuring Blood Pressure
• Patient seated quietly for at least 5minutes in a chair, with feet on the floor and arm supported at heart level
•An appropriate-sized cuff (cuff bladder encircling at least 80% of the arm)
•At least 2 measurements
Continue…
• Systolic Blood Pressure is the point at which the first of 2 or more sounds is heard
• Diastolic Blood Pressure is the point of disappearance of the sounds (Korotkoff 5th)
Continue…
Measuring Blood Pressure
• Ambulatory BP Monitoring - information about BP during daily activities and sleep.
• Correlates better than office measurements with target-organ injury.
Continue…
Measuring Blood Pressure
Laboratory Tests
Routine Tests• Electrocardiogram • Urinalysis • Blood glucose, • Serum potassium, creatinine, or the corresponding estimated GFR,
and calcium• Lipid profile, after 9- to 12-hour fast, that includes high-density and
low-density lipoprotein cholesterol, and triglycerides Optional tests
• Measurement of urinary albumin excretion or albumin/creatinine ratio
More extensive testing for identifiable causes is not generally indicated unless BP control is not achieved
How to treat ?
Treatment Overview
Goals of therapyLifestyle modificationPharmacologic treatment Algorithm for treatment of hypertensionFollow up and monitoring
Goals of Therapy
Reduce Cardiac and renal morbidity and mortality.
Treat to BP <140/90 mmHg or BP <130/80 mmHg in patients with diabetes or chronic kidney disease.
Non pharmacological Treatment of hypertension
Avoid harmful habits ,smoking ,alcohal
Reduce salt and high fat diets
Loose weight , if obese
Regular exercise
DASHdiet
Life style modifications
• Lose weight, if overweight• Increase physical activity• Reduce salt intake• Stop smoking• Limit intake of foods rich in fats and
cholesterol• increase consumption of fruits and
vegetables• Limit alcohol intake
Lifestyle Modification
Modification Approximate SBP reduction(range)
Weight reduction 5–20 mmHg / 10 kg weight loss
Adopt DASH eating plan
8–14 mmHg
Dietary sodium reduction
2–8 mmHg
Physical activity 4–9 mmHg
Moderation of alcohol consumption
2–4 mmHg
Antihypertensive Drugs
Continue….
AT1 receptor
ARB
Drug therapy for hypertension
Class of drug Example Initiating dose Usual maintenance dose
DiureticsHydrochlorothiazide 12.5 mg o.d. 12.5-25 mg o.d.
-blockers Atenolol 25-50 mg o.d. 50-100 mg o.d.
Calcium Amlodipine 2.5-5 mg o.d. 5-10 mg o.d.channelblockers
-blockers prazosin 2.5 mg o.d 2.5-10mg o.d.
ACE- inhibitors ramipril 1.25-5 mg o.d. 5-20 mg o.d.
Angiotensin-II Losartan25-50 mg o.d. 50-100 mg o.d.receptor blockers