Hypertension & Stroke

7/30/2019 Hypertension & Stroke

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HYPERTENSION

& STROKE

Prepared by:

Sharinah Ainee S. Pasandalan BSN-III, Group 4



What is Hypertension?

Hypertension or high bloodpressure is a condition in which

the blood pressure in the arteries is

chronically elevated. With everyheart beat, the heart pumps blood

through the arteries to the rest of

the body.



Blood pressure is the force of

blood that is pushing up againstthe walls of the blood vessels. If

the pressure is too high, the heart

has to work harder to pump, and

this could lead to organ damage

and several illnesses such asheart attack, stroke, heart failure,

aneursym, or renal failure.



The normal level for blood

pressure is below 120/80,where 120 represents the

systolic measurement (peakpressure in the arteries) and

80 represents the diastolic

measurement (minimum

pressure in the arteries).



Blood pressure between120/80 and 139/89 is called

prehypertension (to denote

increased risk of hypertension), and a blood

pressure of 140/90 or above isconsidered hypertension.



Hypertension may be classified as

essential or secondary. Essentialhypertension is the term for high

blood pressure with unknown cause.

It accounts for about 95% of cases.Secondary hypertension is the term

for high blood pressure with a known

direct cause, such as kidney disease,tumors, or birth control pills.



What causes hypertension?

SMOKING

Smoking injures blood vessel walls andspeeds up the process of hardening of the

arteries (Atherosclerosis). So even though it

does not cause high blood pressure,smoking is bad for anyone, especially those

with high blood pressure. If you smoke, quit.

If you don't smoke, don't start. Once you quit,your risk of having a heart attack is reduced

after the first year. So you have a lot to gain

by quitting.



Moreover, The nicotine in cigarettes

and other tobacco products causesyour blood vessels to constrict andyour heart to beat faster, whichtemporarily raises your bloodpressure. If you quit smoking orusing other tobacco products, youcan significantly lower your risk of

heart disease and heart attack, aswell as help lower your bloodpressure.



OBESITY (OVERWEIGHT)

If you are overweight, your body requires

extra blood to pass to the bigger areas of flesh; otherwise they would not receive

enough oxygen and vital nutrients that are

required for the growth and repair of allbody cells. This means that the blood

pressure raises and puts unnecessary

stress on the blood vessels, which willeventually lead to heart disease, heart

attack and ultimately, death.



DIABETES

Hypertension occurs because of anarrowing in the arteries. In

diabetics, this can be caused by

continued and consistently highblood glucose levels (a good

reason to keep blood sugar levels

under control). When the blood flowis restricted, the blood pressure

increases.



High levels of salt intake

A general rule in biology is that water will

flow towards higher concentrations of salt.

In the case of blood vessels, water moves

in and out towards higher sodium

concentrations, primarily through adiffusion process termed osmosis. Sodium

chloride concentration in blood is highly

regulated in the body to remain between136-145 mEq/L. This range is slightly

larger at 132-146 mEq/L for persons over

the age of 90.



As more sodium is found in the blood,

water follows to maintain a balance

between the sodium concentration

found in tissue cells, body

compartments and blood vessels. Asa result, increasing salt intake may

increase the volume of fluid contained

in the bloodstream



Vitamin D deficiency

Recent research suggests that adequate

levels of vitamin D in the body can help toprotect against hypertension working as a

natural blood pressure regulator. A

cardiovascular researcher from the EmoryUniversity School of Medicine concluded

that a lack of vitamin D can impair

vascular health leading to high bloodpressure. Supplementation given to study

participants to increase vitamin D levels

resulted in lowered blood pressure.



Chronic kidney disease

The relationship between CKD and hypertension

can be explained by several factors. CKD canlead to salt retention and subsequent volume

overload. This may or may not be accompanied

by swelling (edema) along with increased blood

pressure. In addition, failing kidneys appear totrigger increased activity of the sympathetic

nervous system, causing something like an

adrenaline surge. More advanced CKD can also

lead to low blood count or anemia. The

treatment may help to produce hypertension,

depending on the resultant rise in the blood

count.



Other factors include:

- Stress

- Aging

-Medicines such as birth control pills

- Genetics and a family history of hypertension

- Adrenal and thyroid problems or tumors

- Sedentary lifestyle- Lack of physical activity



Signs & Symptoms:

Extremely high blood pressure may lead to some

symptoms, however, and these include:- Severe headache

- Fatigue or confusion

- Dizziness- Nausea

- Problems with vision

- Chest pains- Breathing problems

- Irregular heartbeat

- Blood in the urine



Diagnosing Hypertension

Measuring Blood Pressure

Blood pressure is most often measuredwith a device known as a

sphygmomanometer, which consists of a

stethoscope, arm cuff, dial, pump, and

valve



Blood pressure is measured in two

ways: systolic and diastolic.

- Systolic blood pressure is the

maximum pressure during aheartbeat.

- Diastolic blood pressure is the lowest

pressure between heartbeats.



If you're diagnosed with high blood

pressure, your doctor may

recommend other tests, such as:

Electrocardiogram (EKG or ECG):

A test that measures the electrical

activity, rate, and rhythm of your

heartbeat via electrodes attached toyour arms, legs, and chest. The

results are recorded on graph paper.



Echocardiogram:

This is a test that uses ultrasoundwaves to provide pictures of the

heart's valves and chambers so

the pumping action of the heartcan be studied and measurement

of the chambers and wallthickness of the heart can be

made.



How is hypertension treated?

High blood pressure may be treatedmedically, by changing lifestyle

factors, or a combination of the two.

Important lifestyle changes includelosing weight, quitting smoking, eating

a healthful diet, reducing sodium

intake, exercising regularly, andlimiting alcohol consumption.



How is hypertension treated?

Medical options to treat hypertension include

several classes of drugs. ACE inhibitors, ARB drugs, beta-blockers, diuretics, calcium

channel blockers, alpha-blockers, and

peripheral vasodilators are the primary drugsused in treatment. These medications may

be used alone or in combination, and some

are only used in combination. In addition,some of these drugs are preferred to others

depending on the characteristics of the

patient (diabetic, pregnant, etc.).



STROKE



What is a Stroke?

A stroke is a condition where a blood

clot or ruptured artery or blood vessel

interrupts blood flow to an area of thebrain. A lack of oxygen and glucose

(sugar) flowing to the brain leads to the

death of brain cells and brain damage,often resulting in an impairment in

speech, movement, and memory.



TYPES OF STROKE

Ischemic strokeIschemic stroke occurs when an

artery to the brain is blocked. The

brain depends on its arteries to bringfresh blood from the heart and lungs.

The blood carries oxygen andnutrients to the brain, and takes away

carbon dioxide and cellular waste.



If an artery is blocked, the brain

cells (neurons) cannot make enoughenergy and will eventually stop

working. If the artery remains

blocked for more than a fewminutes, the brain cells may die.

This is why immediate medical

treatment is critical.



What causes it?

Ischemic stroke can be caused by

several different kinds of diseases.

The most common problem is

narrowing of the arteries in the neck or head. This is most often caused by

atherosclerosis, or gradual cholesterol

deposition. If the arteries become toonarrow, blood cells may collect and

form blood clots.



Another cause of stroke is blood

clots in the heart, which can occur as a result of irregular heartbeat (for

example, atrial fibrillation), heart

attack, or abnormalities of the heartvalves. While these are the most

common causes of ischemic stroke,

there are many other possiblecauses.



Types of ischemic stroke

A thrombotic stroke occurs when

diseased or damaged cerebral

arteries become blocked by the

formation of a blood clot within thebrain. Clinically referred to as

cerebral thrombosis or cerebral

infarction, this type of event isresponsible for almost 50 percent of

all strokes.



Cerebral thrombosis can also be divided

into an additional two categories that

correlate to the location of the blockagewithin the brain: large-vessel thrombosis and

small-vessel thrombosis. Large-vessel

thrombosis is the term used when the

blockage is in one of the brain’s larger blood-

supplying arteries such as the carotid or

middle cerebral, while small-vessel

thrombosis involves one (or more) of thebrain’s smaller, yet deeper, penetrating

arteries. This latter type of stroke is also

called a lacuner stroke.



Thrombotic Stroke



Embolic stroke is also caused by a clot

within an artery, but in this case the clot(or emboli) forms somewhere other than

in the brain itself. Often from the heart,

these emboli will travel in thebloodstream until they become lodged

and cannot travel any farther. This

naturally restricts the flow of blood to thebrain and results in near-immediate

physical and neurological deficits.



Embolic Stroke



Transient ischemic attack (TIA)

A transient ischemic attack (TIA) — also

called a ministroke — is a brief episode of symptoms similar to those you'd have in a

stroke. A transient ischemic attack is

caused by a temporary decrease in bloodsupply to part of your brain. TIAs often last

less than five minutes. Like an ischemic

stroke, a TIA occurs when a clot or debrisblocks blood flow to part of your brain. A TIA

doesn't leave lasting symptoms because the

blockage is temporary.



Hemorrhagic Stroke

Hemorrhagic stroke occurs when a blood

vessel in your brain leaks or ruptures. Brainhemorrhages can result from many

conditions that affect your blood vessels,

including uncontrolled high blood pressure(hypertension) and weak spots in your blood

vessel walls (aneurysms). A less common

cause of hemorrhage is the rupture of anarteriovenous malformation (AVM) — an

abnormal tangle of thin-walled blood vessels,

present at birth.



The types of hemorrhagic stroke include:

Intracerebral hemorrhage. In an

intracerebral hemorrhage, a blood vesselin the brain bursts and spills into the

surrounding brain tissue, damaging brain

cells. Brain cells beyond the leak aredeprived of blood and damaged. High

blood pressure, trauma, vascular

malformations, use of blood-thinningmedications and other conditions may

cause intracerebral hemorrhage.



Intracerebral Hemorrhage



Subarachnoid hemorrhage

In a subarachnoid hemorrhage, an artery on or

near the surface of your brain bursts and spills intothe space between the surface of your brain and

your skull. This bleeding is often signaled by a

sudden, severe headache. A subarachnoid

hemorrhage is commonly caused by the rupture of an aneurysm, a small sack-shaped or berry-shaped

outpouching on an artery in the brain.After the

hemorrhage, the blood vessels in your brain maywiden and narrow erratically (vasospasm), causing

brain cell damage by further limiting blood flow to

parts of your brain.



Subarachnoid Hemorrhage



Who gets stroke?

Risk factors for stroke include the following:

High blood pressure. High blood pressurecauses significant damage to the arteries when

it goes untreated for a long period. When the

force, or pressure, of the blood flowing throughthe arteries is greater than normal, those

arteries weaken over time. Weakened arteries

are more susceptible to burst, or rupture,leading to a hemorrhagic stroke. Chronic high

blood pressure is one of the primary reasons

why hemorrhagic stroke occurs.

Hi h h l t l Ch l t l i



High cholesterol. Cholesterol is a waxy

substance that contributes to the buildup of

deposits, known as plaques, within blood

vessels. Plaques can accumulate in the

coronary arteries, which supply oxygen to the

heart, and in the carotid arteries, which

supply oxygen to the brain. LDL is the "badcholesterol" in terms of its potential for

harming the heart and brain and is a major

contributor to arterial plaque development.Levels of LDL cholesterol greater than 130

milligrams per deciliter (mg/dL) are linked to

an increased risk for ischemic stroke.



Smoking cigarettes

Smoking can cause a stroke bythickening or narrowing the blood

vessels that lead to the brain, mostly

by increasing the likelihood of ablood clot. The nicotine and carbon

monoxide in cigarette smoke

damage the endothelium, which

sets the stage for the build-up of

plaque.



Diabetes

The second scenario is actually theone that leads to stroke--ischemic

stroke, to be exact. The excess glucose

or blood sugar in the blood adds toplaque that sticks to the walls of

arteries, which in turn may cause blood

clots that trigger stroke. Having highglucose levels also leads to high blood

pressure, which is another stroke risk.



Obesity

Obesity is one of many causes of

stroke. Obesity can lead to fat deposits

in the arteries. These may form blood

clots that travel to the brain blocking

blood and oxygen flow causing stroke.

The health effects of obesity cannot be

disputed. Obesity significantly raises the

risk factor for these and other diseases

like sleep apnea and colon, breast,

gallbladder cancer.



Heavy use of alcohol

Chronic excessive alcohol intake can

precipitate hemorrhagic stroke. This is inmany cases the result of harmful effects of

alcohol on the liver, as this organ makes

proteins which are necessary to preventspontaneous bleeding. However, most of

the risk of stroke with excess alcohol

intake appears to be due to a combinationof high blood pressure, and impaired blood

clotting mechanisms.



What are the symptoms of stroke?

Within a few minutes of having a

stroke, brain cells begin to die and

symptoms can become present. It isimportant to recognize symptoms, as

prompt treatment is crucial to recovery.



Common symptoms include:

- Dizziness, trouble walking, loss of

balance and coordination

- Speech problems

- Numbness, weakness, or paralysis onone side of the body

- Blurred, blackened, or double vision

- Sudden severe headache



- A possible sign that a stroke is about

to occur is called a transient ischemicattack (TIA) - a temporary interruption in

blood flow to part of the brain.

Symptoms of TIA are similar to strokebut last for a shorter time period and do

not leave noticeable permanent

damage.



How is stroke diagnosed?

- Physical assessment - blood pressure tests

and blood tests to see cholesterol levels,blood sugar levels, and amino acid levels

- Ultrasound- a wand waved over the carotid

arteries in the neck can provide a picture that

indicates any narrowing or clotting

- Arteriography - a catheter is inserted into

the arteries to inject a dye that can be picked

up by X-rays



- Computerized tomography (CT) scan - ascanning device that creates a 3-D image

that can show aneurysms, bleeding, or

abnormal vessels within the brain- Magnetic resonance imaging (MRI) - a

magnetic field generates a 3-D view of the

brain to see tissue damaged by stroke



- CT and MRI with angiography - scans

that are aided by a dye that is injectedinto the blood vessels in order to provide

clearer and more detailed images

- Echocardiography - an ultrasound that

makes images of the heart to check for

embolus



How is stroke treated?

The primary goal in treatingischemic stroke is to restore blood

flow to the brain. This will be

attempted using blood clot-bustingdrugs such as aspirin, heparin, or

tissue plasminogen activators thatmust be administered within three

hours of the stroke.

http://www.medicalnewstoday.com/articles/161255.php

http://www.medicalnewstoday.com/articles/161255.php



In addition, surgical procedures

may be performed that can open upor widen arteries. These include

carotid endarterectomy (removal of

plaque and widening of the carotidartery) and angioplasty (a balloon

that widens the cartoid artery and is

held open with a metallic mesh tube

called a stent).



Hemorrhagic stroke is treated differently

than ischemic stroke. Surgical methods

used to treat this stroke variant include

aneurysm clipping, aneurysm embolisation,

and arteriovenous malformation (AVM)

removal.

Aneurysm clipping consists of a small

clamp placed at the base of the aneurysm

that isolates it from the circulation of it's

attached artery and keeps the aneurysm

from bursting or re-bleeding.



Aneurysm embolisation (coiling) uses

a catheter inserted into the aneurysm todeposit a tiny coil that coil fills the

aneurysm, causing clotting and sealing

off the aneurysm off from arteries. AVM removal is a surgical procedure

to remove usually smaller AVMs or

AMVs that are in more accessibleportion of the brain in order to eliminate

the risk of rupture.

Hypertension & Stroke

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