Slide 1 Hypertension (HT) High Blood Pressure (HBP)
-
date post
22-Dec-2015 -
Category
Documents
-
view
223 -
download
3
Transcript of Slide 1 Hypertension (HT) High Blood Pressure (HBP)
![Page 1: Slide 1 Hypertension (HT) High Blood Pressure (HBP)](https://reader035.fdocuments.us/reader035/viewer/2022062308/56649d815503460f94a65988/html5/thumbnails/1.jpg)
slide 1
Hypertension (HT)
High Blood Pressure (HBP)
![Page 2: Slide 1 Hypertension (HT) High Blood Pressure (HBP)](https://reader035.fdocuments.us/reader035/viewer/2022062308/56649d815503460f94a65988/html5/thumbnails/2.jpg)
slide 2
Introduction
• Definition: Hypertension is defined as elevated arterial blood pressure.
• Hypertension is one of the most common disease in the world
• In our country, 160 million people over the age of 15 have established or borderline HP
• HP Essential HP (95%) Secondary HP (5%)
![Page 3: Slide 1 Hypertension (HT) High Blood Pressure (HBP)](https://reader035.fdocuments.us/reader035/viewer/2022062308/56649d815503460f94a65988/html5/thumbnails/3.jpg)
slide 3
Etiology
• Genetic
• Environment
Dietary: Salt intake
Alcohol intake
Obesity
Infant dysnutrition
![Page 4: Slide 1 Hypertension (HT) High Blood Pressure (HBP)](https://reader035.fdocuments.us/reader035/viewer/2022062308/56649d815503460f94a65988/html5/thumbnails/4.jpg)
slide 4
Pathogenesis1. High activity of the SNS (Sympathetic
Nervous System)2. RAAS (Renin-Angiotension Aldosterone
System)3. Renal Sodium Handling4. Vascular Remodelling5. Endothelial Cell Dysfunction6. Insulin Resistance
![Page 5: Slide 1 Hypertension (HT) High Blood Pressure (HBP)](https://reader035.fdocuments.us/reader035/viewer/2022062308/56649d815503460f94a65988/html5/thumbnails/5.jpg)
slide 6
The pathological changes of small artery
![Page 6: Slide 1 Hypertension (HT) High Blood Pressure (HBP)](https://reader035.fdocuments.us/reader035/viewer/2022062308/56649d815503460f94a65988/html5/thumbnails/6.jpg)
slide 7
The pathological change of the Heart
Left ventricular hypertrophy (LVH)
Heart failure
Coronary artery atherosclerosis
Myocardial infarction
![Page 7: Slide 1 Hypertension (HT) High Blood Pressure (HBP)](https://reader035.fdocuments.us/reader035/viewer/2022062308/56649d815503460f94a65988/html5/thumbnails/7.jpg)
slide 8
Pathological change of the Brain
Stroke:
Ischemic stroke
Hemorrhagic stoke
Arterial Aneurysm
![Page 8: Slide 1 Hypertension (HT) High Blood Pressure (HBP)](https://reader035.fdocuments.us/reader035/viewer/2022062308/56649d815503460f94a65988/html5/thumbnails/8.jpg)
slide 9
Pathological change of Renal
Hypertension induced nephrosclerosis, atrophy of renal cortex
![Page 9: Slide 1 Hypertension (HT) High Blood Pressure (HBP)](https://reader035.fdocuments.us/reader035/viewer/2022062308/56649d815503460f94a65988/html5/thumbnails/9.jpg)
slide 10
Clinical Features
• The blood pressure varies widely over time, depending on many variables, including SNS activity, posture, state of hydration, and skeletal muscle tone.
• Symptoms: Always asymptomatic Symptoms often attributed to hypertension: headache, tinnitus, dizziness, fainting
![Page 10: Slide 1 Hypertension (HT) High Blood Pressure (HBP)](https://reader035.fdocuments.us/reader035/viewer/2022062308/56649d815503460f94a65988/html5/thumbnails/10.jpg)
slide 11
Clinical Features
• Complications of Hypertension
Heart: LVH, CHD,HF
Brain: TIA, Stroke
Renal: Microalbuminuria, renal dysfunction
Ratinopathy
![Page 11: Slide 1 Hypertension (HT) High Blood Pressure (HBP)](https://reader035.fdocuments.us/reader035/viewer/2022062308/56649d815503460f94a65988/html5/thumbnails/11.jpg)
slide 12
Laboratory Examination
• Blood pressure measurement: Clinic Blood Pressure Home Blood Pressure Ambulatory monitoring
![Page 12: Slide 1 Hypertension (HT) High Blood Pressure (HBP)](https://reader035.fdocuments.us/reader035/viewer/2022062308/56649d815503460f94a65988/html5/thumbnails/12.jpg)
slide 13
Ambulatory Measurement
• Ambulatory monitoring can provide:– readings throughout day during usual activities
– readings during sleep to assess nocturnal changes
– measures of SBP and DBP load
– Exclude white coat or office hypertension
• Ambulatory readings are usually lower than in clinic (hypertension is defined as > 135/85 mm Hg)
![Page 13: Slide 1 Hypertension (HT) High Blood Pressure (HBP)](https://reader035.fdocuments.us/reader035/viewer/2022062308/56649d815503460f94a65988/html5/thumbnails/13.jpg)
slide 14
Laboratory Examination
• Urinalysis
• Blood examination
• Chest X Ray
• EKG
• UCG (Ultrasound cardiography)
• Retina examination
![Page 14: Slide 1 Hypertension (HT) High Blood Pressure (HBP)](https://reader035.fdocuments.us/reader035/viewer/2022062308/56649d815503460f94a65988/html5/thumbnails/14.jpg)
slide 15
![Page 15: Slide 1 Hypertension (HT) High Blood Pressure (HBP)](https://reader035.fdocuments.us/reader035/viewer/2022062308/56649d815503460f94a65988/html5/thumbnails/15.jpg)
slide 16
![Page 16: Slide 1 Hypertension (HT) High Blood Pressure (HBP)](https://reader035.fdocuments.us/reader035/viewer/2022062308/56649d815503460f94a65988/html5/thumbnails/16.jpg)
slide 17
![Page 17: Slide 1 Hypertension (HT) High Blood Pressure (HBP)](https://reader035.fdocuments.us/reader035/viewer/2022062308/56649d815503460f94a65988/html5/thumbnails/17.jpg)
slide 18
The Keith-Wagner Criteria (change in retina)
KW I: Minimal arteriolar narrowing, irregularity
of the lumen, and increased light reflex
KW II: More marked narrowing and irregularity
with arteriovenous nicking (crossing defects)
KW III: Flame-shaped hemorrhages and exudates in
addition to above arteriolar changes
KW IV: Any of the above with addition of papilledema
![Page 18: Slide 1 Hypertension (HT) High Blood Pressure (HBP)](https://reader035.fdocuments.us/reader035/viewer/2022062308/56649d815503460f94a65988/html5/thumbnails/18.jpg)
slide 19
Flame shaped hemorrhage
Pepilledema
![Page 19: Slide 1 Hypertension (HT) High Blood Pressure (HBP)](https://reader035.fdocuments.us/reader035/viewer/2022062308/56649d815503460f94a65988/html5/thumbnails/19.jpg)
slide 20
Diagnosis & Differential Diagnosis
![Page 20: Slide 1 Hypertension (HT) High Blood Pressure (HBP)](https://reader035.fdocuments.us/reader035/viewer/2022062308/56649d815503460f94a65988/html5/thumbnails/20.jpg)
slide 21
Classification of blood pressure for adult
Category SBP (mmHg) DBP (mmHg)
Normal < 120 < 80
High normal 120-139 80-89
Hypertension ≥140 ≥90
Stage 1 140-159 90-99
Stage 2 160-179 100-109
Stage 3 ≥180 ≥110
Systolic HBP ≥140 < 90
When the SBP and DBP fall into different categories, use the higher category
![Page 21: Slide 1 Hypertension (HT) High Blood Pressure (HBP)](https://reader035.fdocuments.us/reader035/viewer/2022062308/56649d815503460f94a65988/html5/thumbnails/21.jpg)
slide 22
Evaluation Objectives
• To identify cardiovascular risk factors
• To assess presence or absence of target organ damage
• To identify other causes of hypertension
These evaluation may used in stratification of the hypertension patients
![Page 22: Slide 1 Hypertension (HT) High Blood Pressure (HBP)](https://reader035.fdocuments.us/reader035/viewer/2022062308/56649d815503460f94a65988/html5/thumbnails/22.jpg)
slide 23
Cardiovascular Risk Factors
• Blood pressure
• Age
• Gender
• Dyslipidemia
• Abdomen Obesity
• Family History of cardiovascular disease
• CRP ≥1mg/dl
![Page 23: Slide 1 Hypertension (HT) High Blood Pressure (HBP)](https://reader035.fdocuments.us/reader035/viewer/2022062308/56649d815503460f94a65988/html5/thumbnails/23.jpg)
slide 24
Target Organ Damage
• Left ventricular hypertrophy
• Echo shows IMT of carotid artery
• Plasma creatinine slight elevation
• Microalbuminuria
![Page 24: Slide 1 Hypertension (HT) High Blood Pressure (HBP)](https://reader035.fdocuments.us/reader035/viewer/2022062308/56649d815503460f94a65988/html5/thumbnails/24.jpg)
slide 25
Associated Clinical Condition
• Cerebrovascular diseases: Stroke, TIA• Heart diseases: MI, AP, CHF, Coronary
artery revasculation• Kidney diseases: DN, Dysfunction of the
kidney, Proteinuria, CRF • Diabetes• Peripheral artery disease• Retinopathy
![Page 25: Slide 1 Hypertension (HT) High Blood Pressure (HBP)](https://reader035.fdocuments.us/reader035/viewer/2022062308/56649d815503460f94a65988/html5/thumbnails/25.jpg)
slide 26
Evaluation Components
• Medical history
• Physical examination
• Routine laboratory tests
![Page 26: Slide 1 Hypertension (HT) High Blood Pressure (HBP)](https://reader035.fdocuments.us/reader035/viewer/2022062308/56649d815503460f94a65988/html5/thumbnails/26.jpg)
slide 27
Stratification of Hypertension patients
Blood Pressure
risk factors & Disease History
Grade I Grade II Grade III
I . No risk factors Low risk Med risk High risk
II. 1-2 risk factors Med risk Med risk Very high risk
III. 3 or more risk factors or TOD or diabetes
High risk High risk Very high risk
IV. ACC Very high risk Very high risk Very high risk
TOD-Target Organ Damage; ACC-Associated Clinical Conditions
![Page 27: Slide 1 Hypertension (HT) High Blood Pressure (HBP)](https://reader035.fdocuments.us/reader035/viewer/2022062308/56649d815503460f94a65988/html5/thumbnails/27.jpg)
slide 28
Differential Diagnosis
Should exclude Secondary Hypertension
![Page 28: Slide 1 Hypertension (HT) High Blood Pressure (HBP)](https://reader035.fdocuments.us/reader035/viewer/2022062308/56649d815503460f94a65988/html5/thumbnails/28.jpg)
slide 29
Secondary Hypertension Common Causes
• Renal Glomerulonephritis Pyelonephritis
Obstructive nephropathy Collagen diseases, Congenital diseases Diabetes nephropathy Renal tumor---- renin secreting tumor
• Pheochromocytoma
• Primary aldosteronism
![Page 29: Slide 1 Hypertension (HT) High Blood Pressure (HBP)](https://reader035.fdocuments.us/reader035/viewer/2022062308/56649d815503460f94a65988/html5/thumbnails/29.jpg)
slide 30
Phenochromocytoma• Ganglion-neurotomas and neuroblastomas • Excretion of large amounts of catecholamines• 90% arise in the adrenal medulla • 10% are malignant.• Paroxymal or persist HT • Clinic features: Headache, sweating,
palpitations, nervousness, weight loss, hypermetabolism, orthostatic hypotension, severe presser response
![Page 30: Slide 1 Hypertension (HT) High Blood Pressure (HBP)](https://reader035.fdocuments.us/reader035/viewer/2022062308/56649d815503460f94a65988/html5/thumbnails/30.jpg)
slide 31
Primary Aldosteronism
• Mild or moderate hypertension
• Hypokalemia, muscle weakness, paralysis
• Polyuria, nocturia and polydipsia,
• Hypochloremic alkalosis
• Urine aldosterone elevation
• Plasma renin active decrease
![Page 31: Slide 1 Hypertension (HT) High Blood Pressure (HBP)](https://reader035.fdocuments.us/reader035/viewer/2022062308/56649d815503460f94a65988/html5/thumbnails/31.jpg)
slide 32
Secondary Hypertension
• Obstructive Sleep Apnea (OSA)• Renal artery stenosis • Cushing’s syndrome• Coarctation of the aorta• Drug-induced: NSAIDs; Sympathomimetic medications; Prophylactic; Monoamine oxidase inhibitors; Mineralocorticoids; Immuno-inhibitors; Epogen
![Page 32: Slide 1 Hypertension (HT) High Blood Pressure (HBP)](https://reader035.fdocuments.us/reader035/viewer/2022062308/56649d815503460f94a65988/html5/thumbnails/32.jpg)
slide 33
Therapy
![Page 33: Slide 1 Hypertension (HT) High Blood Pressure (HBP)](https://reader035.fdocuments.us/reader035/viewer/2022062308/56649d815503460f94a65988/html5/thumbnails/33.jpg)
slide 34
Goal of Hypertension Management
• < 140/90 mm Hg
• With Diabetes or kidney dysfunction: <130/80mmHg
– To reduce morbidity and mortality of cerebral and cardiovascular complications.
– Controlling other cardiovascular risk factors
![Page 34: Slide 1 Hypertension (HT) High Blood Pressure (HBP)](https://reader035.fdocuments.us/reader035/viewer/2022062308/56649d815503460f94a65988/html5/thumbnails/34.jpg)
slide 35
Lifestyle Modifications
• Stop smoking
• Limit alcohol intake
• Lose weight or keep fit
• Suitable diet
• Increase aerobic physical activity
• Decrease psychological stress
![Page 35: Slide 1 Hypertension (HT) High Blood Pressure (HBP)](https://reader035.fdocuments.us/reader035/viewer/2022062308/56649d815503460f94a65988/html5/thumbnails/35.jpg)
slide 36
Principle of Drug Therapy
• Drug therapy should be individually
• A low dose of initial drug therapy
• Combination therapies may provide additional efficacy with fewer adverse effects.
• Optimal formulation should provide 24-hour efficacy with once-daily dose.
![Page 36: Slide 1 Hypertension (HT) High Blood Pressure (HBP)](https://reader035.fdocuments.us/reader035/viewer/2022062308/56649d815503460f94a65988/html5/thumbnails/36.jpg)
slide 37
Antihypertensive Drugs
• Diuretics
• ß-Adrenergic receptor blockers (BB)
• Calcium channel blockers (CCB)
• ACE inhibitors (ACEI)
• Angiotensin II receptor blockers (ARB)
![Page 37: Slide 1 Hypertension (HT) High Blood Pressure (HBP)](https://reader035.fdocuments.us/reader035/viewer/2022062308/56649d815503460f94a65988/html5/thumbnails/37.jpg)
slide 38
Not at Goal Blood Pressure
Algorithm for Treatment of Hypertension
Hypertension patient
Lifestyle Modifications
Initial Drug Choices
![Page 38: Slide 1 Hypertension (HT) High Blood Pressure (HBP)](https://reader035.fdocuments.us/reader035/viewer/2022062308/56649d815503460f94a65988/html5/thumbnails/38.jpg)
slide 39
Not at Goal Blood Pressure
Initial Drug Choices
No associated clinical condition
Algorithm for Treatment of Hypertension (continued)
Associated clinical condition
I stage hypertension: Diuretics,
BB,CCB,ACEI,ARB
II stage hypertension: Two drugs
combination therapy
Choice the drugs according to ACC
Increase dosage or add another agent from different class
![Page 39: Slide 1 Hypertension (HT) High Blood Pressure (HBP)](https://reader035.fdocuments.us/reader035/viewer/2022062308/56649d815503460f94a65988/html5/thumbnails/39.jpg)
slide 40
Drug choices in hypertension patient associated with clinical condition
ACCDrug
Diuretics BB ACEI ARB CCB Antialdosterone
HF √ √ √ √
MI √ √ √
CAD √ √ √ √
DM √ √ √ √ √
CRF √ √
Stroke √ √
![Page 40: Slide 1 Hypertension (HT) High Blood Pressure (HBP)](https://reader035.fdocuments.us/reader035/viewer/2022062308/56649d815503460f94a65988/html5/thumbnails/40.jpg)
slide 41
Combination Therapies• May provide additional efficacy with fewer adverse
effects.
• Diuretics as the basement drug in combination therapy.
Diuretics ---- ACEI / ARB
Diuretics ---- BB
Diuretics ---- CCB
• CCB as the basement drug in combination therapy
CCB ---- ACEI
CCB ---- BB • Others: Three drugs combination
![Page 41: Slide 1 Hypertension (HT) High Blood Pressure (HBP)](https://reader035.fdocuments.us/reader035/viewer/2022062308/56649d815503460f94a65988/html5/thumbnails/41.jpg)
slide 42
Causes for InadequateResponse to Drug Therapy
• Incorrect measurement of the BP
• Volume overload or Pseudo-resistance
• Drug-related causes• Associated conditions
![Page 42: Slide 1 Hypertension (HT) High Blood Pressure (HBP)](https://reader035.fdocuments.us/reader035/viewer/2022062308/56649d815503460f94a65988/html5/thumbnails/42.jpg)
slide 43
Hypertensive crisis• Hypertensive Emergencies and Urgencies
• Emergencies: The blood pressure is elevated severely and associated with target organ damage, such as hypertensive encephalopathy, AMI, pulmonary edema, require immediate blood pressure reduction.
• Urgencies: The blood pressure is elevated severely but no target organ damage has acute target organ damage.
• Fast-acting drugs are available.
![Page 43: Slide 1 Hypertension (HT) High Blood Pressure (HBP)](https://reader035.fdocuments.us/reader035/viewer/2022062308/56649d815503460f94a65988/html5/thumbnails/43.jpg)
slide 44
Drugs Available forHypertensive Crisis
Vasodilators
•Nitroprusside
•Nicardipine
•Nitroglycerin
•Hydralazine
Adrenergic Inhibitors
•Labetalol
•Esmolol
•Phentolamine
![Page 44: Slide 1 Hypertension (HT) High Blood Pressure (HBP)](https://reader035.fdocuments.us/reader035/viewer/2022062308/56649d815503460f94a65988/html5/thumbnails/44.jpg)
slide 45
Case 1Male 29 years oldBlood pressure elevated for two years With paroxysmal dizziness, blurred vision,
sweating and palpitation BP: 160-180/90-100mmHg HR: 100-120 bpmWhen the patient with symptoms, the BP would
elevate to 240-260/120-130mmHg, and HR increase to 130-150 bpm.
![Page 45: Slide 1 Hypertension (HT) High Blood Pressure (HBP)](https://reader035.fdocuments.us/reader035/viewer/2022062308/56649d815503460f94a65988/html5/thumbnails/45.jpg)
slide 46
Physical examination:
BP: 165/100mmHg HR: 112 bpm
No positive sign in chest examination
Can find a mass at right abdomen, if press on it the BP of the patient elevated to 250/120mmHg, and the HR increased to 145 bpm.
![Page 46: Slide 1 Hypertension (HT) High Blood Pressure (HBP)](https://reader035.fdocuments.us/reader035/viewer/2022062308/56649d815503460f94a65988/html5/thumbnails/46.jpg)
slide 47
Laboratory test:Blood routine, Urinalysis, Blood biochemistry are
normalPlasma renine activation: 0.93ng/ml.h (0.93-6.56) AT II: 51.5pg/ml ↓ (55.3-115.3) Aldosterone: 129.4pd/ml (63-239.6)NE: 33.40pmol/ml ↑↑ (0.51-3.26)12-lead electrocardiogram: High voltage of LV
Chest X ray: Normal
![Page 47: Slide 1 Hypertension (HT) High Blood Pressure (HBP)](https://reader035.fdocuments.us/reader035/viewer/2022062308/56649d815503460f94a65988/html5/thumbnails/47.jpg)
slide 48
CT scan of abdomen:
Found a mass at right adrenal
Diagnosis as Phenochromocytoma
![Page 48: Slide 1 Hypertension (HT) High Blood Pressure (HBP)](https://reader035.fdocuments.us/reader035/viewer/2022062308/56649d815503460f94a65988/html5/thumbnails/48.jpg)
slide 49
Case 2
Male, 65 years old
Hypertension history for 30 years
Headache, blurred vision, vomiting for 2 hours
Paralysis of left side body
BP: 220/130mmHg
HR: 106 bpm
CT scan of the head: Normal
![Page 49: Slide 1 Hypertension (HT) High Blood Pressure (HBP)](https://reader035.fdocuments.us/reader035/viewer/2022062308/56649d815503460f94a65988/html5/thumbnails/49.jpg)
slide 50
Diagnosis: Hypertensive crisis
Therapy: Controlled the BP, using fast-acting drug , such as Nitroprusside, Labetalol
The reduction of BP should less than 25% in 24 hours
BP ≥ 160/100mmHg in 48 hours
![Page 50: Slide 1 Hypertension (HT) High Blood Pressure (HBP)](https://reader035.fdocuments.us/reader035/viewer/2022062308/56649d815503460f94a65988/html5/thumbnails/50.jpg)
slide 51
Summary• Specific therapy for patients with LVF, CAD, and
HF. ACEI can be used for all type patients.
• In older persons, diuretics and CCB are preferred.
• Many patients need combination therapy.
• Goal of the patients with renal insufficiency with proteinuria (>1 g/day): 125/75 mmHg;
(< 1 g/day): 130/80 mmHg. • Patients with diabetes should be treated to a
therapy goal of below 130/80 mm Hg.