Recent guidelines classify hypertension into four stages based on increasing levels of systolic and diastolic blood pressure. Hypertension increases risks for cardiovascular and kidney diseases, and adequate control can reduce risks by 20-50%. Primary hypertension is usually essential and related to multiple genetic and lifestyle factors in 95% of cases. Treatment involves lifestyle changes, medication, and interventional procedures for resistant cases. Goals are to control blood pressure and reduce long-term health risks.
Hypertension, or high blood pressure, is defined as blood pressure above 140/90 mmHg. It can be classified into stages based on systolic and diastolic blood pressure readings. The majority of cases are primary or essential hypertension, while a small percentage are secondary to other conditions. Target organ damage to the heart, brain, kidneys and eyes can occur if hypertension is not controlled. Lifestyle modifications and medications are used to treat and manage hypertension. Nursing care involves educating patients, monitoring for complications, and promoting treatment adherence.
Hypertension (HTN) is a major health problem known as the "silent killer" due to its asymptomatic nature. It is classified by the ACC/AHA and other guidelines into normal, elevated, stage 1, and stage 2 categories based on systolic and diastolic blood pressure readings. HTN can be primary (essential) or secondary to other medical conditions and is a leading cause of heart disease and stroke. Treatment involves lifestyle modifications like diet, exercise, and weight loss as well as antihypertensive medications like thiazide diuretics, ACE inhibitors, ARBs, and calcium channel blockers, often in combination therapy. Medication and treatment goals depend on the severity and type of HTN as
This document provides an overview of hypertension (high blood pressure). It defines hypertension as a condition where blood pressure is elevated over the long term, which can damage the heart and lead to issues like stroke if not treated. The document discusses pre-hypertension blood pressure levels, stages of hypertension, and common causes like diet, lack of exercise, and obesity. It also examines the pathophysiology (disease processes) of hypertension, including how the sympathetic nervous system, renin-angiotensin system, vascular endothelium, and kidney functions can increase blood pressure through mechanisms like vasoconstriction and increased blood volume.
Hypertension, or high blood pressure, is classified as either primary (essential) or secondary. Primary hypertension accounts for 90% of cases and has no identifiable cause, while secondary hypertension is caused by an underlying condition like renal disease. Treatment involves lifestyle modifications and medication, with thiazide diuretics often used as initial therapy. Other common drug classes for treatment include ACE inhibitors, calcium channel blockers, beta blockers, and alpha blockers. Multiple drug therapy is usually required to control hypertension.
High blood pressure, or hypertension, is defined as blood pressure above 140/90 mmHg and affects around 50 million people in the US. It occurs when the force of blood against artery walls is too high and can lead to heart disease and stroke over time if not managed. Hypertension is primarily diagnosed through repeated blood pressure readings and treated initially through lifestyle changes like diet, exercise, and reducing stress and alcohol/tobacco use. If lifestyle changes are insufficient, medication therapy is used, which may include ACE inhibitors, ARBs, calcium channel blockers, diuretics, beta blockers, and alpha blockers to help relax blood vessels and lower blood pressure.
Hypertension, also known as high blood pressure, is a condition where the blood vessels have persistently raised pressure. It is classified based on systolic and diastolic blood pressure readings into normal, prehypertension, and stages 1 and 2 hypertension. Essential or primary hypertension has no known cause, while secondary hypertension is caused by underlying conditions like kidney disease, diabetes or medications. Risk factors include family history, obesity, lack of exercise, too much salt or alcohol. Treatment involves lifestyle changes and medication to control blood pressure.
This document summarizes drugs used to manage hypotension and hypertension. It discusses drugs that can be used to treat hypotension like norepinephrine, phenylephrine, and methoxamine, which are direct-acting alpha agonists that increase blood pressure by constricting blood vessels. It also discusses various classes of drugs to treat hypertension, including ACE inhibitors, ARBs, calcium channel blockers, diuretics, and vasodilators. Each drug class is explained in terms of its mechanism of action and examples are provided of commonly used drugs within each class. Adverse effects are also outlined for each drug class.
Hypertension pharmacotherapy part 2 pptPranatiChavan
First-line medications used in the treatment of hypertension include diuretics, angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs), beta-blockers, and calcium channel blockers (CCBs). Some patients will require 2 or more antihypertensive medications to achieve their BP target. As per special consideration, modified treatment is given in the presentation.
Hypertension, or high blood pressure, is defined as blood pressure above 140/90 mmHg. It can be classified into stages based on systolic and diastolic blood pressure readings. The majority of cases are primary or essential hypertension, while a small percentage are secondary to other conditions. Target organ damage to the heart, brain, kidneys and eyes can occur if hypertension is not controlled. Lifestyle modifications and medications are used to treat and manage hypertension. Nursing care involves educating patients, monitoring for complications, and promoting treatment adherence.
Hypertension (HTN) is a major health problem known as the "silent killer" due to its asymptomatic nature. It is classified by the ACC/AHA and other guidelines into normal, elevated, stage 1, and stage 2 categories based on systolic and diastolic blood pressure readings. HTN can be primary (essential) or secondary to other medical conditions and is a leading cause of heart disease and stroke. Treatment involves lifestyle modifications like diet, exercise, and weight loss as well as antihypertensive medications like thiazide diuretics, ACE inhibitors, ARBs, and calcium channel blockers, often in combination therapy. Medication and treatment goals depend on the severity and type of HTN as
This document provides an overview of hypertension (high blood pressure). It defines hypertension as a condition where blood pressure is elevated over the long term, which can damage the heart and lead to issues like stroke if not treated. The document discusses pre-hypertension blood pressure levels, stages of hypertension, and common causes like diet, lack of exercise, and obesity. It also examines the pathophysiology (disease processes) of hypertension, including how the sympathetic nervous system, renin-angiotensin system, vascular endothelium, and kidney functions can increase blood pressure through mechanisms like vasoconstriction and increased blood volume.
Hypertension, or high blood pressure, is classified as either primary (essential) or secondary. Primary hypertension accounts for 90% of cases and has no identifiable cause, while secondary hypertension is caused by an underlying condition like renal disease. Treatment involves lifestyle modifications and medication, with thiazide diuretics often used as initial therapy. Other common drug classes for treatment include ACE inhibitors, calcium channel blockers, beta blockers, and alpha blockers. Multiple drug therapy is usually required to control hypertension.
High blood pressure, or hypertension, is defined as blood pressure above 140/90 mmHg and affects around 50 million people in the US. It occurs when the force of blood against artery walls is too high and can lead to heart disease and stroke over time if not managed. Hypertension is primarily diagnosed through repeated blood pressure readings and treated initially through lifestyle changes like diet, exercise, and reducing stress and alcohol/tobacco use. If lifestyle changes are insufficient, medication therapy is used, which may include ACE inhibitors, ARBs, calcium channel blockers, diuretics, beta blockers, and alpha blockers to help relax blood vessels and lower blood pressure.
Hypertension, also known as high blood pressure, is a condition where the blood vessels have persistently raised pressure. It is classified based on systolic and diastolic blood pressure readings into normal, prehypertension, and stages 1 and 2 hypertension. Essential or primary hypertension has no known cause, while secondary hypertension is caused by underlying conditions like kidney disease, diabetes or medications. Risk factors include family history, obesity, lack of exercise, too much salt or alcohol. Treatment involves lifestyle changes and medication to control blood pressure.
This document summarizes drugs used to manage hypotension and hypertension. It discusses drugs that can be used to treat hypotension like norepinephrine, phenylephrine, and methoxamine, which are direct-acting alpha agonists that increase blood pressure by constricting blood vessels. It also discusses various classes of drugs to treat hypertension, including ACE inhibitors, ARBs, calcium channel blockers, diuretics, and vasodilators. Each drug class is explained in terms of its mechanism of action and examples are provided of commonly used drugs within each class. Adverse effects are also outlined for each drug class.
Hypertension pharmacotherapy part 2 pptPranatiChavan
First-line medications used in the treatment of hypertension include diuretics, angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs), beta-blockers, and calcium channel blockers (CCBs). Some patients will require 2 or more antihypertensive medications to achieve their BP target. As per special consideration, modified treatment is given in the presentation.
Hypertension is also known as high blood pressure. There are mainly two type of blood pressure i.e. systolic and another one is diastolic . The hypertension are categories into two parts that is primary hypertension and secondary hypertension. People are suffering from 3 stage during the condition of hypertension. There are following agents are used to treat hypertension like calcium channel blockers, ACE inhibitors, beta blocker, alpha + beta blockers these are commonly used.
This document defines hypertension and describes its types, etiology, risk factors, pathophysiology, clinical features, diagnostic evaluations, and management. Hypertension is defined as a systolic blood pressure of 140 mmHg or higher and/or a diastolic blood pressure of 90 mmHg or higher. It is managed primarily through lifestyle modifications like diet and exercise changes as well as pharmacological therapies including diuretics, beta blockers, ACE inhibitors, and calcium channel blockers. Nursing care involves monitoring the patient's condition, educating on lifestyle changes, and ensuring proper treatment adherence.
Hello all, I am Nehal Sharma; owner of this slideshare. I created this slideshare to share my knowledge and experience so i can give wings to all other students aspiring to touch the goal.
Hypertension, or high blood pressure, refers to blood pressure above 140/90 mmHg. It puts stress on blood vessels and vital organs like the heart, brain, and kidneys over time if not controlled. The document discusses what causes hypertension, risk factors, potential health effects, diagnosis through blood pressure monitoring, treatment through lifestyle modifications and medications, and treatment goals of lowering blood pressure to reduce risks of heart disease, stroke, and other complications. Treatment involves lifestyle changes like losing weight, reducing salt, exercising, and quitting smoking, as well as medications like diuretics, beta-blockers, calcium channel blockers, ACE inhibitors, and ARBs.
Secondary hypertension is high blood pressure caused by an underlying medical condition that affects the kidneys, heart, blood vessels or endocrine system. It differs from primary hypertension which has no clear cause. Proper treatment of the underlying condition can control both secondary hypertension and reduce risks of complications like heart disease, kidney failure and stroke. Some common causes of secondary hypertension include kidney disease, Cushing's syndrome, pheochromocytoma, thyroid problems and obstructive sleep apnea.
Hypertension, also known as high blood pressure, is a major public health problem worldwide. It is a chronic medical condition in which the blood pressure in the arteries is persistently elevated. While there is no cure, lifestyle modifications and medication can help prevent and manage hypertension. The goal of treatment is to reduce cardiovascular and renal risks and complications through lowering blood pressure. Treatment typically involves a combination of lifestyle changes and medications, with regular monitoring needed to control the condition.
This document discusses hypertension, including its causes, mechanisms, clinical features, investigations, and treatment. It defines hypertension as a persistent blood pressure above 140/90 mm Hg. The causes are primarily essential (80-90%) or secondary (10-20%), which can be renal, endocrine, metabolic, drug-related, congenital, or psychogenic. Hypertension occurs via increased cardiac output or peripheral resistance. Clinical features involve the cerebral, cardiac, vascular, ocular, and renal systems. Investigations include urine tests, imaging, and blood tests. Treatment involves lifestyle changes and medications like diuretics, adrenergic blockers, or vasodilators. Treatment duration is typically lifelong.
Hypertension. Causes, Effect. Mechanism of Hypertensive activities.
Treatment and Management of hypertension. effect of angiotensin. Investigations. kidney and hypertension. How to keep Normal Bloos Pressure. Normal Ranges of Blood Pressure. Stages Of Hypertension. Complications of Hypertension. Clinical Features of Elevated B.p. Endocrine System . Life style Modification in Hypertension. Pharmacological Therapy in Hypertension
This document discusses the classification, clinical manifestations, investigations, and management of hypertensive crises. It distinguishes between hypertensive urgency, which involves severe but asymptomatic elevations in blood pressure, and emergency, which involves elevations with associated end-organ damage. Common symptoms include headache, fatigue, confusion, and chest pain. Investigations include blood tests, electrocardiograms, urinalysis, and imaging. Treatment depends on the situation but generally aims to lower blood pressure by 10-15% within the first hour using intravenous medications such as nitroglycerin, nitroprusside, or labetolol. Oral agents like captopril may also be used but reductions should be more gradual. The
This document discusses hypertension, including guidelines for diagnosis, treatment, and management based on individual patient factors. It recommends measuring blood pressure in both arms using a mercury sphygmomanometer and checking for postural drops. Lifestyle modifications like maintaining a healthy BMI, reducing salt intake, moderate alcohol consumption, regular exercise, and smoking cessation are first-line treatment options. It provides guidance on when pharmacological treatment should begin based on a patient's global cardiovascular risk profile and comorbidities. It also outlines protocols for treating severe, urgent, and emergency cases of hypertension.
Systemic Hypertension causes symptoms like headaches, dizziness, and organ damage at hypertensive crisis. It is usually essential or primary hypertension but can be secondary to other causes like renal or endocrine diseases. Diagnosis involves measuring elevated blood pressure over multiple readings and checking for organ damage. Treatment focuses on lifestyle changes like reducing sodium, alcohol, and stress as well as medications to lower blood pressure and reduce risks of complications like stroke and heart attack.
This document is a quiz about hypertension (high blood pressure). It contains 20 multiple choice questions that test understanding of what hypertension is, normal blood pressure values, risk factors, symptoms, health problems associated with uncontrolled hypertension, lifestyle changes and medications for treatment. The key points covered are:
- Hypertension refers to high blood pressure caused by increased force of blood flow in arteries.
- Normal blood pressure is a reading between 90/60mmHg to 120/80mmHg.
- Risk factors include age, family history, obesity, smoking, physical inactivity, diabetes and excess alcohol.
- Hypertension often has no noticeable symptoms and is called the "silent killer".
- Uncontrolled hypertension can lead to
Hypertension, also known as high blood pressure, is a common disease where blood pressure in the arteries is elevated. It has no symptoms but can damage organs if left untreated. There are two types - primary hypertension which has no identifiable cause and accounts for 90-95% of cases, and secondary hypertension which is caused by other conditions affecting the kidneys, heart or endocrine system. Risk factors include obesity, high salt diet, excess alcohol, stress and caffeine. Treatment involves lifestyle changes as well as medications like diuretics, beta blockers, ACE inhibitors and calcium channel blockers to control blood pressure. Regular monitoring of blood pressure and prevention methods can help reduce the risk of hypertension.
This document discusses definitions of hypertension, hypertensive emergencies, and malignant hypertension. It notes that hypertensive emergencies involve systolic blood pressure over 180 or diastolic over 120 with end-organ damage. Malignant hypertension is defined as a sudden increase in blood pressure in a patient with underlying hypertension, or sudden onset of hypertension in a previously normotensive individual, with irreversible organ damage. Preeclampsia, occurring in 5-7% of pregnancies after 20 weeks, is characterized by new onset hypertension and proteinuria, with risk of seizures. Treatment options discussed include delivery, magnesium sulfate, labetalol, nifedipine and hydralazine.
This document discusses hypertension and its treatment. It defines hypertension and describes its prevalence globally. It notes that only half of those with hypertension have been diagnosed, treated, and adequately controlled. It describes primary and secondary causes of hypertension. The main classes of antihypertensive medications are discussed - diuretics, beta blockers, calcium channel blockers, ACE inhibitors, and alpha blockers. Specific examples within each class are explained. The document emphasizes the goal of treatment is to reduce blood pressure below 140/90 mmHg to prevent cardiac and renal complications.
This document discusses hypertension (high blood pressure) including its definition, causes, clinical presentation, assessment, and management. It notes that hypertension is defined as blood pressure above 140/90 mmHg and risks of cardiovascular disease double for every 20/10 mmHg rise. Common complications include stroke, myocardial infarction, heart failure, and renal failure. Treatment involves lifestyle modifications and medication, starting with ACE inhibitors, calcium channel blockers, or thiazides. The goals are to lower blood pressure and reduce cardiovascular risk based on individual patient factors.
The document discusses hypertensive urgencies and emergencies. It defines hypertensive urgency as severe hypertension without acute end-organ damage, requiring blood pressure reduction within hours. Hypertensive emergency involves both severe hypertension and acute end-organ damage, requiring rapid blood pressure reduction within 1 hour to prevent serious morbidity or death. The document provides guidelines for evaluating and diagnosing these conditions, goals for reducing blood pressure, drug options for specific types of hypertensive emergencies, and subsequent oral therapy once the emergency is resolved.
This document discusses hypertensive diseases and their complications. It begins by outlining various hypertensive diseases that can affect the cerebrovascular system, eyes, heart and kidneys. It then defines hypertension and hypertensive emergencies/urgencies. The remainder of the document provides more details on specific hypertensive diseases and complications, including hypertensive encephalopathy, cerebrovascular accidents, retinopathy, left ventricular hypertrophy, coronary artery disease, cardiac arrhythmias, congestive heart failure, benign and malignant nephrosclerosis. It also discusses diagnostic criteria and management of various hypertensive conditions.
This document summarizes guidelines for the treatment and management of hypertension. It discusses stages of hypertension and treatment thresholds. Lifestyle modifications like following the DASH diet, reducing sodium intake, weight loss, and exercise are recommended first line approaches. If goals are not met with lifestyle changes alone, pharmacologic therapy with diuretics, ACE inhibitors, ARBs, calcium channel blockers, and beta blockers is recommended. Specific considerations and guidelines are provided for managing hypertension in special populations like those with diabetes, pregnancy, the elderly, and black patients.
Hypertension is highly prevalent in the elderly population. The risk of hypertension increases dramatically with age, with over 90% of people over 70 having hypertension. In the elderly, hypertension is characterized by an elevated systolic blood pressure with a normal or low diastolic blood pressure due to arterial stiffening caused by reduced elasticity of arteries with age. Multiple changes occur in the arteries with aging that result in increased systolic blood pressure and decreased diastolic blood pressure. Hypertension is the most important modifiable risk factor for cardiovascular disease in the elderly. Lifestyle modifications and medication are effective for treating hypertension in the elderly, with the goal of reducing blood pressure and cardiovascular risk.
Hypertension is also known as high blood pressure. There are mainly two type of blood pressure i.e. systolic and another one is diastolic . The hypertension are categories into two parts that is primary hypertension and secondary hypertension. People are suffering from 3 stage during the condition of hypertension. There are following agents are used to treat hypertension like calcium channel blockers, ACE inhibitors, beta blocker, alpha + beta blockers these are commonly used.
This document defines hypertension and describes its types, etiology, risk factors, pathophysiology, clinical features, diagnostic evaluations, and management. Hypertension is defined as a systolic blood pressure of 140 mmHg or higher and/or a diastolic blood pressure of 90 mmHg or higher. It is managed primarily through lifestyle modifications like diet and exercise changes as well as pharmacological therapies including diuretics, beta blockers, ACE inhibitors, and calcium channel blockers. Nursing care involves monitoring the patient's condition, educating on lifestyle changes, and ensuring proper treatment adherence.
Hello all, I am Nehal Sharma; owner of this slideshare. I created this slideshare to share my knowledge and experience so i can give wings to all other students aspiring to touch the goal.
Hypertension, or high blood pressure, refers to blood pressure above 140/90 mmHg. It puts stress on blood vessels and vital organs like the heart, brain, and kidneys over time if not controlled. The document discusses what causes hypertension, risk factors, potential health effects, diagnosis through blood pressure monitoring, treatment through lifestyle modifications and medications, and treatment goals of lowering blood pressure to reduce risks of heart disease, stroke, and other complications. Treatment involves lifestyle changes like losing weight, reducing salt, exercising, and quitting smoking, as well as medications like diuretics, beta-blockers, calcium channel blockers, ACE inhibitors, and ARBs.
Secondary hypertension is high blood pressure caused by an underlying medical condition that affects the kidneys, heart, blood vessels or endocrine system. It differs from primary hypertension which has no clear cause. Proper treatment of the underlying condition can control both secondary hypertension and reduce risks of complications like heart disease, kidney failure and stroke. Some common causes of secondary hypertension include kidney disease, Cushing's syndrome, pheochromocytoma, thyroid problems and obstructive sleep apnea.
Hypertension, also known as high blood pressure, is a major public health problem worldwide. It is a chronic medical condition in which the blood pressure in the arteries is persistently elevated. While there is no cure, lifestyle modifications and medication can help prevent and manage hypertension. The goal of treatment is to reduce cardiovascular and renal risks and complications through lowering blood pressure. Treatment typically involves a combination of lifestyle changes and medications, with regular monitoring needed to control the condition.
This document discusses hypertension, including its causes, mechanisms, clinical features, investigations, and treatment. It defines hypertension as a persistent blood pressure above 140/90 mm Hg. The causes are primarily essential (80-90%) or secondary (10-20%), which can be renal, endocrine, metabolic, drug-related, congenital, or psychogenic. Hypertension occurs via increased cardiac output or peripheral resistance. Clinical features involve the cerebral, cardiac, vascular, ocular, and renal systems. Investigations include urine tests, imaging, and blood tests. Treatment involves lifestyle changes and medications like diuretics, adrenergic blockers, or vasodilators. Treatment duration is typically lifelong.
Hypertension. Causes, Effect. Mechanism of Hypertensive activities.
Treatment and Management of hypertension. effect of angiotensin. Investigations. kidney and hypertension. How to keep Normal Bloos Pressure. Normal Ranges of Blood Pressure. Stages Of Hypertension. Complications of Hypertension. Clinical Features of Elevated B.p. Endocrine System . Life style Modification in Hypertension. Pharmacological Therapy in Hypertension
This document discusses the classification, clinical manifestations, investigations, and management of hypertensive crises. It distinguishes between hypertensive urgency, which involves severe but asymptomatic elevations in blood pressure, and emergency, which involves elevations with associated end-organ damage. Common symptoms include headache, fatigue, confusion, and chest pain. Investigations include blood tests, electrocardiograms, urinalysis, and imaging. Treatment depends on the situation but generally aims to lower blood pressure by 10-15% within the first hour using intravenous medications such as nitroglycerin, nitroprusside, or labetolol. Oral agents like captopril may also be used but reductions should be more gradual. The
This document discusses hypertension, including guidelines for diagnosis, treatment, and management based on individual patient factors. It recommends measuring blood pressure in both arms using a mercury sphygmomanometer and checking for postural drops. Lifestyle modifications like maintaining a healthy BMI, reducing salt intake, moderate alcohol consumption, regular exercise, and smoking cessation are first-line treatment options. It provides guidance on when pharmacological treatment should begin based on a patient's global cardiovascular risk profile and comorbidities. It also outlines protocols for treating severe, urgent, and emergency cases of hypertension.
Systemic Hypertension causes symptoms like headaches, dizziness, and organ damage at hypertensive crisis. It is usually essential or primary hypertension but can be secondary to other causes like renal or endocrine diseases. Diagnosis involves measuring elevated blood pressure over multiple readings and checking for organ damage. Treatment focuses on lifestyle changes like reducing sodium, alcohol, and stress as well as medications to lower blood pressure and reduce risks of complications like stroke and heart attack.
This document is a quiz about hypertension (high blood pressure). It contains 20 multiple choice questions that test understanding of what hypertension is, normal blood pressure values, risk factors, symptoms, health problems associated with uncontrolled hypertension, lifestyle changes and medications for treatment. The key points covered are:
- Hypertension refers to high blood pressure caused by increased force of blood flow in arteries.
- Normal blood pressure is a reading between 90/60mmHg to 120/80mmHg.
- Risk factors include age, family history, obesity, smoking, physical inactivity, diabetes and excess alcohol.
- Hypertension often has no noticeable symptoms and is called the "silent killer".
- Uncontrolled hypertension can lead to
Hypertension, also known as high blood pressure, is a common disease where blood pressure in the arteries is elevated. It has no symptoms but can damage organs if left untreated. There are two types - primary hypertension which has no identifiable cause and accounts for 90-95% of cases, and secondary hypertension which is caused by other conditions affecting the kidneys, heart or endocrine system. Risk factors include obesity, high salt diet, excess alcohol, stress and caffeine. Treatment involves lifestyle changes as well as medications like diuretics, beta blockers, ACE inhibitors and calcium channel blockers to control blood pressure. Regular monitoring of blood pressure and prevention methods can help reduce the risk of hypertension.
This document discusses definitions of hypertension, hypertensive emergencies, and malignant hypertension. It notes that hypertensive emergencies involve systolic blood pressure over 180 or diastolic over 120 with end-organ damage. Malignant hypertension is defined as a sudden increase in blood pressure in a patient with underlying hypertension, or sudden onset of hypertension in a previously normotensive individual, with irreversible organ damage. Preeclampsia, occurring in 5-7% of pregnancies after 20 weeks, is characterized by new onset hypertension and proteinuria, with risk of seizures. Treatment options discussed include delivery, magnesium sulfate, labetalol, nifedipine and hydralazine.
This document discusses hypertension and its treatment. It defines hypertension and describes its prevalence globally. It notes that only half of those with hypertension have been diagnosed, treated, and adequately controlled. It describes primary and secondary causes of hypertension. The main classes of antihypertensive medications are discussed - diuretics, beta blockers, calcium channel blockers, ACE inhibitors, and alpha blockers. Specific examples within each class are explained. The document emphasizes the goal of treatment is to reduce blood pressure below 140/90 mmHg to prevent cardiac and renal complications.
This document discusses hypertension (high blood pressure) including its definition, causes, clinical presentation, assessment, and management. It notes that hypertension is defined as blood pressure above 140/90 mmHg and risks of cardiovascular disease double for every 20/10 mmHg rise. Common complications include stroke, myocardial infarction, heart failure, and renal failure. Treatment involves lifestyle modifications and medication, starting with ACE inhibitors, calcium channel blockers, or thiazides. The goals are to lower blood pressure and reduce cardiovascular risk based on individual patient factors.
The document discusses hypertensive urgencies and emergencies. It defines hypertensive urgency as severe hypertension without acute end-organ damage, requiring blood pressure reduction within hours. Hypertensive emergency involves both severe hypertension and acute end-organ damage, requiring rapid blood pressure reduction within 1 hour to prevent serious morbidity or death. The document provides guidelines for evaluating and diagnosing these conditions, goals for reducing blood pressure, drug options for specific types of hypertensive emergencies, and subsequent oral therapy once the emergency is resolved.
This document discusses hypertensive diseases and their complications. It begins by outlining various hypertensive diseases that can affect the cerebrovascular system, eyes, heart and kidneys. It then defines hypertension and hypertensive emergencies/urgencies. The remainder of the document provides more details on specific hypertensive diseases and complications, including hypertensive encephalopathy, cerebrovascular accidents, retinopathy, left ventricular hypertrophy, coronary artery disease, cardiac arrhythmias, congestive heart failure, benign and malignant nephrosclerosis. It also discusses diagnostic criteria and management of various hypertensive conditions.
This document summarizes guidelines for the treatment and management of hypertension. It discusses stages of hypertension and treatment thresholds. Lifestyle modifications like following the DASH diet, reducing sodium intake, weight loss, and exercise are recommended first line approaches. If goals are not met with lifestyle changes alone, pharmacologic therapy with diuretics, ACE inhibitors, ARBs, calcium channel blockers, and beta blockers is recommended. Specific considerations and guidelines are provided for managing hypertension in special populations like those with diabetes, pregnancy, the elderly, and black patients.
Hypertension is highly prevalent in the elderly population. The risk of hypertension increases dramatically with age, with over 90% of people over 70 having hypertension. In the elderly, hypertension is characterized by an elevated systolic blood pressure with a normal or low diastolic blood pressure due to arterial stiffening caused by reduced elasticity of arteries with age. Multiple changes occur in the arteries with aging that result in increased systolic blood pressure and decreased diastolic blood pressure. Hypertension is the most important modifiable risk factor for cardiovascular disease in the elderly. Lifestyle modifications and medication are effective for treating hypertension in the elderly, with the goal of reducing blood pressure and cardiovascular risk.
This document provides information on hypertension including its definition, causes, diagnosis, treatment targets, and management. It defines hypertension as a sustained abnormal elevation in blood pressure. Left untreated, hypertension can damage organs like the heart, brain, and kidneys. Treatment involves lifestyle modifications and medication, with a target blood pressure below 140/90 mmHg for most patients. Management may involve starting with a calcium channel blocker or diuretic, and adding additional drugs like ACE inhibitors as needed. Special considerations are provided for treating hypertension in pregnancy, the elderly, those with diabetes or kidney disease.
Hypertension emergencies require rapid reduction of blood pressure to prevent end organ damage. Hypertensive urgency can be managed as an outpatient but emergencies require hospitalization. Initial evaluation assesses for signs of damage to heart, kidneys, brain, or vasculature. Parenteral drugs like nicardipine, labetalol, and esmolol are used to lower blood pressure 10-15% within 1 hour and further to 160/100 mmHg in 2-6 hours, with goals tailored to specific conditions like stroke, heart failure, or aortic dissection. Oral agents like clonidine or nifedipine may be used after initial parenteral treatment to control blood pressure before discharge
Hypertension emergencies require rapid reduction of blood pressure to prevent end organ damage. Hypertensive urgency can be managed as an outpatient with oral medications, while emergencies require hospitalization and intravenous drugs. Initial evaluation assesses for signs of heart, brain, kidney and vascular damage. Parenteral drugs like nicardipine, labetalol and esmolol are used but sodium nitroprusside is no longer first-line due to risks. Treatment goals depend on the specific organ involved and reduce pressure by 10-25% within 1-2 hours.
(1) The document discusses the evaluation, classification, and treatment of hypertensive emergencies and urgencies. It defines the differences between the two conditions and outlines the goals and approaches for treating each.
(2) For hypertensive urgencies, the goal is to lower blood pressure within several hours to prevent further increases without causing too rapid of a drop. For emergencies, the goal is to reduce blood pressure more quickly to prevent end-organ damage, while maintaining adequate perfusion.
(3) Several intravenous antihypertensive drugs are discussed as options for treatment in hypertensive emergencies, including nitroprusside, nicardipine, labetalol, and
Hypertension is defined as blood pressure over 140/90 mmHg or taking medication for it. It can be essential or secondary hypertension. Treatment involves lifestyle modifications like weight loss, exercise, and diet changes as well as medications. Goals of treatment are to lower blood pressure to under 140/90 mmHg or 130/80 mmHg for those with diabetes or kidney disease to prevent heart disease and stroke. Treatment begins with lifestyle changes and may involve one or more classes of blood pressure medications including diuretics, ACE inhibitors, calcium channel blockers, beta blockers, and ARBs.
Hypertension, or high blood pressure, is one of the most common diseases worldwide. It is a major risk factor for heart disease and stroke. The document discusses the definition, classification, evaluation, causes, treatment, and prevention of hypertension. Prevention strategies recommended by WHO include reducing salt intake, maintaining a healthy weight, regular exercise, stress reduction, not smoking, and modifying lifestyle behaviors. Treatment aims to lower blood pressure below 140/90 mmHg through lifestyle changes and lifelong medication if needed.
This document provides an overview of hypertension including its classification, types, signs and symptoms, causes, and treatment. It defines hypertension as having a systolic blood pressure over 140 mmHg or a diastolic blood pressure over 90 mmHg. The document classifies hypertension and discusses the types of essential and secondary hypertension. It outlines the signs and symptoms of hypertension and discusses its causes. The document then describes the classification and mechanisms of antihypertensive drugs and provides details on drug classes including diuretics, ACE inhibitors, calcium channel blockers, and others. It discusses treatment approaches for hypertension and managing hypertensive emergencies.
this presentation describes the rational treatment of hypertension and its management. there are some pharmacological and non - pharmacological approaches.
Hypertension is defined as blood pressure over 140/90 mmHg or taking medication for it. The document discusses diagnosis and management of hypertension including lifestyle modifications like weight loss, exercise, and diet changes as well as drug therapies. Drug classes discussed are diuretics, beta-blockers, ACE inhibitors, calcium channel blockers, and ARBs. Treatment is aimed at reducing blood pressure below 140/90 mmHg or 130/80 for those with diabetes or kidney disease to decrease risk of heart disease, stroke, kidney disease and other complications. Selection of drug depends on individual patient factors and conditions.
Hypertension is defined as high blood pressure with a systolic reading over 140 mmHg or diastolic over 90 mmHg. It can be caused by many factors like increased cardiac output, vasoconstriction, fluid volume, and activation of the renin-angiotensin system. Treatment involves lifestyle modifications like weight loss, reduced sodium intake, and exercise as well as drug therapy using diuretics, ACE inhibitors, calcium channel blockers, and beta blockers. Uncontrolled hypertension can damage organs and lead to complications like heart disease, stroke, and kidney disease so treatment aims to control blood pressure and reduce cardiovascular risk.
High blood pressure (BP) is a major cause of death worldwide. Non-pharmacological management of hypertension includes weight loss and following the DASH diet. Pharmacological treatment should be initiated when BP is above 140/90 mmHg or 150/90 mmHg for those over 60, and targets are not met within 1 month additional medication should be added. For hypertensive emergencies associated with end organ damage, BP should be reduced up to 25% within the first hour. Calcium channel blockers and combining drugs at lower doses are preferable for elderly patients.
This document discusses the diagnosis and management of hypertension. It defines hypertension as blood pressure above 140/90 mmHg or being on antihypertensive medication. The main types are essential and secondary hypertension. Lifestyle modifications like weight loss, exercise, and diet changes can help control hypertension before starting medications. Common drug classes for treatment include diuretics, ACE inhibitors, calcium channel blockers, angiotensin receptor blockers, and beta blockers. The goals of treatment are to reduce target organ damage and cardiovascular risk by achieving a blood pressure under 140/90 mmHg or 130/80 mmHg for those with diabetes or chronic kidney disease.
Hypertension is defined as systolic blood pressure over 140 mmHg or diastolic over 90 mmHg. The document discusses the diagnosis, management, treatment, and goals of treating hypertension. Treatment involves lifestyle modifications like weight loss, reduced salt intake, exercise, as well as pharmacologic treatments including diuretics, ACE inhibitors, calcium channel blockers, and others. The goals of treatment are to reduce cardiovascular and renal morbidity and mortality by achieving a blood pressure under 140/90 mmHg or under 130/80 for those with diabetes or chronic kidney disease.
This document discusses the diagnosis and management of hypertension. It defines hypertension as blood pressure above 140/90 mmHg or being on antihypertensive medication. The main types are essential and secondary hypertension. Lifestyle modifications like weight loss, exercise, and diet changes can help control hypertension before starting medications. Common drug classes for treatment include diuretics, ACE inhibitors, calcium channel blockers, angiotensin receptor blockers, and beta blockers. The goals of treatment are to reduce target organ damage and cardiovascular risk by achieving a blood pressure under 140/90 mmHg or 130/80 mmHg for those with diabetes or chronic kidney disease.
Hypertension is defined as systolic blood pressure over 140 mmHg or diastolic over 90 mmHg. The document discusses the diagnosis, management, treatment, and goals of treating hypertension. Treatment involves lifestyle modifications like weight loss, reduced salt intake, exercise, as well as pharmacologic treatments including diuretics, ACE inhibitors, calcium channel blockers, and others. The goals of treatment are to reduce cardiovascular and renal morbidity and mortality by achieving a blood pressure under 140/90 mmHg or under 130/80 for those with diabetes or kidney disease.
This document discusses Phase 1 clinical trials. Phase 1 trials involve small studies (20-80 subjects) to determine the safety and tolerability of new drugs in healthy volunteers. They aim to determine the maximum tolerated dose and identify any side effects. The document outlines the objectives, study designs, populations and endpoints of Phase 1 trials. It provides guidance on determining starting doses based on preclinical toxicology studies in animals and safety factors. It also discusses assessments required for special populations and potential drug interactions.
This document discusses anticholinergic drugs, including their classification, mechanisms of action, pharmacokinetics, effects, clinical uses, and contraindications. The drugs are classified based on their lipid solubility and ability to cross the blood brain barrier. Tertiary amines are highly lipid soluble and can cross the BBB, while quaternary compounds are poorly lipid soluble and cannot cross the BBB. The document outlines the anticholinergic drugs' effects on various organ systems and their clinical uses for conditions like peptic ulcer disease, asthma, mydriasis, and Parkinsonism. Contraindications include narrow angle glaucoma, BPH, and congestive heart failure.
This document provides an overview of nanotechnology applications. It discusses the history of nanotechnology, types including dry, wet and computational nanotechnology, and structures such as nanoparticles, polymeric micelles, dendrimers, and magnetic nanoparticles. Applications of nanotechnology discussed include drug delivery, therapeutics such as cancer treatment and spinal fusion, diagnostics, sensors, and theranostics. Limitations regarding drug delivery such as toxicity and accumulation are also mentioned.
This document provides information on general anesthesia including:
1. It defines general anesthesia as reversible blocking of pain and sensation in the whole body or parts using pharmacology or other methods.
2. It describes the parts of general anesthesia including hypnosis, analgesia, areflexia, and muscle relaxation which must be balanced.
3. It explains the different types of general anesthesia including total intravenous anesthesia, volatile induction and maintenance anesthesia.
Tetracyclines and chloramphenicol are broad-spectrum antibiotics that act by inhibiting bacterial protein synthesis. Tetracyclines are bacteriostatic and include doxycycline and minocycline. They are used for respiratory, skin, and sexually transmitted infections. Adverse effects include gastrointestinal issues and photosensitivity. Chloramphenicol is bacteriostatic and used for serious infections but can cause fatal blood disorders so is reserved for life-threatening infections when safer alternatives cannot be used.
This document discusses various classes of antifungal drugs including polyenes, echinocandins, azoles, and allylamines. It provides details on specific drugs in each class like amphotericin B, fluconazole, terbinafine, and caspofungin. It also covers the mechanisms of action, indications, dosing considerations, toxicities and interactions for many of these antifungal agents. Finally, it discusses several topical antifungal drugs and their uses in treating superficial fungal infections.
This document summarizes recent advances in bronchial asthma and newer drug targets. It discusses the heterogeneity and pathophysiology of asthma. Newer biologics that target Th2 inflammatory pathways like IL-5, IL-13, and IgE are used to treat eosinophilic asthma. Triple inhalers combining ICS, LABA and LAMA are in development. Novel bronchodilators include MABA combinations and bitter taste receptor agonists. Improved corticosteroids aim to separate anti-inflammatory from side effects. Kinase inhibitors targeting pathways like p38 MAPK and PI3K show potential but challenges remain around selectivity and side effects. Inhaled formulations are being explored for mediators antagonists and
This document discusses melatonin, including its sources, receptors, biosynthesis, physiological roles, therapeutic uses, and causes of low levels. Melatonin is a hormone secreted in darkness that affects circadian rhythms and is found in many living things. It has roles in sleep, diabetes, and inflammatory conditions. Melatonin levels can be low due to factors like alcohol, caffeine, medications, and stress. Several melatonin supplements and medications are discussed for uses like insomnia, depression, and circadian rhythm disorders. Adverse effects are outlined for different doses.
The document provides an overview of antipsychotic drugs. It discusses the history and classification of antipsychotics and their mechanisms of action. First generation antipsychotics act primarily as dopamine antagonists, while second generation drugs also act as serotonin antagonists. Common side effects include extrapyramidal symptoms, weight gain, metabolic issues, and tardive dyskinesia. Newer treatments target glutamate receptors or have novel mechanisms of action like partial dopamine agonism to provide antipsychotic effects with fewer side effects.
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptxHolistified Wellness
We’re talking about Vedic Meditation, a form of meditation that has been around for at least 5,000 years. Back then, the people who lived in the Indus Valley, now known as India and Pakistan, practised meditation as a fundamental part of daily life. This knowledge that has given us yoga and Ayurveda, was known as Veda, hence the name Vedic. And though there are some written records, the practice has been passed down verbally from generation to generation.
How to Control Your Asthma Tips by gokuldas hospital.Gokuldas Hospital
Respiratory issues like asthma are the most sensitive issue that is affecting millions worldwide. It hampers the daily activities leaving the body tired and breathless.
The key to a good grip on asthma is proper knowledge and management strategies. Understanding the patient-specific symptoms and carving out an effective treatment likewise is the best way to keep asthma under control.
low birth weight presentation. Low birth weight (LBW) infant is defined as the one whose birth weight is less than 2500g irrespective of their gestational age. Premature birth and low birth weight(LBW) is still a serious problem in newborn. Causing high morbidity and mortality rate worldwide. The nursing care provide to low birth weight babies is crucial in promoting their overall health and development. Through careful assessment, diagnosis,, planning, and evaluation plays a vital role in ensuring these vulnerable infants receive the specialize care they need. In India every third of the infant weight less than 2500g.
Birth period, socioeconomical status, nutritional and intrauterine environment are the factors influencing low birth weight
Cell Therapy Expansion and Challenges in Autoimmune DiseaseHealth Advances
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
Lecture 6 -- Memory 2015.pptlearning occurs when a stimulus (unconditioned st...AyushGadhvi1
learning occurs when a stimulus (unconditioned stimulus) eliciting a response (unconditioned response) • is paired with another stimulus (conditioned stimulus)
NAVIGATING THE HORIZONS OF TIME LAPSE EMBRYO MONITORING.pdfRahul Sen
Time-lapse embryo monitoring is an advanced imaging technique used in IVF to continuously observe embryo development. It captures high-resolution images at regular intervals, allowing embryologists to select the most viable embryos for transfer based on detailed growth patterns. This technology enhances embryo selection, potentially increasing pregnancy success rates.
These lecture slides, by Dr Sidra Arshad, offer a simplified look into the mechanisms involved in the regulation of respiration:
Learning objectives:
1. Describe the organisation of respiratory center
2. Describe the nervous control of inspiration and respiratory rhythm
3. Describe the functions of the dorsal and respiratory groups of neurons
4. Describe the influences of the Pneumotaxic and Apneustic centers
5. Explain the role of Hering-Breur inflation reflex in regulation of inspiration
6. Explain the role of central chemoreceptors in regulation of respiration
7. Explain the role of peripheral chemoreceptors in regulation of respiration
8. Explain the regulation of respiration during exercise
9. Integrate the respiratory regulatory mechanisms
10. Describe the Cheyne-Stokes breathing
Study Resources:
1. Chapter 42, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 36, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 13, Human Physiology by Lauralee Sherwood, 9th edition
Kosmoderma Academy, a leading institution in the field of dermatology and aesthetics, offers comprehensive courses in cosmetology and trichology. Our specialized courses on PRP (Hair), DR+Growth Factor, GFC, and Qr678 are designed to equip practitioners with advanced skills and knowledge to excel in hair restoration and growth treatments.
Travel vaccination in Manchester offers comprehensive immunization services for individuals planning international trips. Expert healthcare providers administer vaccines tailored to your destination, ensuring you stay protected against various diseases. Conveniently located clinics and flexible appointment options make it easy to get the necessary shots before your journey. Stay healthy and travel with confidence by getting vaccinated in Manchester. Visit us: www.nxhealthcare.co.uk
Co-Chairs, Val J. Lowe, MD, and Cyrus A. Raji, MD, PhD, prepared useful Practice Aids pertaining to Alzheimer’s disease for this CME/AAPA activity titled “Alzheimer’s Disease Case Conference: Gearing Up for the Expanding Role of Neuroradiology in Diagnosis and Treatment.” For the full presentation, downloadable Practice Aids, and complete CME/AAPA information, and to apply for credit, please visit us at https://bit.ly/3PvVY25. CME/AAPA credit will be available until June 28, 2025.
2. • Cardiovascular morbidity and mortality increase as both SBP and DBP
• over 50 years, SBP and PP are better predictors of complications .
• prevalence increases with age, more common in blacks .
• Adequate control reduces ACS by 20–25%, stroke by 30–35%, and
CHF by 50%.
3. 2017 guidelines from the ACC/AHA
conventional office based measurement,
• NORMAL < 120/80 mm Hg,
• ELEVATED/PREHYPERTENSION 120–129/< 80 mm Hg,
• stage 1 130–139/80–89 mm Hg
• stage 2 >/= 140/90 mm Hg
• Hypertensive crisis: Systolic over 180 and/or diastolic over 120, with patients
needing prompt changes in medication if there are no other indications of
problems, or immediate hospitalization if there are signs of organ damage.
4.
5.
6.
7.
8. Primary Essential Hypertension
• in 95% ,complex interactions between multiple genetic and
environmental factors.
• overactivation of the sympathetic nervous and RAAS, blunting of the
pressure-natriuresis relationship, CV and renal development, and
elevated intracellular Na and Ca levels.
• obesity, sleep apnea, increased salt intake, excessive alcohol
use,smoking, polycythemia, NSAID and low potassium intake
9. Secondary Hypertension
• at early age or after 50 years
• in those previously well controlled who become refractory to
treatment
• genetic syndromes; kidney disease; renal vascular disease; primary
hyperaldosteronism; Cushing syndrome; pheochromocytoma;
coarctation of the aorta and preclampsia, estrogen use,thyroid or
parathyroid ds and medications.
18. Resistant hypertension
• the failure to reach blood pressure control in patients who are
adherent to full doses of an appropriate three-drug regimen
(including a diuretic).
• confirm compliance and rule out “white coat hypertension,”
• Aldosterone may play an important role in resistant hypertension and
aldosterone receptor blockers can be very useful.
19.
20. HYPERTENSIVE URGENCIES
• patients with asymptomatic severe hypertension (SBP > 220 mm Hg
or DBP> 120 mm Hg that persists after a period of observation) and
those without evidence of end organ damage.
21. CLONIDINE 0.1-0.2 mg orally then 0.1
mg every hour to 0.8mg
sedation Rebound can occur
captopril 12.5-25mg orally Excessive hypotension
nifedipine 10mg orally initially
repeated after 30 mins
Hypotension
tachycardia,headache
angina, MI, stroke
Response unpredictable
22. HYPERTENSIVE EMERGENCIES
• though BP is usually strikingly elevated (DBP 130 mm Hg), the
correlation between pressure and end-organ damage is often poor.
• hypertensive encephalopathy, hypertensive nephropathy, intracranial
hemorrhage, aortic dissection, preeclampsia-eclampsia, pulmonary
edema, unstable angina, or MI
• Parenteral therapy is indicated, especially if encephalopathy is
present. initial goal is to reduce the BP by no more than 25% (within
minutes to 1 or 2 hours) and then toward a level of 160/100 mm Hg
within 2–6 hours.
23.
24. Pharmacologic Management
• A. Parenteral Agents
enalapritat 1.25mg iv every 6 hours hypotension May protect kidney function
furosemide 10-80 mg orally Hypokalemia, hypotension Additive with diuretic, may
continued orally
hydralazine 5-20 mg iv ,can be repeated
after 20 min
Tachycardia,headache Adjunct to vasodilator
Nitroglycerine 0.25-5 mcg/kg/min iv Headache,nausea,hypotensio
n,bradycardia
Tolerance develops,used
primarily with MI
nitroprusside 0.25-10mcg/kg/min iv Thiocyanate and CN toxicity
with renal and hepatic
dysfunction,hypotension,coro
nary steal,decreased cerebral
blood flow,increased ICP
NO LONGER FIRST LINE DRUG
uncontrolled in half population.
among them, about 36% unaware.
among treated, control only 60%.
intermittent self-monitoring (home blood pressure)
with an automated device programmed to take measurements at regular intervals (ambulatory blood pressure)
the guidelines stress the importance of using proper technique to measure blood pressure; recommend use of home blood pressure monitoring using validated devices; and highlight the value of appropriate training of health care providers to reveal "white-coat hypertension."
Ambulatory BP readings normally lowest at night and the loss of nocturnal dip is dominant predictor of CV risk, thrombotic stroke.
Accentuation of normal morning increase in BP associated with increased likelihood of cerebral hemorrhage.
variability of SBP predicts CV events independently of mean SBP.
if AutomatedOfficeBP measurements are not available, blood pressures recorded manually in the office may be substituted if taken as the mean of the last two readings of three consecutive readings. Note that the blood pressure threshold for diagnosing hypertension is higher if recorded manually in these guidelines. If home blood pressure monitoring is unavailable, office measurements recorded over three to five separate visits can be substituted.
Ambulatory bp measurement
If aobp is used use mean calculated and displayed by the device,if non aobp is used take at least 3 readings, discardfirst
—Hypertension has been associated with hypercalcemia, acromegaly, hyperthyroidism, hypothyroidism, baroreceptor denervation, compression of the rostral ventrolateral medulla, and increased intracranial pressure
cyclosporine, tacrolimus, angiogenesis inhibitors, and erythrocyte-stimulating agents (such as erythropoietin). Decongestants, NSAIDs, cocaine and alcohol should also be considered. Over-the-counter products should not be overlooked, eg, a dietary supplement marketed to enhance libido was found to contain yohimbine, an alpha-2–antagonist, which can produce severe rebound hypertension in patients taking clonidine.
Dietary Approaches to Stop Hypertension (DASH) emphasizes vegetables, fruits and low-fat dairy foods — and moderate amounts of whole grains, fish, poultry and nuts
Cardiac output and peripheral arteriolar resistance, the major determinants
of arterial blood pressure, are regulated by myriad mechanisms, including the SNS (main peripheral neurotransmitter NE), the balance between salt intake by
the intestine (GI) and salt excretion by the kidneys, the RAAS (main agonists AngII and Aldo), and natriuretic peptides produced in the heart (ANP and
BNP). Sensors (green circles) provide afferent input on pressure in the heart and great vessels and on salt concentrations in the kidney. Note positive feedback
between the SNS and RAAS via β1-stimulated renin release and AngII-stimulated NE release. Drug classes are indicated in boldface type at their main site of
action. Arrows indicate blood pressure-increasing (red) and -decreasing (green) effects. Neprilysin inhibitors (e.g., sacubitril) are in clinical testing for hypertension
and have been approved for the treatment of heart failure (in combination with an ARB).
Excessive reductions in pressure may precipitate coronary, cerebral, or renal ischemia.
To avoid such declines, the use of agents that have a predictable, dose-dependent, transient, and progressive antihypertensive effect is preferable. In that regard, the use of sublingual or oral fast-acting nifedipine preparations is best avoided.
asoactive intestinal peptide (VIP) is a neuropeptide with vasodilator
and positive inotropic/chronotropic properties that
are mediated via the G-protein-coupled receptors VPAC1 and
VPAC 2.106 Deficiency in VIP and alterations in properties of
VPAC1 and 2 have been described in various forms of cardiopulmonary
disease, and VIP is a therapeutic target for hypertension,
both systemic and pulmonary, as well as HF
Orally active dual inhibitors of neprilysin and endothelinconverting
enzyme have been developed, and one of these
(daglutril, SLV-306) has been studied in rodent models of
diabetes mellitus and in patients with hypertension, HF, and
type 2 diabetes mellitus89–93 (Figure 4; Table). Daglutril is a
prodrug that is hydrolyzed after oral administration to the
active metabolite KC-12615, a mixed inhibitor of neprilysin
and endothelin-converting enzyme.89 In diabetic rat models,
daglutril and a similar compound have been shown to reduce BP and proteinuria and prevent nephrosclerosis as effectively
as the ACE inhibitor captopril.90,94 Daglutril has also been
shown to be safe and well tolerated in healthy volunteers,92,95
and biomarker measurements confirmed dual suppression of
neprilysin and endothelin-converting enzyme activity in these
subjects.92
Aldosterone synthase inhibitors (ASIs), such as LCI699, inhibit the rate
limiting step of aldosterone production. Mineralocorticoid receptor agonists (MRAs), such as finerenone, compete for the binding sites of
aldosterone and effectively decrease blood pressure and aldosterone-mediated gene transcription. Both approaches have been shown to
be useful in treating aldosterone-mediated hypertension and vascular disease. Aldosterone synthesis, green; cortisol synthesis, red; antialdosterone
drugs, blue.
Activation of the classical RAS
pathway increases BP and target organ damage, and this pathway is the target for many currently available antihypertensive drugs,
including angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs). Novel approaches to RAS inhibition,
including vaccines targeting angiotensin II (Ang II) and the angiotensin II type 1 (AT1) receptor, are being evaluated in preclinical and
clinical trials. In contrast, activation of the more recently described counter regulatory RAS pathway decreases blood pressure (BP) and
target organ damage, and drugs that activate this pathway are beginning to be developed as antihypertensive agents. These include
ACE2 activators, Ang (1–7) analogs, AT2 receptor agonists, peptide and nonpeptide activators of the Mas receptor, and alamandine
complexed with cyclodextrin. Classical RAS, red; counter regulatory RAS, green; drugs, blue. ATR indicates AT1 receptor; MrgD, Masrelated
G-protein-coupled receptor, member D;
rhACE2, recombinant human ACE2.
Downloaded from
Activation of the brain RAS in
response to oxidative stress and inflammation
increases sympathetic nervous system outflow
and arginine vasopressin (AVP) release and
inhibits the baroflex, thus raising BP. Angiotensin
(Ang) III, which is generated from Ang II by
aminopeptidase A (APA), is the predominant
pressor peptide in brain in animal models, and
APA is a therapeutic target for treatment of
hypertension. The APA inhibitor RB150 (QGC 001)
has been shown to pass the blood–brain barrier
and lower BP in animal models; exploratory
studies are underway in humans. Red, classical
RAS; light blue, brain RAS pathway; blue, drugs,
dotted arrows indicate crosstalk between the
systems. APN indicates aminopeptidase N; AT1,
angiotensin II type 1; ATR, AT1 receptor; and
ROS, reactive oxygen species.
Two
membrane-bound zinc metalloproteases, aminopeptidase A
(APA) and aminopeptidase N, are involved in the metabolism
of brain Ang II and III, respectively (Figure 3). APA cleaves
the N-terminal Asp from Ang II to form Ang III, and aminopeptidase
N cleaves the N-terminal Arg from Ang III to form
Ang IV. Ang II and Ang III have similar affinities for Ang II
receptors and both peptides stimulate pressor responses by
activating sympathetic nervous system activity, inhibiting the
baroreflex at the level of the nucleus tractus solitarius and increasing
release of arginine vasopressin into the circulation.
Studies using selective APA (EC33) and aminopeptidase N
(PC18) inhibitors have demonstrated that brain Ang III (not
Ang II, as in the periphery) plays a predominant role in BP
control in animal models and have identified APA as a potential
therapeutic target for the treatment of hypertension68
Combining an inhibitor of the natriuretic peptide degrading enzyme neprilysin with an angiotensin
receptor blocker (ARB) or an endothelin converting enzyme (ECE) inhibitor in the same molecule offers the theoretical advantage
of enhancing the favorable vasodilator/natruiretic effects of the natriuretic peptides and reducing the deleterious vasoconstrictor/
proinflammatory effects of angiotensin II (Ang II) and endothelin-1 (ET-1) on blood pressure (BP) and target organ damage. The ARB–
neprilysin inhibitor (ARNI), LCZ696, is a single molecule comprising the ARB valsartan and the neprilysin inhibitor pro-drug AHU377
(sacubitril). LCZ696 has been shown to lower BP, particularly in Asian populations, and to prevent death from cardiovascular (CV) causes
and hospitalization for heart failure (HF) in patients with reduced left ventricular ejection fraction (LVEF). The ECE–neprilysin inhibitor
dagutril has been shown to lower BP in patients with type 2 diabetes mellitus and nephropathy and to reduce pulmonary arterial pressure
in patients with HF. Red, classical RAS; orange, natriuretic peptide system; purple, endothelin system; blue, LCZ696; green, dagutril.
n a small, randomized, crossover,
placebo-controlled study, deactivation of CB chemoreceptors
by hyperoxia (respiration with 100% oxygen) attenuated the
enhanced muscle sympathetic nerve activity in untreated hypertensive
men, but no change was observed in controls.177
It has also been shown that hyperoxia decreases BP acutely
in patients with hypertension, but not in normotensive controls.
178
Several mechanisms
are hypothesized to cause BP reduction after creation
of an AVF.182 Reduction in total systemic vascular resistance,
despite an increment in cardiac output, is considered to be the
key mechanism. Enhanced tissue oxygen delivery caused by
increased arterial oxygen content may reduce peripheral and
renal chemoreceptor activation and thus decrease sympathetic
activity. Reductions in systemic vascular compliance and effective
arterial volume may also improve arterial compliance,
contributing to a reduced cardiac workload, despite increased
cardiac output.182
Animal studies have shown that pulsatile compression of
the rostral ventrolateral medulla at the root-entry zone of
cranial nerves IX and X increases both BP and sympathetic
outflow,184,185 and clinical data suggest that neurosurgical decompression
of the rostral ventrolateral medulla (used for
neurological disorders) leads to BP reduction.186
In the ASTRAL trial, renal arterial revascularization did not
result in a clinically relevant reduction in BP, but did cause a
high incidence (17%) of adverse procedure-related complications.
192