This document discusses hypertension (high blood pressure). It notes that over 1 billion people worldwide have hypertension, including 1 in 4 men and 1 in 5 women. Less than 1 in 5 people with hypertension have it under control. Hypertension is a major cause of premature death and reducing its prevalence is a global health target. The document defines hypertension, classifies its stages, discusses risk factors like family history and lifestyle, and examines causes like issues with sodium regulation and the renin-angiotensin-aldosterone system. It also outlines non-pharmacological therapies like diet, exercise, and reducing alcohol intake to help control hypertension.

1. Hypertension
Dr Hassan Yar

2. Hypertension Global
• 1.13 billion people worldwide have hypertension
• 1 in 4 men have hypertension
• 1 in 5 women suffer from hypertension
• < 1 in 5 people with hypertension have the problem under control
• Hypertension is a major cause of premature death worldwide
• One of the global targets for noncommunicable diseases is to reduce
the prevalence of hypertension by 25% between 2010 and 2025
• 17th May is world hypertension day!

3. WHO definition
• Hypertension is diagnosed if, when it is measured on two different
days, the systolic blood pressure readings on both days is ≥140 mmHg
and/or the diastolic blood pressure readings on both days is ≥90
mmHg.

4. Classification of HTN stages
Blood Pressure Classification SBP (mmHg) DBP (mmHg)
Normotensive ~120 ~80mmHg
Prehypertension 120-139 80-89
Stage 1 HTN 140-159 90-99
Stage 2 HTN >159 >99

6. Risk Factors for HTN
Modifiable Risk factors
Factors that are not in patients/physicians control
Non-modifiable Risk factors
Factors that could/could’ve been avoided
• Family History
• Age
• Gender
• Ethnicity/Race (African are more likely to be HTNsive)
• Genetic deffects
• DM (type 2 especially)
• Stress
• Smoking
• Obesity/Lifestyle
• Disorders causing HTN ( pheochromocytoma, thyroid
disorders, acromegaly)

7. Types
• Primary vs Secondary
• 85-95% of hypertensive cases are idiopathic (essential/primary)
• The rest of the cases (secondary type) are secondary to a disorder
effecting sodium and water balance or cardiovascular.

8. Causes of Hypertension

9. Pathogenesis
• Multifactorial
• Renal Sodium Hemostasis (sodium and water imbalance)
predominant cause
• Defects in RAAS and SNS activity (vasoconstriction)
• Vascular pathologies ( structural changes in vessels e.g. stenosis)

12. Pathogenesis

13. Essential
hypertension
Environmental
Factors
Increased PVR
chronic vasoconstriction
may result in permanent
thickening of the walls
Genetic
Factors
Reduced renal Na
excretion
Decreased sodium
excretion causes an
obligatory increase in fluid
volume and increased
cardiac output

14. Genetic Pathologies
• Gene defects in enzymes involved in aldosterone metabolism,
aldosterone synthase, 11β-hydroxylase,17α-hydroxylase
• Mutations in proteins that affect sodium resorption, defects in
ENaC/CFTR.
The overall effect is increased renal tubular Na resorption and
subsequent increased in plasma volume expansion

15. Morphological Changes
• Hyaline Arteriosclerosis
Leads to Nephrosclerosis
Associated with benign hypertension
ECM production/plasma leakage to vessel
• Hyperplastic Arteriosclerosis
Leads to Necrotizing arteriolitis
Associated with severe hypertension
Onion-skin thickening

16. Hyaline arteriosclerosis
Narrowing of
the lumen
Thickening of
the arteriolar
wall

17. Hyperplastic arteriosclerosis
Onion-skinning
Laminated sheets of
reduplicated
basement membrane
Luminal
obstruction

18. Consequences/Complications
• The complications of long standing uncontrolled hypertension arise
due to damage to vasculature of the target organ and causing one of
the few pathologies i.e. sclerotic changes, aneurysms, metabolic
changes etc.
• The major objective in patients with hypertension is to prevent Target
organ damage that of:
• Heart
• Brain
• Eyes
• Kidney
• Vessels

20. Non-pharmacological Therapy of HTN
• DASH therapy (dietary approaches to stop hypertension)
• Weight reduction
• Smoking cessation
• Exercise
• Reducing alcohol intake

21. The End