This document discusses hypertension (high blood pressure). It defines hypertension and provides normal and elevated blood pressure readings. It describes the types and causes of primary and secondary hypertension. It discusses the risk factors, mechanisms, diagnosis, clinical presentation, complications and treatment of hypertension, including lifestyle modifications and medication options. The goal of treatment is to reduce blood pressure levels to lower the risks of complications like stroke, heart disease and kidney damage.
PowerPoint presentation describing various aspects of Pulmonary Hypertension. Please mail me your feedback on this presentation to following Email ID: tinkujoseph2010@gmail.com.
PowerPoint presentation describing various aspects of Pulmonary Hypertension. Please mail me your feedback on this presentation to following Email ID: tinkujoseph2010@gmail.com.
What are the pulmonary function tests used?
What are the indications?
What are the contraindications?
How to perform each and prepare patients?
How to interpret and reach a diagnosis?
How to clean and calibrate devices?
Hypertension Emergencies and their managementpptxUzomaBende
This Presentation talks about Hyprtension, the mode of presentation of hypertensive crisis and the effective management of hypertensive crisis to prevent case fatalities.
What are the pulmonary function tests used?
What are the indications?
What are the contraindications?
How to perform each and prepare patients?
How to interpret and reach a diagnosis?
How to clean and calibrate devices?
Hypertension Emergencies and their managementpptxUzomaBende
This Presentation talks about Hyprtension, the mode of presentation of hypertensive crisis and the effective management of hypertensive crisis to prevent case fatalities.
An assignment in the subject "Pharmacological and Toxicological Screening", 1st year, M.Pharm, Pharmacology, 1st semester. This presentation provides a brief knowledge about Pre-clinical Screening, Hypertension, Its Types, Normal body mechanism in Hypertension, Screening Procedures, Animal models, Animal model criteria, various screening procedures and their evaluation, Recent discovery, Hypertension Facts, Recent Discovery and Treatment for Hypertension.
Hypertension- High blood pressure is a common condition that affects the body's arteries. It's also called hypertension.
If you have high blood pressure, the force of the blood pushing against the artery walls is consistently too high. The heart has to work harder to pump blood.
A condition in which the force of the blood against the artery walls is too high.
Usually hypertension is defined as blood pressure above 140/90, and is considered severe if the pressure is above 180/120.
High blood pressure often has no symptoms. Over time, if untreated, it can cause health conditions, such as heart disease and stroke.
Eating a healthier diet with less salt, exercising regularly and taking medication can help lower blood pressure.
Hypertension is rarely accompanied by symptoms, and its identification is usually through health screening, or when seeking healthcare for an unrelated problem. Some people with high blood pressure report headaches (particularly at the back of the head and in the morning), as well as lightheadedness, vertigo, tinnitus (buzzing or hissing in the ears), altered vision or fainting episodes.[23] These symptoms, however, might be related to associated anxiety rather than the high blood pressure itself.[24]
On physical examination, hypertension may be associated with the presence of changes in the optic fundus seen by ophthalmoscopy.[25] The severity of the changes typical of hypertensive retinopathy is graded from I to IV; grades I and II may be difficult to differentiate.[25] The severity of the retinopathy correlates roughly with the duration or the severity of the hypertension
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Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
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Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
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The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
2. Hypertension
Definition
Persistent elevation of arterial blood pressure is called
as hypertension.
High blood pressure is said to be present if it is often
at or above 140/90 mmHg.
• Blood pressure = CO X TPR
• Cardiac output = stroke vol X heart rate
Types of BP:
• Systolic BP ( contraction).
• Diastolic BP ( relaxation).
Normal BP
• Systolic BP = 120 mmHg
• Diastolic BP =80 mmHg
3.
4.
5. Blood Pressure SBP DBP
Classification mmHg mmHg
• Normal <120 and <80
• Prehypertensi
on
120–139 or 80–89
• Stage 1
Hypertension
140–159 or 90–99
• Stage 2
Hypertension
≥160 or ≥110
Classification of BP according to JNC
7 Its the Seventh Report of
the Joint National Committee (USA) on Prevention,
Detection, Evaluation, and Treatment of High Blood
Pressure .
6. Epidemiology
• Overall, approximately 20% of the world’s adults are
estimated to have hypertension, when hypertension is
defined as BP in excess of 140/90 mm Hg.
• The prevalence dramatically increases in patients older
than 60 years.
• In many countries, 50% of individuals in this age group
have hypertension.
• Worldwide, approximately 1 billion people have
hypertension, contributing to more than 7.1 million
deaths per year.
• National health surveys in various countries have shown
a high prevalence of poor control of hypertension.
7. Age Distribution for Hypertension :
A progressive rise in BP with increasing age is observed. Age-related
hypertension appears to be predominantly systolic rather than
diastolic.
Cardiovascular disease risk :
According to the JNC in individuals older than 50 years :
• SBP of greater than 140 mm Hg is a more important cardiovascular
disease risk factor than DBP.
• Beginning at a BP of 115/75 mm Hg, the cardiovascular disease
risk doubles for each increment of 20/10 mm Hg.
Prevalence of Hypertension by Race :
• Black individuals have a higher prevalence and incidence of
hypertension than white persons .
• The prevalence of hypertension has been reported to be increased
by 50% in blacks.
8. To understand ethnic influence, an understanding of the renin-
angiotensin system (RAS) is essential.
Renin secretion is suppressed when the kidney detects that the
amount of sodium excretion is increased; thus, this is a clue to the
excess sodium in the circulation.
• Black people tend to develop hypertension at an earlier age and
have lower renin activity.
• Genetics of Hypertension :
• There are rare forms of hypertension due to genetic mutations.
• These involve mutations in the epithelial sodium channel (ENaC) in
the distal renal tubule (Liddle syndrome). involves abnormal kidney
function, with excess reabsorption of sodium and loss of potassium
from the renal tubule, and is treated with a combination of low
sodium diet and potassium-sparing diuretic drugs (e.g., amiloride)
• The inheritance of the mutation almost always results in the
development of hypertension.
9. Age
Gro
ups
(y)
All Races White Black
Me
n
(%)
Wo
men
(%)
Tota
l (%)
Me
n
(%)
Wo
men
(%)
Tota
l (%)
Me
n
(%)
Wo
men
(%)
Tota
l (%)
18-24 2.6 4.6 0.7 2.5 4.6 0.5 2.6 4.1 1.4
25-34 5.4 8.4 2.4 4.9 8.1 1.6 8.2 10.6 6.2
35-44 13.0 16.0 10.2 11.3 14.3 8.5 25.9 29.5 22.9
45-54 27.6 30.0 25.2 25.8 29.1 22.6 46.9 44.3 48.8
55-64 43.7 44.2 43.2 42.1 43.0 41.4 60.0 58.0 63.0
65-74 59.6 55.8 62.7 58.6 54.9 61.7 71.0 65.2 75.6
75+ 70.3 60.5 76.2 69.7 59.0 76.1 75.5 71.3 77.9
Total 23.4 23.5 23.3 23.2 23.4 23.1 28.1 27.9 28.2
National Estimates of Hypertension
National High Blood Pressure Education Program
The prevalence according to age group, sex, and race is shown in Table :
10. HTN in Pakistan
• The National Health Survey of Pakistan
estimated that hypertension affects 18% of
adults and 33% of adults above 45 years old.
• In another report, it was shown that 18% of
people in Pakistan suffer from hypertension
with every third person over the age of 40
increasingly effected to HTN.
• It was also mentioned that only 50% of the
people with hypertension were diagnosed and
that only half of those diagnosed were ever
treated.
• Thus, only 12.5% of hypertension cases were
adequately controlled.
11.
12. MECHANISM
• The renin-angiotensin system (RAS) or the renin-
angiotensin-aldosterone system (RAAS) is a
hormone system that regulates blood pressure and water
(fluid) balance.
• When blood volume is low, juxtaglomerular cells in the
kidneys activate their prorenin and secrete renin directly
into circulation.
• Plasma renin then carries out the conversion of
angiotensinogen released by the liver to angiotensin I.
• It is subsequently converted to angiotensin II by the
enzyme angiotensin-converting enzyme found in the
lungs.
13. • Angiotensin II is a potent vaso-active peptide that
causes blood vessels to constrict, resulting in
increased blood pressure.
• Angiotensin II also stimulates the secretion of the
hormone aldosterone from the adrenal cortex.
• Aldosterone causes the tubules of the kidneys to
increase the reabsorption of sodium and water into
the blood.
• This increases the volume of fluid in the body, which
also increases blood pressure.
• If the renin-angiotensin-aldosterone system is
abnormally active, blood pressure will be too high.
17. Primary HTN
• It may be from an underlying pathophysiologic
mechanism of unknown cause.
• Also called essential or idopathic HTN.
• 95 % cases no cause of HTN is found.
• Uncommon before age 20.
• Onset is between ages 25 and 55 years.
• Life long persist.
18. Multiple factors may contribute to the development of primary
hypertension :
✓ Abnormalities involving the renin-angiotensin-aldosterone system.
✓ A pathologic disturbance in the CNS, like stress.
Abnormalities in either the renal or tissue autoregulatory processes
for sodium excretion, plasma volume, and arteriolar constriction.
A high sodium intake .
✓ Increased intracellular concentration of calcium, leading to altered
vascular smooth muscle function and increased peripheral vascular
resistance.
✓ A deficiency in the local synthesis of vasodilating substances in the
vascular endothelium, such as prostacyclin, bradykinin , and nitric oxide,
or an increase in production of vasoconstricting substances such as
angiotensin II.
19.
20.
21. Secondary HTN
Identifible causes revealed by :
• History
• Physical examination
• Routine lab tests.
• In 5% cases causes of HTN discovered.
• Over age 50 years.
22. Disease related HTN
chronic kidney disease or renovascular disease
(2-6%) :
• Chronic glomerular nephritis.
• Polycystic kidney disease. is characterized by the presence of
multiple cysts
• chronic pyelonephritis. an inflammation of the renal
parenchyma, calyces, and pelvis.[
Endocrine disorders (1- 2%) :
• Pheochromocytoma.
• Cushing’s syndrome.
• Hyperthyroidism.
• primary aldosteronism.
26. Diagnosis of HTN
• Take history of
patient.
• Measurement
of BP.
• Physical
examination.
• Lab findings.
27. PHYSICAL EXAMINATION
• Frequently, the only sign of primary hypertension on
physical examination is elevated BP.
• The diagnosis of hypertension should be based on
the average of two or more readings taken at each of
two or more clinical encounters.
• As hypertension progresses, signs of end-organ
damage begin to appear chiefly related to pathologic
changes in the :
o Eye.
o Brain.
o Heart.
o Kidneys.
o peripheral blood vessels.
28. • Cardiopulmonary examination may reveal :
o Abnormal heart rate or rhythm.
o Left ventricular (LV) hypertrophy.
o Third and fourth heart sounds.
• Peripheral vascular examination can detect
evidence of :
o Atherosclerosis.
o Distended veins.
• Patients with Cushing’s syndrome may have the
classic physical features of :
o Moon face
o Buffalo hump
o Hirsutism
o Abdominal striae.
29. • Baseline hypokalemia may suggest mineralocorticoid-
induced hypertension.
• The presence of protein, blood cells, and casts in the urine
may indicate renovascular diseases.
• Laboratory findings that should be obtained
in all patients prior to initiating drug therapy include :
o Urine analysis.
o complete blood cell count.
o serum chemistries (sodium, potassium, creatinine, fasting
glucose).
o These tests are used to assess other risk factors and to
develop baseline data for monitoring drug-induced
metabolic changes.
30. Tests to Evaluate the Heart.
An electrocardiogram (ECG) :
It records the electrical activity of the heart.
The heart produces tiny electrical impulses which
spread through the heart muscle to make the heart
contract.
These impulses can be detected by the ECG machine.
The machine amplifies the electrical impulses that
occur at each heartbeat, and records them on to a
paper or computer.
An ECG recording is painless and harmless.
The ECG machine records electrical impulses coming
from your body, it does not put any electricity into your
body.
31.
32.
33. An exercise tolerance test (ETT) records the
electrical activity of your heart while you exercise.
How is an exercise tolerance test done?
Small electrodes are stuck on to your chest.
Wires from the electrodes are connected to the ECG machine.
You will then be asked to exercise on a treadmill or on an
exercise bike.
The exercise starts at a very easy pace, and is gradually made
more strenuous by increasing the speed and incline of the
treadmill, or by putting some resistance on the bike wheel.
While you exercise, ECG tracings are made and you will also
have your blood pressure measured from time to time.
The test lasts about 15-20 minutes.
34. Why is an exercise
tolerance test done?
The ETT helps to diagnose and
assess the severity of ischaemic
heart disease (sometimes called
coronary heart disease or coronary
artery disease).
This disease is due to narrowing of
the coronary arteries. It can cause
angina (chest pains) and other
problems. So, if you develop chest
pains you may be advised to have
an ETT to help to clarify the cause.
35. Investigations
For Pheochromocytoma:
• Plasma norepinephrine.
• Urinary metanephrine
levels Plasma. (PCC) is a
neuroendocrine tumor of
the medulla of the
adrenal glands
primary aldosteronism:
• urinary aldosterone levels
for Plasma renin activity.
For renovascular disease
• Captopril stimulation test.
• Renal vein renins . Renal
36. A Doppler ultrasound is a noninvasive test that can be used to
estimate your blood flow through blood vessels by bouncing high-
frequency sound waves (ultrasound) off circulating red blood cells. A
regular ultrasound uses sound waves to produce images, but can't
show blood flow.
A Doppler ultrasound may help diagnose many conditions, including:
o Blood clots
o Poorly functioning valves in your leg veins, which can cause blood or
other fluids to pool in your legs (venous insufficiency)
o Heart valve defects and congenital heart disease
o A blocked artery (arterial occlusion)
o Decreased blood circulation into your legs (peripheral artery
disease)
o Narrowing of an artery.
37. • A Doppler ultrasound can estimate how fast blood flows by
measuring the rate of change in its pitch (frequency).
• A Doppler ultrasound test may also help your doctor check for
injuries to your arteries or to monitor certain treatments to your
veins and arteries.
38. CLINICAL PRESENTATIONS
• Patients with uncomplicated primary hypertension are
usually asymptomatic.
• Patients with secondary hypertension may complain of
symptoms suggestive of the underlying disorder.
Patients with pheochromocytoma may
have a history of :
o headaches
o Sweating
o Tachycardia
o Palpitations
o Orthostatic hypertension.
39. In primary aldosteronism :
Hypokalemic symptoms of muscle cramps and weakness.
Patients with hypertension secondary to
Cushing’s syndrome may complain of :
o weight gain.
o Polyuria.
o Edema.
o Menstrual irregularities.
o Acne.
o Muscular weakness.
Symptoms of complications such as :
o heart failure.
o Stroke.
o renal failure.
40. Complications of HTN
Central nervous
system
• Stroke.
• Hypertensive
encephalopathy.
• Subarachnoid
hemorrhage.
• Multi infarct dementia.
Heart :
• Ventricular hypertrophy.
• Ischemic heart disease.
• Heart failure.
Kidneys:
• Nephropathy.
• Proteinuria.
• Renal failure.
Eyes related
problems :
• Retina grade 1 to 4.
• Sometimes blindness.
41. Symptoms of Malignant Hypertension
In rare cases (fewer than 1% of all patients with
hypertension), the blood pressure rises quickly resulting in
malignant or accelerated hypertension.
This is a life-threatening condition and must be treated
immediately.
People with uncontrolled hypertension or a history of
heart failure are at increased risk for this crisis.
People should call a doctor immediately if these symptoms
occur:
o Drowsiness
o Confusion
o Headache
o Nausea
o Loss of vision
o Respiratory distress (difficulty breathing)
42.
43.
44.
45. DESIRED OUTCOME
• The overall goal of treating hypertension is to reduce
morbidity and mortality by the possible means.
Goal BP values are <140/90 for most patients,
but <130/80 for patients with :
o Diabetes mellitus.
o Significant chronic kidney disease.
o Coronary artery disease .
o Myocardial infarction
o Angina.
46. Patients with LV dysfunction have
a :
o BP goal of <120/80 mm Hg.
o SBP is a better predictor of CV risk than DBP and
must be used as the primary clinical marker of
disease control in hypertension.
47. Treatment
NONPHARMACOLOGIC THERAPY
• All patients with prehypertension and hypertension should
be prescribed lifestyle modifications, including :
• Weight reduction if overweight.
• Adoption of the Dietary Approaches (eating plan) to Stop
Hypertension.
• Dietary sodium restriction .
• Regular aerobic physical activity.
• Moderate alcohol consumption (two or fewer drinks per day)
• Smoking cessation.
48.
49.
50. • Lifestyle modifications alone is appropriate therapy for
patients with prehypertension. Patients diagnosed with stage
1 or 2 hypertension should be placed on lifestyle
modifications and drug therapy concurrently.
51. Pharmacological therapy
• Initial drug selection depends on the degree of BP
elevation and the presence of compelling indications
for selected drugs.
• Most patients with stage 1 hypertension should be
treated initially with :
• Thiazide diuretics, angiotensin-converting enzyme
(ACE) inhibitors, angiotensin II receptor blockers
(ARB), or calcium channel blockers (CCB).
• Combination therapy is recommended for patients
with stage 2 disease, with one of the agents being a
thiazide-type diuretic unless contraindications exist.
52. • Diuretics, ACE inhibitors, ARBs, and CCBs are primary
agents acceptable as first-line options based on outcome data
demonstrating CV risk reduction benefits .
β-Blockers may be used either to treat a specific compelling
indication or as combination therapy with a primary
antihypertensive agent for patients without a compelling
indication.
α1-Blockers, direct renin inhibitors, central α2-agonists,
peripheral adrenergic antagonists, and direct arterial
vasodilators are alternatives that may be used in select
patients after primary agents .
53.
54.
55.
56.
57.
58.
59. Preclampsia or Eclampsia
• Hypertension occurs in approximately 8–10% of pregnancies.
• High BP in pregnancy may usually be due to pre-existing HTN or
pre-eclampsia.
• Two blood pressure measurements in six hours an apart of greater
than 140/90 mm Hg is considered diagnostic of hypertension in
pregnancy.
• Pre-eclampsia is characterised by increased blood pressure and the
presence of protein in the urine. proteinuria (≥300 mg/24 hours),
can lead to life-threatening complications for both the mother and
fetus.
• It occurs in about 5% of pregnancies and is responsible for
approximately 16% of all maternal deaths globally.
• Usually there are no symptoms in pre-eclampsia and it is detected
by routine screening.
60. When symptoms of pre-eclampsia occur the most
common are :
• Headache
• Visual disturbance .
• Vomiting.
• Epigastric pain
• Edema.
Eclampsia can occasionally progress to life-threatening
which is a hypertensive emergency and has several
serious complications including :
• vision loss
• cerebral edema
• seizures or convulsions
• renal failure
• pulmonary edema
• intravascular coagulation (a blood clotting disorder)
61. TREATMENT :
• Methyl dopa is safe in pregnancy.
• Beta blockers are effective and safe in 3rd trimester of
pregnancy.
• Modified release preparations of nifidipine are also
used in HTN in pregnancy.
• IV labetolol or hydralazine can be used to control
hypertensive crisis.
• Mg sulphate is drug of choice to prevent seizures in
preclampsia.
• ACE inhibitors and ARB,s are contraindicated
because they cross placenta.
66. HTN with liver disease
• All hypertensive drugs can be used except methyldopa.
HTN with gout
All hypertensive drugs can be used.
But all diuretics can increase serum uric acid level.
So diuretics should be avoided if possible.
67.
68. White coat HTN also known as white coat
syndrome :
It is a phenomenon in which patients exhibit elevated blood pressure in
a clinical sitting but not in other sittings.
It is believed that this is due to the anxiety some people experience
during a clinic visit.
In general, individuals with white coat hypertension have lower
morbidity than patients with sustained hypertension.
White coat" hypertension do not require even very small doses of
antihypertensive therapy as it may result in hypotension, but must still
be careful as patients may show signs of vascular changes and may
eventually develop hypertension.
The term "masked hypertension" can be used to
describe the contrasting phenomenon, where blood pressure is
elevated during daily living, but not in an office sitting.
69.
70.
71. Measurement of BP
• Arterial pressure is most commonly measured via a
sphygmomanometer which historically used the height of a column
of mercury to reflect the circulating pressure.
• Systolic and diastolic arterial blood pressures are not static but
undergo natural variations from one heartbeat to another and
throughout the day (in a circadian rhythm).
• They also change in response to :
o Stress.
o Nutritional factors.
o Drugs.
o Disease.
o Exercise.
72.
73.
74. Hypertensive urgencies
• Severe HTN without or with minimal symptoms
and controlled slowly in 24 hours.
• It is ideally managed by adjusting maintenance
therapy by adding a new antihypertensive and/or
increasing the dose of a present medication.
• Acute administration of a short-acting oral drug
(captopril, clonidine, or labetalol) followed by
careful observation for several hours to ensure a
gradual BP reduction is an option.
75. Hypertensive emergencies :
• Hypertensive emergency is severe HTN with
symptomatic end organ damage require
immediate BP reduction to limit new or
progressing target-organ damage.
• The goal is not to lower BP to normal; instead,
the initial target is a reduction in mean arterial
pressure of up to 25% within minutes to hours.
• If BP is then stable, it can be reduced toward
160/100– 110 mm Hg within the next 2 to 6
hours.
76. • If BP reduction is well tolerated, additional gradual
decrease toward the goal BP can be attempted after 24 to
48 hours.
• Nitroprusside is the agent of choice :for minute-
to-minute control in most cases. It is usually given as a continuous IV
infusion at a rate of 0.25 to 10 mcg/kg/min.
• Its onset of hypotensive action is immediate and disappears within 1
to 2 minutes of discontinuation.
• When the infusion must be continued longer than 72 hours, serum
thiocyanate levels should be measured, and the infusion should be
discontinued if the level exceeds 12 mg/dL.
• The risk of thiocyanate toxicity is increased in patients with
impaired kidney function.
77. Refractory HTN
The more common cause of treatment failure in
HTN :
• Non compliance i.e patient is not taking drug regularly.
• Inadequate therapy.
• Failure to recognize secondary causes of HTN e.g renal
artery stenosis & pheochromocytoma.
• Use of antagonistic drugs e.g NSAIDS
o Steroids
o cocaine
• Increase alcohol intake.
78. EVALUATION OF
THERAPEUTIC OUTCOMES
• Clinic-based BP monitoring is the standard for managing
hypertension.
• BP response should be evaluated 2 to 4 weeks after initiating or
making changes in therapy.
• More frequent evaluations are required in patients with a
history of :
Poor control.
Non adherence
Progressive target-organ damage
Symptoms of adverse drug effects.
• These techniques are currently recommended only for select
situations such as suspected white coat hypertension.
79. Monitoring for adverse drug effects should typically occur 2
to 4 weeks after starting a new agent or dose increases,
and then every 6 to 12 months in stable patients.
Additional monitoring may be needed for other
concomitant diseases.
Patients taking aldosterone antagonists should have
potassium concentration and kidney function assessed .
Patients should be questioned periodically about changes
in:
o their general health perception.
o energy level.
o physical functioning.
o overall satisfaction with treatment.
.