This document provides an overview of hypertension (high blood pressure) presented by Mohammad Ilyas, M.D. It begins with course policies for the 16 session course on hypertension. It then discusses grading, prevalence of hypertension worldwide and in China, and objectives of the course. The outline presented covers definition, measurement, evaluation, management, and specific types of hypertension. Key topics like what is blood pressure, causes of hypertension, and health risks are explained. Quizzes are also included to test knowledge.

1. HYPERTENSION
An Update
Mohammad Ilyas, M.D.
Assistant Clinical Professor
University of Florida / Health Sciences Center
Jacksonville, Florida USA
6/28/2014
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2. Course Policies
 Course will be of total 16 sessions and each session will
be about 45 minutes.
 Each session will have few quizzes.
 The “After Course Test” will be at the end of course.
 Turn off all cell phones during class.
 Discussion of items are encouraged.
 If you have a specific question you may ask any time.
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3. Grading
 Quizzes will be graded on a percentage of standardized
points.
 Grade A = 86 - 100%
 Grade B = 70 - 85%
 Grade C = 60 - 69%
 Grade D = 50 - 59%
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4. Why Hypertension?
 Worldwide prevalence estimates for HTN may be as much as 1 billion.
 Hypertension in 2025 is predicted to increase by 60% to 1.56 billion.
 7.1 million deaths/year may be due to hypertension.
 1.27 million in china.
 A total of 26.6% of Chinese adults had hypertension.
 The age-specific prevalence of hypertension was 13.0%, 36.7%, and
56.5% among persons aged 20 to 44 years (young people), 45 to 64
years (middle-aged people), and ≥65 years (elderly people),
respectively.
 Among hypertensive patients, 45.0% were aware of their condition,
36.2% were treated, and 11.1% were adequately controlled.
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5. 6/28/2014
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6. 6/28/2014
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7. 6/28/2014
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8. Prevalence, awareness, treatment, and control of
hypertension among Chinese aged ≥20 years.
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9. Prevalence, awareness, treatment, and control of
hypertension among Chinese aged ≥20 years.
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10. 6/28/2014
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11. 0
10
20
30
40
50
60
70
80
Hypertension Awareness, Treatment, and Control:
US 1976 to 2000*
NHANES III
(Phase 2)
1991-1994
NHANES III
(Phase 1)
1988-1991
51%
73% 68%
31%
55% 54%
10%
29% 27%
%Adults
NHANES II
1976-1980
NHANES
1999-2000
70%
59%
34%
Healthy People
2000/2010 Control
Target = 50%
Control
Awareness
Treated
Chobanian et al. JAMA. 2003;289:2560-2572.
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12. Objective of Course
1. This course will provide a better understanding of
pathophysiology of hypertension, it’s classification, new
monitoring tools, and management with non-
pharmacology and pharmacology methods.
2. Impact of diet and life style on blood pressure
3. The course will help to prevent the dire consequences
of mismanagement and teach the easy hand-on
approach.
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13. Outline
1. Definition, Regulation and Pathophysiology
2. Measurement of Blood Pressure, Staging of Hypertension and
Ambulatory Blood Pressure Monitoring
3. Evaluation of Primary Versus Secondary
4. Sequel of Hypertension and Hypertension Emergencies
5. Management of Hypertension (Non-Pharmacology versus Drug
Therapy)
6. The Relation Between Hypertension: Obesity, Drugs, Stress and
Sleep Disorders.
7. Hypertension in Renal diseases and Pregnancies
8. Pediatric, Neonatal and Genetic Hypertension (After Course Test)
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14. What is Blood Pressure?
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15. What is Blood Pressure?
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Arterial blood
pressure, is the
pressure exerted by
circulating blood
upon the walls of
blood vessels.
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16. During each heartbeat, blood pressure varies between a
maximum (systolic) and a minimum (diastolic) pressure.
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17. 6/28/2014
Systolic pressure (SBP) is defined as the peak pressure
generated during systolic contraction.
Diastolic pressure (DBP) is the lowest pressure during
diastolic relaxation.
Pulse pressure (PP) is the difference between the systolic
and diastolic pressure. PP = SBP – DBP
Mean arterial pressure (MAP) is average pressure
throughout the cardiac cycle.
MAP=(SBP)+2(DBP)
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18. Differences in mean
blood pressure are
responsible for blood
flow from one
location to another in
the circulation.
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19. Hypertension
• Blood pressure is a function of cardiac output
multiplied by peripheral vascular resistance
Blood Pressure = (Cardiac Output) x (Peripheral
resistance)
Cardiac output = Heart rate x stroke volume
• In clinical setting, Systolic pressure represents the
cardiac output whereas diastolic pressure
reflects peripheral vascular resistance
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20. Increase Cardiac Output
Increase Peripheral Resistance
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21. Blood Vessels Resistance
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Vessel resistance (R) is directly proportional to the length (L) of the vessel and the
viscosity (η) of the blood, and inversely proportional to the radius to the fourth
power (r4). Because changes in diameter and radius are directly proportional to
diameter and can be substituted for radius in the above expression.
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22. Control of Blood Pressure
Mean blood pressure is controlled by changing
total peripheral resistance (TPR) and or cardiac
output. MBP = CO x TPR
Cardiac Output is controlled by sympathetic and
para sympathetic nerves which effect:
Heart rate
Force of contraction (Cardiac output)
TPR controlled by nerves & chemical means to effect
constriction/dilatation of
Arterioles and venules
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23. Challenge your brain !!
Check your knowledge !!
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24. WHAT IS HYPERTENSION/HIGH BLOOD
PRESSURE?
 A: A condition where low oxygen supply to the blood
leads to tiredness and other health problems
 B: A condition where force of blood pumping in the walls
of the arteries is high enough to cause health problems
 C: A condition where the heart pumps blood very fast,
giving a high pulse rate
 D: None of the above
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25. WHAT IS HYPERTENSION/HIGH BLOOD
PRESSURE?
 CORRECT ANSWER IS: B
 Blood flow puts too much tension on the wall of the
arteries, leading to its damage and increased heart
workload . This can lead to series of very serious health
problems if uncontrolled, like heart attack, stroke,
kidney disease etc.
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26. WHICH IS THE NORMAL BLOOD
PRESSURE VALUE?
 A: Readings higher than 140/90mmHg
 B: Readings above 120/80mmHg but less than
140/90mmHg
 C: Readings between 90/60mmHg to 120/80mmHg
 D: Readings less than 90/60mmHg
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27. WHICH IS THE NORMAL BLOOD
PRESSURE VALUE?
 CORRECT ANSWER IS: C
 A reading below 120/80 is desirable by most regulatory bodies.
 If between 120/80 to less than 140/90 you have prehypertension,
with possibility of developing hypertension if lifestyle changes are
not started.
 If above 140/90 or above, you have high blood pressure. The higher
the reading, the greater the health risks. So take control TODAY!
 Some Experts suggests that blood pressure below 90/60 is low.
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28. WHAT IS THE MAIN CAUSE OF HIGH
BLOOD PRESSURE?
 A: Unknown
 B: Obesity
 C: Stress
 D: Aging
 E. Anxiety
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29. WHAT IS THE MAIN CAUSE OF HIGH
BLOOD PRESSURE?
• CORRECT ANSWER IS: A
• In 90-95% of the cases, the cause is unknown.
• It’s usually measured with a sphygmomanometer.
• The top reading (systolic) showing pressure when the
heart contracts/beats and the lower reading (diastolic),
the pressure when the relaxes in between beats, to fill up
with blood.
• Occasionally secondary causes like kidney or adrenal
diseases may cause hypertension
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30. WHAT ARE THE EARLY SYMPTOMS OF
HIGH BLOOD PRESSURE?
A: Thirst with/without dehydration
B: Headaches and dizziness
C: Ringing of the ears
D: Mostly no obvious symptoms
E: Nausea and vomiting
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31. WHAT ARE THE EARLY SYMPTOMS OF
HIGH BLOOD PRESSURE?
 CORRECT ANSWER IS: D
 There are usually no obvious noticeable symptoms
during the early onset of high blood pressure, and often
even in later years.
 1 in 5 people with hypertension have no clue that they
have it.
 This is why it's called the “silent killer”, because it will
quietly damage heart, lungs, blood vessels, brain and
kidneys if left untreated.
 It’s usually common amongst African-Americans. 6/28/2014
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32. WHICH OF THE FOLLOWING ARE THE RISK FACTORS
ASSOCIATED WITH HYPERTENSION?
 A: Ageing
 B: Heredity and Race
 C: Gender
(Male/Female)
 D: Smoking
 E: Physical Inactivity
 F: High Cholesterol
 G: Diabetes
 H: Excess Alcohol Intake
 I: All of the Above
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33. WHICH OF THE FOLLOWING ARE RISK FACTORS
ASSOCIATED WITH HYPERTENSION?
 CORRECT ANSWER IS: I
 The non-modifiable risk factors include:
 Ageing: which is associated with increased risk.
 Heredity and race (e.g. Close Family member hypertensive; African-
Americans) who have genes that make them more salt sensitive. Hence
caution especially in consuming salt hidden in canned foods, baking soda,
cheese, dried fruits and some drugs. maximum intake is 1500mg (3/4
tablespoon of salt.) an extra gram (1/2 teaspoon) can raise BP by 5mmHg
in them.
 Gender (Male) are more prone up to 45yrs, then same for both gender, up
to 65yrs when its more in females then.
 Also pregnant women are at risk of developing this condition in pregnancy
from 20weeks.
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34. WHICH OF THE FOLLOWING ARE RISK FACTORS
ASSOCIATED WITH HYPERTENSION?
 However, the others are modifiable factors amenable to lifestyle
changes:
 Smoking builds up fat in arteries hence increased risk.
 Exercising regularly helps lower risk .
 Diet low in salt (which builds up fluid in the heart), saturated fat and
cholesterol, rich in vegetables , fruits and whole grains, with healthy
proteins like fish, poultry and nuts are advisable.
 Excess Alcohol intake can raise blood pressure.
 60% of Diabetics have hypertension.
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35. WHICH OF THE FOLLOWING ARE HEALTH PROBLEMS
ASSOCIATED WITH HYPERTENSION?
 A: Damage to the Heart
(e.g. Heart Attack)
 B: Stroke (brain attack)
 C: Damage to the Kidney
(e.g. Kidney Failure)
 D: Loss of Vision
 E: Problems with Erection
 F: Memory Loss
 G: Chest Pain (Angina)
 H: Breathing Problems
(Fluid in the Lungs)
 I: All of the Above
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36. WHICH OF THE FOLLOWING ARE HEALTH PROBLEMS
ASSOCIATED WITH HYPERTENSION?
 CORRECT ANSWER IS: I All of the above
 High blood pressure can lead to Heart problems, notably Heart
attack and Chest Pain.
 It can affect the kidneys leading to kidney failure.
 It can also affect the nervous system leading to most notably Stroke;
Memory loss.
 Erectile dysfunction may also arise from this and all hypertensives
should beware while taking stimulants like Viagra
(phosphodiesterase inhibitors)
 It can also lead to breathing problem that may result in respiratory
arrest.
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37. YOU HAVE TO TAKE MEDICATIONS ONCE
YOU HAVE HIGH BLOOD PRESSURE?
A: True
B: False
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38. YOU HAVE TO TAKE MEDICATIONS ONCE
YOU HAVE HIGH BLOOD PRESSURE?
 CORRECT ANSWER IS: FALSE
 Lifestyle changes is the first step to control mild high blood pressure.
Exercise, Eat healthy, lose weight, quit smoking, cut alcohol and salt
intake
 If changes are unsuccessful or blood pressure is very high see your
doctor for prescriptions.
 Ensure you take these medications regularly, check your blood
pressure regularly at home and in the clinic.
 Also maintain the lifestyle changes as these help together with
medications to reduce risk of complications from high blood
pressure.
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39. YOU SHOULD STOP TAKING MEDICATIONS ONCE
YOU HAVE YOUR BLOOD PRESSURE CONTROLLED?
A: True
B: False
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40. YOU SHOULD STOP TAKING MEDICATIONS ONCE
YOU HAVE YOUR BLOOD PRESSURE CONTROLLED?
 CORRECT ANSWER IS: FALSE
 Hypertension is a life-long condition that is treated and NOT cured.
 DON’T stop taking your medications if your blood pressure
normalizes.
 Keep monitoring the blood pressure.
 Relaxation exercises like yoga, tai chi and deep breathing are
helpful alongside lifestyle changes already discussed.
 BEWARE of certain herbal preparations, as they may counter
efficacy of your medications.
 Discuss dosage plans with your Doctor always.
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