Hypertension: Definition - mechanisms - causes- treatment.

1. H Y P E R T E N S I O N

2. B I O
Dalyan Eldaly
Education
2023: A PhD Degree in Pharmacology/ Physiology ( Cardiovascular
Diseases ) - UEA
2018: A MSc Degree in Molecular Medicine ( Cancer Research) – UEA
2009: A Bachelor Degree in Pharmacy – Aleppo University
Career Progression
Present: A lecturer in Pharmacology at UON
2021-2023: Biomedical Scientist for SARS-CoV-2 Testing - NHS
2010-2015: A University Teacher at the Faculty of Pharmacy - Aleppo
University
2011-2015: A Team Leader and Sales Manager, BiomedPharma
Pharmaceutical Company
2009-2015: Pharmacist

3. H Y P E R T E N S I O N
A W O R L D W I D E E P I D E M I C
• In 2020, 1.28 billion adults were diagnosed
with hypertension, affecting up to one in
every four men and one in every five women
• Approximately 1 in 5 adults (21%) are
diagnosed with uncontrolled hypertension.
• Hypertension which is responsible for 3
million death annually.

4. W H A T I S H Y P E R T E N S I O N ?
• Hypertension , also known as high blood
pressure (HBP), is a serious medical condition
in which the blood pressure in the arteries is
persistently elevated.
• That can increase the risk of several diseases
including heart failure, stroke, and chronic
kidney disease
• Blood pressure is the amount of force on the
walls of the arteries OR it is a measure of the
force that your heart uses to pump blood
around your body.

5. H O W I S B L O O D P R E S S U R E M E A S U R E D ?
• Blood pressure is measured in millimetres of mercury
(mmHg) and is given as 2 figures:
• Systolic pressure – the pressure when your heart
pushes blood out or a measurement of the force in the
artery when the heart pumps.
• Diastolic pressure – the pressure when your heart
rests between beats or a measurement of the force in
the artery when the heart is at rest.
• Mean arterial blood pressure is the average of
pressures responsible for the driving blood forward
through the arteries into the tissues.

6. Category SBP (mmHg) DBP (mmHg)
Normal < 120 < 80
Prehypertension 120-139 80-89
Hypertension stage I 140-159 90-99
Hypertension stage II ≥ 160 ≥ 100
Hypertensive Crisis Over 180 Over 120
B L O O D P R E S S U R E C L A S S I F I C A T I O N
Pregnancy induced
HTN
Because of increased production of hormones
and enzymes during pregnancy.

7. H Y P E R T E N S I V E C R I S I S
• Severe, abrupt elevation in BP
• BP values are greater than 180/120 mm/Hg
• Most common in patients with a history of HTN who have failed
to comply with medications or who have been undermedicated
• Clinical Manifestations
• Hypertensive encephalopathy (seizures, confusion, coma) - Renal
insufficiency - Heart failure - Pulmonary oedema.

8. H Y P E R T E N S I V E C R I S I S
• Nursing and Collaborative Management
Hospitalization
• IV drug therapy
• Monitor cardiac and renal function
• Neurologic checks
• Determine cause
• Education to avoid future crises

9. W H A T A R E T H E S Y M P T O M S O F H I G H B L O O D P R E S S U R E ?
High blood pressure rarely exhibits any symptoms , so that it is known as silent killer
disease and is identified through screening. However, there are symptoms of severe
hypertension which include:
Shortness of breath
Headaches Nosebleeds
Blurred vision
Fatigue
Blood in the urine
Chest pain
dizziness
Flushing
Pounding in the chest,
neck and ears

10. E T I O L O G Y
• Primary hypertension: it is the elevation in BP without an identified
cause. However this could be because of:
Genetics
Physical changes in
the body
Life style

11. E T I O L O G Y
• Secondary hypertension : it is the elevation in BP with an exact cause.
This type is account for 5-10% of total cases.
Kidney disease Obstructive sleep apnea Congenital heart defects
Alcohol abuse
Use of illegal drugs
Certain medications
Thyroid problems
Adrenal gland
tumors
Kidney disease Obstructive sleep apnea Congenital heart defects
Certain medications
Thyroid problems

14. R I S K F A C T O R S
Pregnancy
Stress
Smoking
High sodium
intake
Intake of too
much of liquor
Inactive life
style
Family history
Age
Intake of too little of
potassium
Certain chronic conditions
Obesity Gender

16. P A T H O P H Y S I O L O G Y
The normal blood pressure is maintained by
four mechanisms
• Peripheral nervous system activities
(abnormal neuronal mechanism)
• Activities of vascular endothelium.
• Humoral (e.g., The renin-angiotensin-
aldosterone system [RASS]. Most
antihypertensives target this mechanism.
• Disturbances in Na+, K+ and Ca++.
• Activities of renal system.
• These factors could affect cardiac output
and peripheral resistance.

17. The net effect of SNS activation is to increase the arterial blood pressure by
increasing cardiac output and systemic vascular resistance.
BP=CO X SVR

18. 1 - S Y M P A T H E T I C N E R V O U S S Y S T E M A C T I V I T I E S
• When the BP is decreasing the activation of
SNS will occur. The increased SNS activity
increases the heart rate and cardiac
contraction.
• The increased the heart rate and cardiac
contraction produce vasoconstriction in the
peripheral arterioles and promotes the
release of renin from kidney.
• Other neural regulations include:
autonomic nerve fibers, Adrenergic
receptors, baroreceptors and certain area in
CNS.
The nucleus tractus solitarius (NTS)
The paraventricular nucleus of the hypothalamus (PVN)
The rostral ventrolateral medulla (RVLM)

19. 2 - A C T I V I T I E S O F V A S C U L A R E N D O T H E L I U M
• The vascular endothelium is a single cell layer that
lines the blood vessel.
• It will produce endothelium-derived relaxant factors
including NO, EDHF, and PGI2.
• In the healthy endothelium of blood vessels, platelet
aggregation is inhibited causing nucleotides to act at
endothelial P2Y receptors to release NO and EDHF,
promoting vasorelaxation.
• However, in the case of dysfunctional endothelium
or damage, platelet aggregation and accumulation of
leukocytes can happen, leading to these elements
bind to vascular smooth muscle P2 receptors causing
vasoconstriction and smooth muscle proliferation

20. 3 - T H E R E N I N - A N G I O T E N S I N - A L D O S T E R O N E S Y S T E M
[ R A S S ]

21. D I A G N O S T I C E V A L U A T I O N S O F B P
• History collection and physical
examination
• Repeated BP measurements
• Medical history of diabetes mellitus
• Laboratory investigations (Complete blood
count)
• Chest x-ray
• ECG

22. M A N A G E M E N T
• Mainly the management of hypertension is possible
by two ways, which include
• Life style modification
• Pharmacological therapy

23. B E N E F I T S O F L O W E R I N G B P
Average Percent Reduction
Stroke incidence 35% – 40%
Myocardial infarction 20% – 25%
Heart failure 50%
Coronary artery disease (CAD) 20% - 25%

25. L I F E S T Y L E M O D I F I C A T I O N
• Weight reduction:
- Maintain normal body weight BMI: 18.5 – 24.9
- BP reduction: 5-20 mmHg/10 kg loss
• DASH Diet (Dietary approaches to stop
hypertension:
- Fruits, Vegetables, Low-fat dairy.
- Reduce saturated and total fat.
- 8-14 mmHg BP reduction
• Dietary sodium reduction
- 2.4 grams Sodium or 6 grams Sodium Chloride
- 2-8 mmHg BP reduction
• Reduce alcohol - Exercise - Stress

30. P H A R M A C O L O G I C A L T H E R A P Y
Primary actions:
• Reduce Systemic vascular resistance
(SVR)
• Reduce volume of circulating blood

31. P H A R M A C O L O G I C A L T H E R A P Y
Various groups of drugs are used for the treatment of
hypertension, collectively these drugs are called as
anti-hypertensive drugs, which includes,
• Diuretics
• Adrenergic inhibitors or blockers
• ACE Inhibitors and AII receptors bclokers
• Calcium channel blockers
• Direct vasodilator

32. 1 - D I U R E T I C S
It helps the kidneys to inhibit the sodium reabsorption in the distal
convoluted tubules, ascending limb and loop of henle.
Agents:
LOOP DIURETICS : Furosemide- 40 mg PO t.i.d
THIAZIDE DIURETICS: Hydrochlorothiazide -25–100 mg/d
POTASSIUM SPARING DIURETICS: Spirinolactone-50–100 mg/d
PO
• Side effects:
• Electrolyte imbalances: ↓ Na+ ↓ Cl-, ↓ K+ (advise K+ rich foods)
• Fluid volume depletion (monitor for orthostatic hypotension)
• Impotence, decreased libido

33. 2 – A D R E N E R G I C B L O C K E R S
( S U F F I X “ O L O L ” ) :
• They Block β – adrenergic receptors >> They reduce sympathetic
effects that cause HTN by: Reducing sympathetic outflow -.
Reduce cardiac work by negative inotropic, negative chronotropic
and hypotensive.
Agents: Atenolol: 50-100 mg, Propranolol
– Side effects:
• Bradycardia
• Hypotension
• Heart failure
• Impotence

34. 3 - A L P H A B L O C K E R S ( S U F F I X “ O S I N ” ) :
• Alpha blockers (suffix “osin”): They Block α1 –
adrenergic receptors >> They reduce sympathetic
effects that cause HTN by: Reducing sympathetic
outflow - Blocking effects of sympathetic activity on
vessels. These medications causes the peripheral
vasodilation of blood vessels.
Agents: Prazosin - Doxazosin
• Side effects:
• Can produce first dose syncope

35. 4 - A C E I N H I B I T O R S ( S U F F I X “ P R I L ) :
• Prevents conversion of angiotensin I to
angiotensin II, thereby preventing the
vasoconstriction associate with A II.
Agents: Enalapril, captopril
Hypotension - Cough - Potassium retention
5- Angiotensin II–Receptor Blockers(suffix
“tan”):
Agents: Losartan, Telmisartan-40–80 mg/d
PO
• Side effects:
Hyperkalaemia could occur

36. 6 - C A L C I U M C H A N N E L B L O C K E R S
Block movement of calcium into cells, causing
vasodilation. Reduce cardiac work by negative
inotropic (heart rate), negative chronotropic
(contractility) and systemic vasodilation.
• Agents: Amlodipine, Verapamil
• Side effects:
• Bradycardia, heart block
7- Direct Vasodilators: they relax SMCs >> Dilate
resistance vessels
• Agents: Nitroglycerin-40-50 mg /d

37. R E S E N T R E S E A R C H
• Despite the availability of multiple antihypertensive drugs such as β-receptor
blockers, angiotensin II receptor blockers, and angiotensin-converting enzyme
inhibitors, approximately 1 in 5 adults (21%) are diagnosed with uncontrolled
hypertension and these drugs are associated with side effects such as intolerance
and poor efficacy
• Developing new antihypertensive agents to provide more choices for those
people is important.

39. N U R S I N G M A N A G E M E N T
• Proper history collection should be done which includes family
history also.
• Dietary habits should be assessed
• Identify the medical history such as diabetes, CAD, renal disease
etc…
• Instruct the patient to avoid smoking and alcoholism
• Auscultate heart rate and palpate peripheral pulses.
• Identify the use of medications such as contraceptives, steroids,
NSAID etc…
• Monitor vital signs frequently
• Provide diet which is low in sodium and rich with fruits and
vegetables.
• Monitor the blood cholesterol level frequently

40. N E X T L E C T U R E
Diabetes

41. P R A C T I C A L
S E S S I O N
How to measure
blood pressure