Hypertension Measurement Of Blood pressure Pathophysiology Treatment of hypertension Diagnosis

1.  High Blood Pressure (HBP)
 Hypertension
also known as
 long-term medical condition
 blood pressure in the arteries is
persistently elevated.

2.  Major risk factor for coronary artery disease, stroke, heart failure, atrial
fibrillation, peripheral vascular disease, vision loss, chronic kidney
disease, and dementia.
 Hypertension
 Primary (essential) high blood pressure 90–95%
Excess salt in the diet, excess body weight, smoking, and
alcohol use.
 Secondary high blood pressure. 5–10%
Due to an identifiable cause, such as chronic kidney disease,
narrowing of the kidney arteries, an endocrine disorder, or the use of birth
control pills.

3. Specialty Cardiology
Symptoms None
Complications Coronary artery
disease, stroke, heart
failure, peripheral vascular
disease, vision loss, chronic kidney
disease, dementia
Causes Usually lifestyle and genetic factors
Risk factors Excess salt, excess body
weight, smoking, alcohol
Diagnostic method Resting blood pressure
130/90 or 140/90 mmHg
Treatment Lifestyle changes, medications
Frequency 16–37% globally
Deaths 9.4 million / 18% (2010)
 Hypertension

4.  Systolic pressure
 Diastolic pressure
 Measurement Of Blood pressure
• Normal Blood Pressure at rest is within the
range of 100–130 millimeters
mercury(mmHg) systolic and 60–80 mmHg
diastolic.

5.  Epidemiology
 Adults
 As of 2014, approximately one billion adults or ~22% of the population of the
world have hypertension. It is slightly more frequent in men, in those of
low socioeconomic status, and it becomes more common with age. It is
common in high, medium, and low income countries.
 Children
Rates of high blood pressure in children and adolescents have increased in
the last 20 years in the United States. Childhood hypertension, particularly in
pre-adolescents, is more often secondary to an underlying disorder than in
adults. Kidney disease is the most common secondary cause of hypertension
in children and adolescents.

6.  Signs and symptoms
 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.
Secondary hypertension
 Cushing's syndrome
 Glucose intolerance
 Abdominal stretch marks
 Hyperthyroidism
 Fast heart rate,
 bulging eyes
 tremor.
 Renal artery stenosis
 Pheochromocytoma

7. • Hypertensive crisis
Severely elevated blood pressure (equal to or greater than a systolic 180 or
diastolic of 110) is referred to as a hypertensive crisis.
Categorized as either hypertensive urgency or hypertensive emergency,
according to the absence or presence of end organ damage, respectively.
 Hypertensive Emergency
The most affected organs include the brain, kidney, heart and lungs,
producing symptoms which may include confusion, drowsiness, chest
pain and breathlessness.
 Hypertensive Urgency
Absence of end organ damage. Oral medications are used to
lower the BP gradually over 24 to 48 hours.

8.  Causes
 Primary hypertension
 Insulin resistance
 lack of exercise, obesity, and depression.
 Aging
 Vitamin D deficiency
 Maternal smoking
 high blood urea
 low birth weight

9.  Secondary hypertension
Secondary hypertension results from an identifiable cause. Kidney
disease is the most common secondary cause of
hypertension. Hypertension can also be caused by endocrine
conditions, such as Cushing's
syndrome, hyperthyroidism, hypothyroidism, acromegaly, Conn's
syndrome or hyperaldosteronism, renal artery
stenosis (from atherosclerosis or fibromuscular
dysplasia), hyperparathyroidism, and pheochromocytoma.
Other causes of secondary hypertension include obesity, sleep
apnea, pregnancy, coarctation of the aorta, excessive eating of liquorice,
excessive drinking of alcohol, and certain prescription medicines, herbal
remedies, and illegal drugs such as cocaine and methamphetamine.
Arsenic exposure through drinking water has been shown to correlate with
elevated blood pressure.

10.  Pathophysiology
 Determinants of mean arterial pressure

11.  Pathophysiology

12.  Sympathetic nervous system.
 Pathophysiology
 Renin–angiotensin system
 Immune system chemical signals such
as tumor necrosis factor
alpha, interleukin 1, interleukin 6,
and interleukin 8.
 Endothelial dysfunction and
vascular inflammation

13. Classification in adults (Persons with systolic and diastolic
in different categories are assigned to the higher category.
Category
Systolic, m
mHg
Diastolic, mmHg
Hypotension < 90 < 60
Normal
90–119
90–129
60–79]
60–84
Prehypertension
(high normal, elevated}
120–129
130–139
60–79
85–89]
Stage 1 hypertension
130-139
140–159]
80-89
90–99
Stage 2 hypertension
>140
160–179[
>90[
100–109]
Hypertensive crises ≥ 180 ≥ 120
Isolated systolic hypertension ≥ 160] < 90 to 110

14.  Treatment of hypertension
 Treatment consists of self care and
diuretics
Eating a healthier diet with less salt, exercising regularly and taking
medication can help lower blood pressure.
 Self-care
Physical exercise, Stress management, Quitting smoking, Home
blood pressure monitors, and Low sodium diet
 Medications
ACE inhibitor, Diuretic, Beta blocker, Antihypertensive drug, Calcium
channel blocker, and Vasodilator
 Specialists
Primary Care Provider (PCP), Cardiologist, and Nephrologist

15.  Diagnosis
Typical tests
System Tests
Kidney
Microscopic urinalysis, protein in
the urine, BUN and/or creatinine
Endocrine
Serum sodium, potassium, calcium,
TSH
Metabolic
Fasting blood glucose, HDL, LDL,
and total cholesterol, triglycerides
Other
Hematocrit, electrocardiogram,
and chest radiograph

17.  Rationale for Reducing
Arterial Pressure
 Reduce Cardiac Output
 Reduce blood volume
 Reduce heart rate
 Reduce stroke volume
 Reduce Systemic
Vascular Resistance
 Dilate systemic vasculature