This document discusses hypertension (high blood pressure) including its causes, risk factors, diagnosis, treatment, and lifestyle modifications. It defines normal and abnormal blood pressure readings and stages of hypertension. The major factors that help regulate blood pressure are the sympathetic nervous system and kidneys. Untreated hypertension can damage organs and increase heart attack and stroke risk. Treatment involves lifestyle changes like reducing sodium and alcohol intake, exercising, and weight control as well as medications. The DASH diet is effective for lowering blood pressure. Exercise prescriptions should start gradually and avoid excessive blood pressure rises.

1. Hypertension

2. Hypertension
 Blood pressure levels are a function of cardiac
output multiplied by peripheral resistance (the
resistance in the blood vessels to the flow of
blood)

4. Hypertension
 The major factors which help maintain blood
pressure (BP) include the sympathetic
nervous system and the kidneys.
 Optimal healthy blood pressure is a systolic
blood pressure of <120 mmHg and a
diastolic blood pressure of <80
 <120/80.

5. Hypertension
Category Systolic Blood
Pressure
Diastolic Blood
Pressure
Normal < 120 <80
Pre-hypertension 120-139 80-89
Hypertension –
Stage 1
140-159 90-99
Hypertension –
Stage 2
>160 >100

6. essential hypertension – 90 to 95 % of high blood
pressure
prevalence:
• children...about 4 %, mostly secondary
• middle age ... 11-21 %
• 50-59 years old ... approximately 44 %
• 60-69 years old ... approximately 54 %
• more than 70 years old ... ≥ 64 %

7. Untreated hypertension can result in:
Arteriosclerosis --Kidney damage
Heart Attack --Stroke
Enlarged heart --Blindness

8. Systemic hypertension
• long-lasting, usually permanent increase of systolic and diastolic blood
pressure
primary (essential) hypertension – unknown cause; usually
coincidence of more factors – neural,
hormonal, kidney dysfunction, ...
secondary (symptomatic) hypertension – symptom (sign) of
other disease

9. Factors Influencing the Development of
Hypertension
 High-normal blood pressure
 Family history of hypertension
 African-American ancestry
 Overweight

10. Factors Influencing the Development of
Hypertension
 Excess Consumption of Sodium Chloride
 Certain segments of the population are
‘salt sensitive’ because their blood
pressure is affected by salt
consumption

11. Factors Influencing the Development of
Hypertension
Alcohol consumption

12. Factors Influencing the Development
of Hypertension
 Exercise
 Less active individuals are 30-50% more likely to
develop hypertension.

13. Factors Influencing the Development
of Hypertension
 Other Dietary Factors
 Potassium:
 Calcium:
 Magnesium:

14. Treatment
 The final goal of antihypertensive therapy is
reduction of mortality and morbidity to CVS
and renal diseases.
 Primary goal is reduction of systolic BP.

16. Pharmacologic treatment
Antihypertensives
1st choice drugs:
1. diuretics
2. β-blockers
3. inhibitors of ACE
4. blockers of AT1 receptors (ARB)
5. calcium channel blockers
2nd choice drugs – mainly to drug combinations:
α1-sympatholytics; α2-sympathomimetics; direct
vasodilators;
agonists of I1 receptors in CNS

17.  Other antihypertensives
magnesium (MgSO4) – natural antagonist of calcium
• sodium nitroprusside – simple molecule releasing NO;
only i.v. at severe hypertension crisis
• ketanserin – blocks S2 receptors for serotonin →
prevents effect increase of catecholamines on symp.
receptors

18. Nonpharmacological treatment
Change of life-style:
• intake of salt ... ≤ 5 – 6 g per day
• prevention of obesity – dietetic modification
• alcohol ... ≤ 30 g per day
• smoking – stop
• physical activity
• psychological relaxation

19. The DASH Diet
 The Dietary Approaches to Stop
Hypertension clinical trial (DASH)
 Diet rich in fruits, vegetables, and low fat dairy
foods, can substantially lower blood pressure in
individuals with hypertension and high normal
blood pressure.

20. The DASH Diet
 The DASH Diet includes:
 7-8 servings of grains and grain products
 4-5 servings of vegetables
 4-5 servings of fruits
 2-3 servings of low fat dairy products
 2 or less servings of meat, poultry and fish
 2-3 servings of fats and oils
 Nuts, seeds and dry beans 4-5 times /week
 Limited ‘sweets’ low in fat.

21. Exercise Prescriptions for Patients With
Borderline-to-Moderate Hypertension
Patient
evaluation
Look for lipid disorders, DM,
retinopathy, neuropathy, PVD,
renal insufficiency, LV
dysfunction, silent MI/ischemia
osteoarthritis, osteoporosis
Exercise testing GXT with modified Naughton
protocol, asymptomatic
ischemic CAD
Exercise type Aerobic, low-impact activities:
walking, biking, swimming,
stepper, treadmill walking

22. Modified Naughton
Treadmill Protocol

23. Exercise Prescriptions for Patients With
Borderline-to-Moderate Hypertension
Frequency 5 days/week as a minimum
Intensity Start at 50-60% maximum HRR &
slowly increase to 70%; within 6
weeks work at 85% HRR or from
50-90% of maximal heart rate
Duration Start with 20-30 min/day of
continuous activity for first 3 wk,
then 30-45 min/day for next 4-6
wk, and 60 min/day as
maintenance

24. Exercise Prescriptions for Patients With Borderline-
to-Moderate Hypertension
 Excessive rises in blood pressure should be
avoided during exercise (SBP > 230 mm
Hg; DBP > 110 mm Hg). Restrictions on
participation in vigorous exercise should be
placed on patients with left ventricular
hypertrophy.

25. Weight Training
 Resistive exercise produces the most striking increases
in BP
 Resistive exercise results in less of a HR increase
compared with aerobic exercise and as a result the “rate
pressure product” may be less than aerobic exercise
 Assessment of BP response by handgrip should be
considered in patients with HTN
 Growing evidence that resistive training may be of
value for controlling BP