Garoma Tegegne presented on hypertensive heart disease. The presentation covered the anatomy and physiology of the heart, definitions of HHD, epidemiology, etiology, pathogenesis, pathophysiology, clinical manifestations, diagnosis, management, complications, and prevention of HHD. Uncontrolled high blood pressure can lead to left ventricular hypertrophy, coronary artery disease, heart failure, and stroke over time. Treatment involves lifestyle modifications and medications like beta-blockers, calcium channel blockers, and diuretics to control blood pressure and prevent complications.

1. INSTITUTE OF HEALTH SCIENCE
SCHOOL OF NURSING AND MIDWIFERY
PROGRAM:PCHN
PROGRAM: ADVANCED PEDIATRICS NURSING 1
SEMINAR PRESENTATION ON HYPERTENSIVE
HAERT DISEASE
By Garoma Tegegne……Id no 1500329
Feb, 2023
Nekemte,
Ethiopia
3/26/2024 1

2. Presentation out line
 Anatomy and
physiology of heart
 Definitions of HHD
 Epidemiology of HHD
 Etiology of HHD
 Pathogenesis of HHD
 Pathophysiology of
HHD
 C/M of HHD
 DDX of HHD
 Diagnostic of HHD
 Management of HHD
 Complications of HHD
 Prevention of HHD
 Conclusion
 Reference
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3. Objectives
 At the ends of this Presentation, the students will able to:
 Discuss Anatomy and physiology of heart
 Define HHD
 Describe Epidemiology of HHD
 Identify Etiology of HHD
 Discuss Pathogenesis of HHD
 Explain Pathophysiology of HHD
 Identify C/M of HHD
 Explain DDX of HHD
 Discuss Diagnostic of HHD
 Discuss Management of HHD
 Identify Complications of HHD
 Describe Prevention of HHD
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4. Anatomy and physiology
The heart muscle pumps blood through the body:
 Right side pumps oxygen-poor blood to the lungs
 Left side pumps the oxygen-rich blood to the rest of
the body
 Blood enters right side of heart and flows through the
right atrium and right ventricle to the lung
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5. Anatomy and physiology …
 Oxygen-rich blood in the lung returns to the heart and
enters the left sventricle, where it is pumped
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6. Hypertension
Is defined as average SBP and/or DBP that is greater
than or equal to the 95th percentile, and height on
three or more occasions
Pre-hypertension is average SBP or DBP levels that
are greater than or equal to the 90th percentile, but
less than the 95th percentile.
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7. Hypertensive Heart Disease (HHD)
HHD refers to a constellation of changes in the left
ventricle, left atrium, and coronary arteries as a result of
chronic blood pressure elevation
HTN increases the workload on the heart inducing
structural and functional changes in the myocardium
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8. HHD…
Overweight and obesity in youth is increasing the
prevalence of prehypertension and hypertension among
children and adolescents.
Uncontrolled BP can lead to a variety of changes in the
myocardial structure, coronary vasculature, and
conduction system of the heart.
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9. HHD …
Uncontrolled BP leads to the development of:
Left ventricular hypertrophy
Coronary artery disease
Systolic and diastolic dysfunction of the myocardium
Cardiac arrhythmias (especially atrial fibrillation) and
Congestive heart failure
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10. HHD …
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11. Epidemiology of HHD
 Hypertensive heart disease (HHD) is a condition where
high blood pressure causes damage to the heart.
 The prevalence of HHD in children and young people is
increasing worldwide, owing to the rise in obesity and
Type 2 Diabetes
 According to a recent study, the prevalence of
hypertension in children is increasing globally, with
more than 1 billion people being hypertensive
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12. Cont…
 In Africa, the estimated number of people with
hypertension has increased steadily from 54.6 million
in 1990 to 130.2 million in 2010
 A cross-sectional study from Brazil involving 794
children aged 6-13 years reported a prevalence of 7%
of pediatric hypertension
 In China, the overall prevalence of elevated blood
pressure (≥95th percentile) among school-age children
(6-13 years) was 18.4%
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13. Cont..
A systematic review and meta-analysis of
institutional and community-based studies in
Ethiopia reported:-
• In Ethiopia, the prevalence of cardiovascular
disease (CVD), which includes HHD, was
found to be 5%
• a prevalence of 23% in systolic and/or
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14. Risk factor
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15. Etiology /Cause
 Heart failure
 Thickening of the heart muscle
 Coronary artery disease and
 Other heart conditions
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16. Pathogenesis HHD
 Myocyte hypertrophic enlargement
 Thickened myocardium
Left ventricular compliance reduced
Diastolic filling impaired
Oxygen demand increase.
Myocyte hypertrophy increase the distance for oxygen
and nutrient diffusion from adjacent capillaries
 Coronary atherosclerosis accompanying hypertension add
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17. Cardiovascular effects of hypertension
Thus, hypertensive heart disease is a term applied generally to heart
diseases, such as
I. Left ventricular hypertrophy (LVH )
II. Coronary artery disease
III. Cardiac arrhythmias, and
IV. CHF that are caused by the direct or indirect effects of elevated
BP.
These diseases generally develop in response to chronically
elevated BP
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18. Based systemic hypertension
 Systolic and or diastolic pressure levels greater than 95th
percentile for age & gender on at least three occasions.
 Normal blood pressure at birth 70/50 (increase 10 systolic & 5
diastolic every 3 years).
 Degrees of hypertension: (according to increase above normal
range for age)
 Mild hypertension: systole increase by 10 mmHg or diastole
increase by 5 mmHg
 Moderate hypertension: systole increase by 20 mmHg or
diastole increase by 10 mmHg
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19. Pathophysiology of HHD
 HHD focused on left ventricular hypertrophy (LVH)
 Target-organ damage beyond LVH
 HHD is characterized by micro- and macroscopic myocardial
alterations:
Structural phenotypic adaptations
Functional changes include cardiac fibrosis
Remodeling of the atria and ventricles
Heart valve hypertrophy and failure to pump
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20. Pathophysiology …
Left ventricular hypertrophy
 structural and functional changes of LA are very common
with HTN.
Left atrial abnormalities
 Diastolic dysfunction, may precipitate overt heart failure
Valvular disease
 HTN is accelerate the process of aortic sclerosis and cause
mitral regurgitation
Heart failure
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21. Pathophysiology …
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22. Type of HHD
 HHD is a condition where high blood pressure causes
damage to the heart.
 There are two types of HHD in children:
1) Primary Hypertension:
 This type of hypertension occurs in children with no
underlying medical condition
 It is also known as essential hypertension and is the
most common type of hypertension in children
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23. Type of HHD cont…
2) Secondary Hypertension:
 This type of hypertension occurs as a result of an
underlying medical condition such as kidney disease,
heart disease, or endocrine disorders
 It is less common than primary hypertension in
children
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24. Classification of HTN in children &
adolescents
I SBP or DBP %ile
NORMAL < 90th
PREHYPERTENSION 90th to 95th
>120/80mmHg
STAGE 1 95th to 99th
>5mmHg
STAGE 2 >99th + 5mmHg
Urgency /Emergency stage 2 with clinical Sn/Sx
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25. HHD with marked concentric
thickening of the left
ventricular wall causing
reduction in lumen size
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26. Clinical manifestations
 Cough, Fast heart beat & fast breathing
 Working hard to breathe when feeding
 Restlessness or irritable
 Sweating, SOB and fatigue
 Edema, or swelling in the ankles or abdomen
 Decreased amount of urine..a baby may have fewerwet diapers
(<6-8 a day)
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27. Differential diagnosis
Newborn
 Thrombosis stenosis
 Coarctation of the aorta
 Pheochromocytoma
 Cushing disease
Children < 6 years
 Renal parenchymal
disease
 Other vascular disease
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28. Diagnosis
 Echocardiography
 Ultrasonography
 Angiography
 24-Hour Blood Pressure Monitoring
 MRI
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29. Pharmacological management
β-blockers,
Calcium-channel blockers, and
Diuretics.
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30. Cont…
β-blockers
• Examples of β-blockers include atenolol, metoprolol,
and propranolol
Calcium-channel blockers
• Examples of Calcium-channel blockers include
amlodipine, diltiazem, and verapamil
Diuretics
• Examples of Diuretics include furosemide,
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31. β-blockers
 Pediatric dose: The dose of β-blockers depends on the
child’s age, weight, and medical condition.
 The recommended starting dose of propranolol for
infants is 0.5-1 mg/kg/day in divided doses
 Side effects: Common side effects of β-blockers
include fatigue, dizziness, and cold hands and feet.
 Less common side effects include depression,
nightmares, and hallucinations
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32. Calcium-channel blockers
 Pediatric dose: The dose of Calcium-channel blockers
depends on the child’s age, weight, and medical
condition.
 The recommended starting dose of amlodipine for
children aged 6-17 years is 2.5-5 mg/day
 Side effects: Common side effects of Calcium-
channel blockers include headache, dizziness, and
flushing.
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33. Diuretics
 Pediatric dose: The dose of Diuretics depends on the
child’s age, weight, and medical condition.
 The recommended starting dose of furosemide for
children is 1-2 mg/kg/day in divided doses .
 Side effects: Common side effects of Diuretics
include dehydration, electrolyte imbalances, and low
blood pressure.
 Less common side effects include hearing loss, skin
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34. Non-pharmacological management
Dietary modifications
Reduction weight and obesity
Reduction of sodium intake
Physical activity
Increasing intake of fresh vegetables, fruits, and whole
grain products
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35. Complications of HHD
Without appropriate mgt: HHD leads to:
Heart failure may develop
Thickening of the blood vessel walls
When combined with cholesterol deposits in the
blood vessels
Heart attack and
Stroke
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36. 5C complications of HHD
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37. Prevention
 Weight loss in children with obesity or overweight
 Reduction of salt intake and caloric foods and
 Children ages 6 to 17 should get at least 60 minutes
of moderate to vigorous physical activity daily
 Early treatment of HTN
 Don’t expose kids to cigarette smoke
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38. Conclusion
• The review also highlights that hypertension in children is on
the rise in both developed and developing countries
• The diagnosis of hypertension in children is based on the
average blood pressure readings taken over three or more
visits.
• A child or adolescent is diagnosed with hypertension when
their average blood pressure is at or above the 95th percentile
for their age, sex, and height
• It is important to monitor and manage hypertension in children
to prevent long-term complications.
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39. References
• Dr. Usman Shams HHD
• Cynthia S. Bell, et. Al. prevalence of HTN in
children
• Chike C. Nwabuo & Ramachandran S. Vasan
Pathophysiology of Hypertensive Heart Disease
• Wolf-Maier K, Cooper RS, Banegas JR, Giampaoli
S, Hense HW, Joffres M, et al. Hypertension
prevalence and blood pressure levels in 6
European countries, Canada, and the United States
• Sepiso K. Masenga et al. Hypertensive heart
disease: risk factors, complications and
mechanisms
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