Hypertension

Ghassan, 48 year old man
Hypertension?
1. Defined as blood systolic pressure equal to or >140 and blood diastolic pressure equal to or >90
  1. Blood pressure determinants:
    1. Cardiac output
      1. Heart rate
        Sympathetic and parasympathetic nervous system
      2. Stroke volume
        End diastolic volume
        Venous return
        End systolic volume (ejection fraction)
        Force of contraction
    2. Atrial Resistance
      1. Viscosity of blood
        Concentration of electrolytes and proteins
        Hematocrit
      2. Radius of vessels
        1/r4
  2. Baroreceptor reflex:
  3. Chemoreceptor reflex
  4. Volume or low- pressure receptors:
2. Epidemiology of HT in UAE
3. RISK FACTORS
  1. Non- modifiable
    1. Unhealthy eating
      1. High Na intake
      2. NSAIDs
      3. Loe K intake
    2. Alcohol Intake
    3. Inactive Lifestyle
      1. Obesity
        How to know if the person is Obese?
    4. Tobacco use
    5. Stress
    6. Kidney Disease
    7. Diabetes
    8. Obstructive sleep apnea
    9. Cough and cold medications that contain Pseudoephedrine and Phenylephrine
  2. Modifiable
    1. Age
    2. Gender
    3. Ethnicity
    4. Family History
4. Signs and Symptoms
  1. Most of the time there are none!!
  2. Headahe
  3. Dizziness
  4. Blurred vision
  5. Nausea and vomiting
  6. Chest pain and shortness of breath
  7. Claudication
    1. Is pain caused by too little blood flow to your legs or arms, usually during exercise.
    2. Symptoms:
      1. Pain when exercising
      2. Intermittent pain
      3. Pain when at rest
      4. Discolored skin or ulcerations
      5. An aching or burning feeling
      6. Weakness
    3. Risk Factors
      1. Smoking
      2. High cholesterol
      3. High blood pressure
      4. Obesity
5. Classifications
  1. Primary
    1. Environmental factors
    2. Genetic factors
  2. Secondary
    1. Caused by other disease:
      1. Diabetes
      2. Polycystic kidney disease
      3. Glomerular disease
      4. Renovascular HT
      5. Cushing syndrome
      6. Aldosteronism
      7. Thyroid problems
      8. Coarctation
      9. Sleep apnea
6. Complications
  1. 1- Blood Vessels
    1. -Loss of elasticity
    2. -Aneurisms
    3. -Breaking and leaking
    4. -Arteriosclerosis and Atherosclerosis
  2. 2- The Heart
    1. Increase in vessels resistance
      1. Increase in Pressure
        More force applied to overcome it
    2. Left Ventricular Hypertrophy
      1. Left sided Heart Failure
  3. 3- Kidney
    1. Nephrosclerosis
      1. Leading to Ischemia
    2. Periglomerular Fibrosis
      1. Then Kidney Failure
  4. 4- Brain:
    1. Transient Ischemic Attack
    2. Stroke
    3. Dementia
    4. Mild Cognitive Impairment
  5. 5- Eyes:
    1. Loss of vision
    2. Retinopathy
    3. Blurred vision
    4. Bleeding
Lipid profile
1. It is a test that is measured the for cardiovascular risk prediction and has now become almost a routine test
2. It measure:
  1. Total Cholesterol
  2. HDL
  3. LDL
  4. Triglycerides
Disease Management
Pharmacological Therapy::
1. Anti-Hypertensive
  1. 1- Angiotensin converting enzyme inhibitors (ACE)
  2. 2- Angiotensin II Receptor Blockers
  3. 3- Anti-adrenergics
    1. α1
      1. Present in peripheral vessels (especially arterioles)
      2. Stimulation leads to vasoconstriction
    2. α2
      1. Present in brain
      2. Stimulation leads to decreased sympathetic outflow
    3. β1
      1. Present in heart
      2. Stimulation Leads to increased automaticity, conductivity, contractility
    4. β2
      1. Present in bronchial tree and in blood vessels
      2. Stimulation will lead to bronchodilation and vasodilation
  4. 4- Calcium channel blocker
  5. 5- Diuretics
  6. 6- Direct Vasodilator
2. Anti-Hyperlipidemic
3. How to increase patient's compliance?
  1. 1- Simplifying regimen characteristics
    1. 2- Imparting knowledge
      1. 3- Modifying patient beliefs
        4- Patient communication
        5- Leaving the bias
        6- Evaluating adherence

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Hypertension

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	Created by shahid alzaghari over 7 years ago