Mindmap

Hypertension

Fatma Shwaylia Englisch

Inhalt der Mindmap

Hypertension

physiology of Blood pressure
- How to regulate the mean arterial hypertension
  - Short term regulation (neurological)
    - Baroreceptor reflex
  - Long Term Regulation( hormonal)
    - Renin-angiotensin II- aldosterone system
  - A defect in this mechanism
    - due to
      - decreased sensitivity of the baroreceptors to increases in arterial pressure
      - an increase in the blood pressure set point of the brain stem centers
    - Results in
Types
- Essential or primary
  - no known cause
    - It mainly idiopathic, but genetic , environmental and salt intake may play role
      - old age is most affected
        good prognosis
- Secondary
  - specific cause
    - renal, endocrine , cardiovascular and neurological disorders.
      - all age groups are affected
        bad prognosis
        A table that summarizes all causes
      - Treating the cause can treat the patient
Values of blood pressure and what do they stand for
Risk Factors
- Aging
- physical inactivity
- Gender
- Race
- Obesity
- Too much salt (sodium) in diet
- Too little potassium in diet
- Drinking too much alcohol.
- stress
- smoking
- family history
Asymptomatic for years
- a symptom appears, it’s usually due to organ failure
  - Except malignant hypertension
    - severe headache
    - nausea
    - vomiting
    - confusion
    - nosebleeds
    - changes in vision
Complications
- 1- Heaving apical impulse
  - Apex beat is forceful and well sustained due to systolic overload of ventricle.
    - This is due to pressure overload of Left ventricle ,force and duration of left ventricular contraction is increased
- 2- Loud A2
  - Coronary artery disease.
    - due to a high blood pressure damage that affects the arteries that supply blood to the heart muscle.
      - Arteries narrowed by coronary artery disease don't allow blood to flow freely through your arteries
        loud A2 occurs in systemic hypertension where there is a dilated proximal aorta
- 3- Audible fourth heart sound
  - Produced during atrial systole due to vibrations that set in the atrial musculature during atrial systole
- 4-Hypertensive retinopathy
  - When the blood pressure is too high, the retina’s blood vessel walls may thicken.
    - This may cause your blood vessels to become narrow, which then restricts blood from reaching the retina. In some cases, the retina becomes swollen.
      - limit the retina’s function, and put pressure on the optic nerve, causing vision problems.
    - Examined through an Ophthalmoscope
      - cotton wool spots
Investigations
- Full fasting lipid profile
  - screening tool for abnormalities in lipids
    - identify certain genetic diseases, cardiovascular diseases , pancreatitis, and other diseases.
    - Components
      - Total cholesterol
        measures all of the cholesterol in all the lipoprotein particles.
      - High-density lipoprotein cholesterol (HDL-C)
        measures the cholesterol in HDL particles
      - Low-density lipoprotein cholesterol (LDL-C)
        calculates the cholesterol in LDL particles
      - Triglycerides
        measures all the triglycerides in all the lipoprotein particles
  - it requires a 12-hour fast
  - If it is done after not fasting, the results will be accurate for total cholesterol and HDL, but not LDL or triglyceride levels.
- Waist-hip ratio
  - simple and useful measure of fat distribution.
    - ratio of the circumference of the waist to that of the hips
      - Associated with Nighttime Blood Pressure Dipping
- Urinalysis
  - set of screening tests that can detect some common diseases.
    - screen for and/or help diagnose conditions such as a urinary tract infections, kidney disorders, liver problems, diabetes or other metabolic conditions, to name a few.
- Fundus examination
  - The fundus can be examined by ophthalmoscopy and/or fundus photography
    - Medical signs that can be detected
      - hemorrhages, exudates, cotton wool spots, blood vessel abnormalities (tortuosity, pulsation and new vessels) and pigmentation.
Treatment
- Pharmacological
  - Anti-hypertensives
    - Antiadrenergics (β–blockers)
      - Mechanism of action
      - Adverse side effects
        Bradycardia, hypotension, fatigue, insomina, and sexual dysfunction
    - Calcium channel blockers
      - effective in treating hypertension in patients with angina or diabetes.
        High doses can increase myocardial infarction risk
        due to excessive vasodilation and marked reflex cardiac stimulation
        Adverse side effects
        flushing
        constipation
        dizziness
        Headache
        fatigue
        Hypotension
    - Angiotensin converting enzyme inhibitors (ACEI)
      - Inhibitors block the angiotensin-converting enzyme, thus preventing the formation of angiotensin II.
        decreased systemic vascular resistance (afterload), vasodilation, and therefore, decreased blood pressure
      - prevent the breakdown of the vasodilating substance, bradykinin.
    - Angiotensin II Receptor Blockers
      - Allow angiotensin I to be converted to angiotensin II, but block the receptors that receive angiotensin II
      - Block vasoconstriction and release of aldosterone
    - Diuretics
      - Decrease the plasma and extracellular fluid volumes
        decreased workload of the heart, and decreased blood pressure
    - Direct vasodilators
    - Renin Inhibitors
- Life style modifications
  - Increased physical activity
  - a reduced salt intake
  - weight loss
  - moderation of alcohol intake
  - increased potassium intake
  - DASH diet
    - emphasizes fruits, vegetables, and low-fat dairy products and is reduced in fat and cholesterol
    - reduced saturated fat, total fat, and cholesterol