Mind map

Hypertension

shahid alzaghari English

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Hypertension

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