High Blood Pressure

High Blood Pressure

1. Is a condition in which the blood vessels have persistently raised pressure..

   • Classification
     • Normal:
       • SBP: 120 mmHg DBP: 80 mmHg
     • Prehypertension
       • SBP: 120-139 mmHg DBP: 80-89 mmHg
     • Hypertension grade 1
       • SBP: 140-159 mmHg DBP: 90-99 mmHg
     • Hypertension grade 2:
       • SBP: ≥160 mmHg DBP:100 mm Hg
     • Isolated systolic hypertension
       • SBP: >140 mmHg DBP: <90 mmHg
   • Etiology
     • 95%
       • Essential or Idiopathic
         • Not identified a casual factor
     • 5%
       • Secondary Hypertension
         • -Renal origin -Endocrine origin -Psychogenic origin -Medicines Substances of abuse
           • Obesity and Metabolic Syndrome
             • The set of elements such as:
               • -Insulin resistance -Abdominal obesity -Hypertension -Dyslipidemia
             • Renal Parenchymal Diseases
               • Renovascular Hypertension
                 • Cushing’s Syndrome
                   • Arises from:
                     • The excessive production of cortisol
                       • Signs and Symptoms :
                         • -Red cheeks ·-Abdominal stretch marks -Pendulous Abdomen ·-Fat pads ·-Bruise easily -Thin arms and legs ·-Hypertension
                 • The pathogenesis:
                   • Involves the narrowing of the arteries supplying the kidneys
                     • Which causes a low perfusion pressure that is detected by the juxtaglomerular apparatus
               • Hypertension is present in >80% of patients with chronic renal failure
   • Mechanisms of Hypertension
     • Intravascular volume
       • Sodium is a primary determining ion of extracellular volume
         • High intake of sodium
           • ↑ intravascular volume and PVR
             • = HBP
         • RAAS
           • Synthesized renin in cells juxtaglomerular
             • Cleaves the Angiotensinogen: synthesized in the liver
               • converts angiotensin I
                 • In the lungs are Find it angiotensin converting enzyme
                   • Transform into angiotensin II
                     • Produces arteriolar vasoconstriction
                     • Stimulates the Synthesis of Aldosterone
                       • Retention of liquids and sodium
             • ↑ Sympathetic tone
               • =
                 • Vasoconstriction
                   • = Endothelial dysfunction
                     • imbalance of
                       • Vasoconstriction
                         • ↑ Endothelia, Thromboxane
                       • Vasodilation
                         • ↓ Nitric Oxide and prostacyclins
   • Pathologic Consequences
     • Heart:
       • Hypertensive heart disease
         • Left ventricular hypertrophy (LVH), Congestive Heart Failure (CHF)
           • - CHD (Coronary Heart Disease) - Stroke - Sudden death.
       • Brain:
         • Stroke
           • pressure in individuals >65 years
           • Signs and symptoms
             • -Severe headache Nausea - Vomiting - Focal neurologic signs - Alterations in mental status.
         • Kidney
           • Diminished capacity to excrete sodium
           • Excessive renin secretion in relation to volume status
           • Sympathetic nervous system overactivity
             • = Further renal damage
           • Peripheral Arteries
             • target organ
               • for atherosclerotic disease
             • The mainly disease presented here is
               • "Peripheral artery disease" (PAD)
                 • is characterized by
                   • Aching pain in the calves
                   • Buttocks while walking that is relieved by rest
   • Treatment:
     • Lifestyle Interventions
       • Recommended for individual
         • Weight (BMI < 25Kg/m2)
           • Reduced NaCl intake (<6g NaCl/d)
             • Increased potassium intake
               • Moderation of alcohol consumption
                 • DASH-type dietary plan.
                   • Physical activity that facilitates
                     • Weight loss
                     • Decreases blood pressure
                     • Reduces the overall risk of cardiovascular disease
     • Pharmacologic Therapy:
       • Diuretics:
         • Blockers of the Renin-Angiotensin System:
           • Beta Blockers
             • Aldosterone Antagonists
               • α-Adrenergic Blockers:
                 • Sympatholytic Agents:
                   • Calcium Channel Blockers:
                     • Direct Vasodilators:
                       • Decrease peripheral resistance and concomitantly activate mechanisms that defend arterial pressure
                     • Calcium antagonists
                       • Reduce vascular resistance through L-channel blockade
                         • Which reduces intracellular calcium and blunts vasoconstriction
                   • Centrally acting α2 sympathetic agonists
                     • Decrease peripheral resistance by inhibiting sympathetic outflow
                 • Decreasing peripheral vascular resistance
               • Spironolactone is a nonselective aldosterone antagonis
                 • Used alone or in combination with a thiazide diuretic.
             • β-Adrenergic receptor blockers lower blood
               • Pressure by decreasing cardiac output
                 • By decreasing cardiac output, due to a reduction of heart rate and contractility
           • ACEIs
             • Decrease the production of angiotensin II.
               • Increase bradykinin level
                 • Reduce sympathetic nervous system activity
           • ARBs
             • Provide selective blockade of AT 1 receptor
               • The effect of angiotensin II on unblocked AT 2 receptors may augment their hypotensive effect
         • Thiazide diuretics
           • are used as first-line agents
           • Inhibit the Na + /Cl − pump in the distal convoluted tubule and hence increase sodium excretion.