Hypertension

Hypertension

1. Ghassan, 48 year old man

2. 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

3. 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

4. Disease Management

5. 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

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