Hypertension Basics 2014

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Information about Hypertension Basics 2014
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Published on April 22, 2014

Author: qbank

Source: slideshare.net

Description

Basics of hypertension for rehab students. New 2014 JNC 8 guidelines. Primary vs. secondary hypertension. Diagnosis and treatment of hypertension.

Hypertension Hanna K. Al-Makhamreh, MD FACC Interventional Cardiology

Factors Influencing Blood Pressure Blood Pressure = Cardiac Output x Systemic Vascular Resistance

Factors Influencing BP • Hear rate • Sympathatic/Parasympathatic • Vasoconstriction/vasodilation • Fluid volume – Renin-angiotensin – Aldosterone – ADH

Hypertension Definition • Hypertension is sustained elevation of BPHypertension is sustained elevation of BP – Systolic blood pressure ≥ 140 mm Hg – Diastolic blood pressure ≥ 90 mm Hg

Blood Pressure Classification BPBP ClassificationClassification SBP mmHgSBP mmHg DBP mmHgDBP mmHg NormalNormal < 120 and< 120 and < 80< 80 Pre-hypertension*Pre-hypertension* 120-139 or120-139 or 80-8980-89 Stage 1 HypertensionStage 1 Hypertension 140-159 or140-159 or 90-9990-99 Stage 2 HypertensionStage 2 Hypertension >> 160 or160 or >> 100100 *newly recognized, requiring*newly recognized, requiring lifestyle modificationslifestyle modifications

Hypertension • For persons over age 50, SBP is more important than DBP as a CVD risk factor • Starting at 115/75 mmHg, CVD risk doubles with each increment of 20/10 mmHg throughout the BP range

Classification of Hypertension • Primary (Essential) HypertensionPrimary (Essential) Hypertension -- Elevated BP with unknown causeElevated BP with unknown cause - 90% to 95% of all cases- 90% to 95% of all cases • Secondary HypertensionSecondary Hypertension - Elevated BP with a specific cause- Elevated BP with a specific cause - 5% to 10% in adults- 5% to 10% in adults

Classification of Hypertension • Primary Hypertension - Contributing factors: • ↑ Sympathatic NS activity • ↑ Periphral Vascular Resistence

Classification of Hypertension • Secondary Hypertension - Contributing factors: • Coarctation of aorta • Renal disease • Endocrine disorders • Neurologic disorders - Rx: Treat underlying cause

Risk Factors for Primary Hypertension • Age (> 55 for men; > 65 for women) • Alcohol • Cigarette smoking • Diabetes mellitus • Elevated serum lipids • Excess dietary sodium • Gender

Risk Factors for Primary Hypertension • Family history • Obesity (BMI > 30) • Ethnicity (African Americans) • Sedentary lifestyle • Socioeconomic status • Stress

Hypertension Clinical Manifestations • Frequently asymptomatic until severeFrequently asymptomatic until severe and target organ disease has occurredand target organ disease has occurred – Fatigue, reduced activity tolerance – Dizziness – Palpitations, angina – Dyspnea

Hypertension: Complications • Complications are primarily related to development of atherosclerosis (“hardening of arteries”), or fatty deposits that harden with age

Hypertension Complications The common complications areThe common complications are target organ diseases occurring in thetarget organ diseases occurring in the HeartHeart BrainBrain KidneyKidney EyesEyes

Hypertension Complications Hypertensive Heart Disease • Coronary artery disease • Left ventricular hypertrophy • Heart failure

Left Ventricular Hypertrophy Fig. 32-3

Hypertension Complications  Cerebrovascular Disease • Stroke  Peripheral Vascular Disease  Nephrosclerosis  Retinal Damage

Hypertension Diagnosis • Diagnosis requires two reading at two different clinic visits • BP measurement in both arms - Use arm with higher reading for subsequent measurements Measure BP following 5min of rest in the sitting position with good back support

Hypertension Diagnosis • Ambulatory BP Monitoring – For “white coat” phenomenon, hypotensive or hypertensive episodes, apparent drug resistance

Treatment Goals • Goal is to reduce overall cardiovascular risk factors and control – Diabetes, chronic kidney disease, and every one less than age 60 BP < 140/90 – For those 60 years and older < 150/90

Benefits of Lowering BP Average Percent Reduction Stroke incidence 35–40% Myocardial infarction 20–25% Heart failure 50%

Hypertension • Lifestyle Modifications - Weight reduction - Dietary changes (DASH diet) - Limitation of alcohol intake (< 2 drinks/day for men; < 1/day for women) - Regular physical activity - Avoidance of tobacco use - Stress management

Hypertension • Nutritional Therapy: DASH Diet = Dietary Approahes to Stop HTN - Sodium restriction - Rich in vegetables, fruit, and nonfat dairy products - Calorie restriction if overweight

Hypertension • Drug Therapy - Reduce Systemic Vascular Resistence - Decrease volume of circulating blood

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