Published on April 22, 2014
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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Title: Hypertension Author: Kieran McGlade Last modified by: Queen's University of Belfast Created Date: 11/11/2001 9:43:30 PM Document presentation format