Hypertension

Hypertension

HypertensionDefinition
Hypertension is sustained elevation of BP
Systolic blood pressure  140 mm Hg
Diastolic blood pressure  90 mm Hg

Factors Influencing Blood Pressure

Blood Pressure
=
Cardiac Output
x
Systemic Vascular
Resistance

Factors Influencing BP

HR
SNS/PNS
Vasoconstriction/vasodilation
Fluid volume


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

Classification of Hypertension

Primary Hypertension
- Contributing factors:
•  SNS activity
•  Sodium intake
• Excessive alcohol intake

Classification of Hypertension

• Secondary Hypertension
- Contributing factors:
• vascular disease
• Renal disease
• Endocrine disorders
• Neurologic disorders
- Rx: Treat underlying cause


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Diseases Attributable to Hypertension

Hypertension

Heart failure
Stroke
Coronary heart disease
Myocardial infarction
Left ventricular hypertrophy
Aortic aneurysm
Retinopathy
Peripheral vascular disease
Hypertensive encephalopathy
Chronic kidney failure

Cerebral hemorrhage

Adapted from: Arch Intern Med 1996; 156:1926-1935.
All
Vascular


HypertensionClinical Manifestations
• Frequently asymptomatic until severe and target organ disease has occurred
Fatigue, reduced activity tolerance
Dizziness
Palpitations, angina
Dyspnea

HypertensionComplications

The common complications are
target organ diseases occurring in the

Heart

Brain
Kidney
Eyes

HypertensionDiagnosis

• Diagnosis requires several elevated readings over several weeks (unless > 180/110)
• BP measurement in both arms

HypertensionCollaborative Care

• 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

HypertensionCollaborative Care

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

HypertensionCollaborative Care

• Drug Therapy
- Reduce SVR
- Decrease volume of circulating blood

HypertensionCollaborative Care

• Drug Therapy
Diuretics
Adrenergic inhibitors
β - Adrenergic blockers
ACE Inhibitors
Calcium channel blockers

Measuring Blood Pressure

Blood pressure is indicates your heart health
It is determined by the contractions of the heart
Your pressure varies depending on the condition of your heart and blood vessels
Pressure is measured in millimeters of mercury (mm Hg)








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Systolic Pressure

Systolic pressure is the maximum pressure exerted by the blood against the artery walls.
It results when the ventricles contract.
Normally, it measures 120 mm Hg.
Systolic

Diastolic Pressure

Diastolic Pressure is the lowest pressure in the artery.
It result when the ventricles are relaxed and is usually around 80 mm Hg.
Diastolic

Blood Pressure Sounds

A cuff is inflated to constrict an artery so that no blood flows.
As the cuff pressure is slowly released, but the artery is still partially constricted, blood flow begins again.
Sounds can be heard because the blood flows violently causing audible sounds.
When the artery is fully open, the blood flows freely and the sounds disappear.

Checking Blood Pressure

The first sounds that are heard indicate systolic pressure (top number).
When the sounds stop, diastolic pressure has been reached (bottom number).
Average blood pressure is:
120
80

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Write down as many wrong things as you can find!

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What’s wrong with this picture?

Are you ready for your big wedding?
Not really, there’s so much to do – I am very nervous these days
• Provider and patient are talking
• BP cuff applied over clothing
• Arm supported above heart level
• Patient legs are crossed
• Selected size of the cuff looks big for the patient

THE END