Arterial Hypertension

Arterial Hypertension

1. LECTURE

ARTERIAL
HYPERTENSIONS

2. Definition
• Arterial hypertension is rise arterial
blood pressure (BP), systolicus BP more
than 140 mm.Hg. and dyastolicus more than
90 mm.Hg.
Hypertension is rise pressure
intravasculars or intracavitary.
• Hypertonia is rise muscular tonus.
• Hypertension is correct term in this case

3. Patient is diagnosed as hypertensive if at
least two BP determinations performed at
five-minute intervals suggest for increased
BP level. Sporadic higher levels in patients
who have been resting for > 5 min suggest an
unusual labiality of BP that may precede
sustained hypertension. For example, office
or white coat hypertension refers to BP that
is consistently elevated in the physician's
office but normal when measured at home or
by ambulatory BP monitoring.

4. NORMAL BLOOD PRESSURE
•SYSTOLYCUS BLOOD PRESSURE
100 - 139 mmHg
•DYASTOLICUS BLOOD PRESSURE
60 - 89 mmHg

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6. CLASSIFICATION OF BLOOD PRESSURE LEVELS
Classification Systolic (mm Hg) Diastolic (mm
Hg)
Optimal
<120 < 80
Normal
100 - 139 60 – 89
High-normal
130 – 139 85 – 89
Mild AH (stage 1)
140 - 159 90 – 99
Moderate AH
(stage2 )
160 - 179 100 – 109
Severe AH (stage 3)
>180 >110
Malignant AH
>200 >130

7. Essential and symptomatical AH
•Essential arterial hypertension is arterial
hypertension of unknown origin and not
associated with other deseases.
•Symptomatical (secondary) arterial hypertension
is symptom desease of the
kedneys,endocrinsystem, heart, nervous system,
exogenous(salt-,alcohol-,medicamental
drugs-,toxin associeted),pregnancy associated and
other.

8. Malignant hypertension defines cases, when
diastolic BP is not decreased even after
administration pharmacological therapy.

Arterial hypertension values ranging from 140/90
to 160/95 mmHg also called “borderline
hypertension”

The term isolated systolic hypertension
associated with high systolic pressure and normal
diastolic pressure.
The term systole-diastolic hypertension applied
when patient has increased both systolic and
diastolic pressure level.

9. Factors of blood pressure
regulation
•cardiac output,
•peripheral vascular resistance,
•blood circulating volume.

10. Classification of arterial
hypertension
•Essential, or primary, hypertension is systemic
arterial hypertension is not associated with other
diseases, it cause is not completely understood. ;
90 to 95 percent of systemic hypertension cases
fall under this category.
•Secondary hypertension is elevated systemic
blood pressure of known cause and usually
associated with other definite diseases ; five to ten
percent of systemic hypertension cases are of this
type.

11. Etiology of essential
hypertension
1.Heredity
2.Salt intake and low-calcium intake
3.Obesity
4.Occupation .
5.Alcohol intake.
6.Smoking.
7.Coffee intake
8.Reduced physical activity.
9.Psychoemotional personal pecularity.

12. Pathogenesis of essential AG
•1. Activation of sympathadrenal system.
•2. Activation of renin-angiotensin-
aldosterone
•3. Insulin resistance and/or
hyperinsulinemia
•4. Deficiency of kallikrein system
•5. Deficiency of neutral lipid and a
prostaglandin produced in renal medulla.
•6. Disfunction of endothelial cells.

13. SYSTOLIC HYPERTENSION WITH WIDE
PULSE PRESSURE
•I. Decreased compliance of aorta (arteriosclerosis)
•II. Increased stroke volume
•A. Aortic regurgitation
•B. Thyrotoxicosis
•C. Hyperkinetic heart syndrome
•D. Fever
•E. Arteriovenous fistula
F. Patent ductus arteriosus

14. SYSTOLIC AND DIASTOLIC
HYPERTENSION
•I. Renal
•A. Chronic pyelonephritis
•B. Acute and chronic glomerulonephritis
•C. Polycystic renal disease
•D. Renovascular stenosis or renal infarction
•E. Most other severe renal diseases (arteriolar
nephrosclerosis, diabetic nephropathy, etc.)
•F. Renin-producing tumors

15. SYSTOLIC AND DIASTOLIC
HYPERTENSION
II. Endocrine
•A. Oral contraceptives
•B. Adrenocortical hyperfunction
•1. Cushing's disease and syndrome
•2. Primary hyperaldosteronism
•3. Congenital or hereditary adrenogenital
syndromes (17a-hydroxylase and 11b-
hydroxylase defects)
•C. Pheochromocytoma
•D. Myxedema
•E. Acromegaly

16. SYSTOLIC AND DIASTOLIC
HYPERTENSION
III. Neurogenic
A. Psychogenic
B. Diencephalic syndrome
C. Familial dysautonomia (Riley-Day)
D. Polyneuritis (acute porphyria, lead poisoning)
E. Increased intracranial pressure (acute)
F. Spinal cord section (acute)

17. SYSTOLIC AND DIASTOLIC
HYPERTENSION
IV. Miscellaneous
A. Coarctation of aorta
B. Increased intravascular volume (excessive
transfusion, polycythemia vera)
C. Polyarteritis nodosa
D. Hypercalcemia
E. Medications, e.g., glucocorticoids,
cyclosporine, NSAID

18. Morphologycaly changes
• SPASM
• HYALINOSIS
• SCLEROSIS

19. Pathology of arterial hypertension

20. Hypertrophy of muscular layer

21. Hypertrophy of muscular layer

22. Myointima edema

23. Accelerating of atherosclerosis

24. Complaints
- Occipital headaches,
- dizziness and vertigo,
- light-headedness,
- dimmed vision,
- cardialgia,
- angina pectoris,
- dyspnea,
- increased heart beating,
- edema of low extremities.

25. Physical exams
•- increased density of pulse,
•- increased pulse rate in case of heart failure
developed
•- dilation of left border of heart dullness,
•- mild decreased first sound,
•- second sound aortic closure is accentuated,
•- faint systolic murmur in the heart apex,
•- enlarged liver size and edema of low
extremities due to developing heart failure,

26. 24-hour ambulatory
monitoring

27. Funduscopic exam

28. ECG: left ventricular hypertrophy

29. ECG: left ventricular hypertrophy
with blokade LbHisB

30. X-ray: dilatation of left ventricle

31. Cardiac ultrasound: thickness of left
ventricle wall

32. Laboratory findings
•- Proteinuria.
•- Elevation of creatinin and urea
levels.
•- Сholesterol and triglycerides.
•- Serum glucose ant glucose tolerant
test.

33. Classification of arterial hypertension
I stage – signs of target organs involvement are
absent, but arterias on fundus eyes are spasmed
II stage – presents of target organs lesions without
their insufficiency:
- left ventricle hypertrophy based on signs of
ECG, cardiac ultrasound, X-ray),
- generalized narrowing of the retinal arterioles
based on funduscopic exam,Silus-1,2 symptoms
- proteinuria and/or mild elevation of creatinine
level (up to 133 mkmol/l in male and up to 124
mkmol/l in female).

34. Classification of arterial hypertension
III stage – presents of target organs lesions with symptoms of their
insufficiency (stage of AH complication):
- myocardial infarction,
- heart failure IIA-III stages,
- ischemic stroke,
- transient ischemic attack,
- cerebral hemorrhage syndrome,
- acute hypertensive encephalopathy,
- chronic hypertensive encephalopathy,
- dissecting aortic aneurysm,
- eclampsia,
- appearance of hemorrhages, exudates, and papilledema of retina in
fundoscopy.
- renal insufficiency – elevation of creatinine level over than 133
mkmol/l in male and up to 124 mkmol/l in female

35. Hypertensive emergencies
Hypertensive crisis is defined as sudden
elevation of BP usually with a systolic
blood pressure greater than 240 mm Hg or
diastolic BP greater than 120 mm Hg
associated with exacerbation of clinical
manifestation of AH.

36. Hypertensive emergencies
Hypertensive emergencies are characterized by end
organ damage and associated with the following:
hypertensive encephalopathy, intracranial
hemorrhage, stroke, pulmonary edema, acute
myocardial infarction, adrenergic crisis, dissecting
aortic aneurysm, and eclampsia.
Hypertensive urgencies are characterized by a lack
of end organ damage and reveled by anxiety of
patients, cardialgia, angina pectoris, headache,
dizziness without any evidence of AH
complications and focal neurological
manifestations.

37. Nondrug therapeutic intervention
(1) relief of stress,
(2) dietary management,
(3) regular aerobic exercise,
(4) weight reduction (if needed),
(5) control of other risk factors contributing to the
development of arteriosclerosis:
- diabetes mellitus,
- smoking,
- hypercholesterolaemia,

38. Exercise ladies

39. Diuretics
•Hydrochlorothiazide, 25 mg, 1 time per day
•Indapamide, 2,5 mg 1 time per day
•Spironolactone, 25-50mg, 2-3 times per day
•Triamterene, 50-100, 1-2 times per day
•Amiloride, 5-10, 1-2 times per day

40. b-adrenergic receptor blocking agents
•Propranolol, 40 mg, 4 times per day
•Metoprolol, 50-100 mg, 2 times per day
•Atenolol, 25-50 mg, 2 times per day
•Labetalol, 200 mg, 2 times per day
•Bisoprolol, 5-10 mg, 1 time per day

41. Calcium entry blockers
•Nifedipine, 10 mg, 3-4 times per day
•Amlodipine, 5-10 mg, 1 time per day
•Isradipine, 5-10 mg, 1-2 times per day

42. Angiotensin-converting enzyme
inhibitors
•Captopril, 25-50 mg, 2-3 times per day
•Enalapril, 10-20 mg, 1-2 times per day
•Lisinopril, 10-20 mg, 1-2 times per day
•Perindopril, 4-8 mg, 1 times per day

43. Angiotensin II receptor blockers
•Candesartan, 8-16 mg, 1 time per day
•Losartan, 50-100 mg, 1 time per day

44. a-adrenergic receptor blocking agents
•Prazosin, 1-5 mg, 2-3 times per day
•Doxazosin, 1-4 mg, 1time per day

45. Most preferable combination of
antihypertensive medication
b-adrenergic receptor blocking agents + thiazid
diuretics
Angiotensin-converting enzyme inhibitors + thiazid
diuretics
b-adrenergic receptor blocking agents + Calcium
entry blockers
Calcium entry blockers + Angiotensin-converting
enzyme inhibitors + thiazid diuretics

46. Additional preparations
•Guanethidine, 10-50 mg, 1 time per day
•Clonidine, 0,075-0,15 mg, 3-4 times per
day
•Reserpine, 0,05-0,15 mg, 1 time per day
•Hydralazine, 25-50 mg, 3-4 times per day

47. Treatment of hypertensive
emergencies
•Nitroprusside, I.V. infusion pump with a
dose of 0.25-8 micrograms*kg/min
•Nitroglycerin, I.V. infusion pump with a
dose of 5-100 micrograms/min
•Diazoxide, I.V. 50-150 mg during 5 min
•Trimethaphan, I.V. infusion pump with a
dose of 0.5-5 mg/min
•Labetalol, 2 mg/min IV

48. Treatment of hypertensive
emergencies
•Hydralazine, 10-20 mg IV
•Enalaprilat, I.V. infusion pump with a
dose of 1.25-5 mg I.V. during 6 hrs
•Propranolol, I.V. 5-10 mg during 5-10
min
•Phentolamine, I.V. 5 mg

49. Initial out-patients treatment of
urgent hypertensive crisis
Clonidine 0,15 mg P.O. or S.L.
Captopril 25 mg P.O. or S.L.
Labetalol 200 mg P.O.
Nifedipine 10 mg S.L.

50. happy end
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