Arterial hypertension, blood pressure ppt

Arterial hypotension

1. Arterial hypertension and symptomatic arterial hypertension.

2. Arterial Hypertension is a clinical syndrome, defined as systolic blood pressure ≥ 140 mmHg and/or diastolic blood pressure ≥ 90 mmHg

3. Prevalence Hypertension is one among the most wide- spread among all cardiovascular diseases 15 – 25 % of people in the population have hypertension + 15 % have bordeline hypertension Primary hypertension occupies 80 – 95 % of all arterial hypertensions and 10 % of them are secondary hypertensions

4. Blood pressure

5. Cardiac output

6. Resistance of arterioles

7. Pathophysiology of arterial blood pressure

8. Etiology classification of arterial hypertension Essential (Primary) arterial hypertension (95%) has no clearly identifiable cause,  but is thought to be linked to genetics, poor diet, lack of exercise and obesity Secondary arterial hypertension (5%) is caused by an identifiable underlying primary cause Renoparenchimatous Endocrine disease Due to disorders of hemodynamics (coarctation of the aorta, heart valvular diseases, atherosclerosis) Neurogenic (brain commotion, tumor etc.) Iatrogenic hypertensions

9. Risk-factors of arterial hypertension Non-modified Age Genetics and family history Sex( male or female) Family and personal history of hyperlipidemia Family and personal history of diabetes Modified Cigarette smoking Environment (stress, sedentary lifestyle) Weight (obesity and metabolic syndrome) Dietary habits (high alcohol intake, high sodium intake, low potassium intake) Hypodinamia Personality 

10. Arterial blood pressure measurement rules Before measuring blood pressure for 1 hour to eliminate the use of coffee, strong tea, do not smoke, the use of alcoholic beverages. 5 minutes before measurement patient should be relaxed. If there was some physical or emotional burden, the rest should be about 30 minutes.

11. WHPO classification of arterial hypertension (1993 ) 3 stages Stage I – no evident signs of target organ damage

12. WHPO classification of arterial hypertension (1993 ) Stage II – presence of at least one of the following signs of target organ damage: Heart: LVH (diagnosed radiologically, on ECG or by Echocardiography) Retina: generalized or focal narrowing of retinal arteries Kidney: microalbuminurua , proteinuria, creatinine<2mg/dl (176 µmol/l) Vessels: increased IMT or plaques in carotid, iliac, or femoral arteries

13. WHPO classification of arterial hypertension (1993 ) Stage III – signs of severe target organ damage: Heart: angina pectoris, myocardial infarction, heart failure Brain: stroke, TIA, vascular dementia Retina: haemorrhages , exudates, papilloedema Kidney: renal insufficiency (creatinine>2mg/ml) Vessels: dissecting aortic aneurysm, symptomatic occlusive peripheral arterial disease

14. Stratification of patients by absolute level of cardiovascular risk Decisions about the management of patients with hypertension should not be based on : the level of blood pressure the presence of other risk factors concomitant diseases ( diabetes, target organ damage, and cardiovascular or renal disease )

15. Main (basic) risk factors 1. men and menopause women 2. smoking 3. cholesterol >6,5mmol/L 4. family history of premature cardiovascular disease (women<65y., men - <55 y)

16. Additional risk factors reduced HDL cholesterol level raised LDL cholesterol level diabetes mellitus impaired glucose tolerance obesity 6. sedentary life-style raised fibrinogen , endogenous tissular plasminogen activator , inhibitor of plasminogen activator type I hyperhomocysteinemia raised C-reactive protein oestrogens deficiency

17. Stratification of patients by absolute level of cardiovascular risk Four categories of absolute cardiovascular disease risk are defined (low, medium, high and very high risk) Each category represents a range of absolute disease risks. Within each range, the risk of any one individual will be determined by the severity and number of risk factors present.

18. Complaints Dizziness and lightheaded Sickness and headache Being tired Cramps of a muscle Shortness of breath Breathing issues Heavy pulse rate Trouble in normal vision

19. Past medical history 1. Duration and previous level of high BP 2. Indications of secondary hypertension Family history of renal disease (polycystic kidney) , haematuria , analgesic abuse (parenchymal renal disease) Drug/substance intake: oral contraceptives, nasal drops, cocaine, steroids, NSAID’s, erythropoietin, cyclosporin Episodes of sweating, headache, anxiety, palpitation ( phaeochromocytoma ) Episodes of muscle weakness (aldosteronism) Episodes of muscle weakness (aldosteronism) 3. Risk factors 4. Symptoms of organ damage 5. Previous antihypertensive therapy (drugs used, efficacy, adverse effects) 6. Personal, family, environmental factors 

20. Patient examination Hyperemia of face skin, may be visible pulsation of the head and neck vessels Apex beat : wide, shift to the left, strengthened Borders of relative and absolute heart dullness shift to the left (hypertrophy of left ventricle) Auscultation aortic accent of 2nd sound, systolic murmur on heart apex

21. Diagnosis of essential arterial hypertension depends on repeatedly demonstrating higher-than-normal systolic and/or diastolic BP and excluding secondary causes. At least two BP determinations should be taken on each of 3 days before a patient is diagnosed as hypertensive. More BP determinations are desirable for patients in the low hypertension range and especially for patients with markedly labile BP. Sporadic higher levels in patients who have been resting for > 5 min suggest an unusual lability 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.

22. Twenty-four-hour ambulatory blood pressure monitoring (N. Holter, 1957) is used now to confirm AH.

23. ECG І st. – specific signs are abcent ІІ – ІІІ st. – hypertrophy of the left ventricle: heart electrical axis is deviated leftward, Rv 5-6 > Rv 4, elevation of ST, biphasic Т (+-) Increased amplitude of R in left leads and S - in right leads.

24. Echocardiography finds evidence of left ventricular dysfunction and hypertrophy; aortic aneurysm may be detected.

25. HYPERTENSIVE RETINOPATHY I degree: Arteriolar thickening, tortuosity and increased reflectiveness ('silver wiring’) II degree: plus constriction of veins at arterial crossings ('arteriovenous nipping’) III degree: plus evidence of retinal ischaemia (flame-shaped or blot haemorrhages and 'cotton wool' exudates) IV degree: plus papilloedema

26. Hypertensive crisis Definition Hypertensive crisis is a periodically recurring transient elevations of arterial pressure accompanied by exacerbation of clinical symptoms and possible complications in target-organs. Development of such crises is preceded by psychic traumas, nervous overstrain, variations in atmospheric pressure, irregular intake of antihypertensive medications

27. Clinical picture of hypertensive crisis . Hypertensive crisis develops with a sudden elevation of the arterial pressure that can persist from a few hours to several days. The crisis is attended by sharp headache, feeling of heat, perspiration, palpitation, giddiness, piercing pain in the heart, sometimes by deranged vision, nausea, and vomiting. In severe crisis, the patient may lose consciousness. The patient is excited, haunted by fears, or is indifferent, somnolent, and inhibited. Auscultation of the heart reveals accentuated second sound over the aorta, and also tachycardia. The pulse is accelerated but can remain unchanged or even decelerated; its tension increases. Arterial pressure increases significantly (as a rule diastolic pressure>130mm Hg). ECG shows decreased S-T interval and flattening of the T wave.

28. Complications of hypertensive crisis may be fatal up to death such as cerebral stroke acute myocardial infarction acute left ventricular failure (cardiac asthma or edema of the lungs) loss of vision dissection and rupture of the aortic aneurysm

29. Symptomatic hypertension Definition: is a clinical condition in which arterial pressure rises as a symptom of some other disease, this symptom being far from the leading one.

30. Main causes of Secondary Hypertension Chronic kidney disease Primary aldosteronism Renovascular disease Chronic steroid therapy and Cushings syndrome Pheochromocytoma Coarctation of the aorta Thyroid or parathyroid disease

31. Classification of secondary hypertension Renoparenchimatous (pyelonephritis, glomerulonephritis) or renovascular (renal artery stenosis) disease Endocrine disease ( Phaeochomocytoma , Cusings syndrome, Conn’s syndrome, Acromegaly and hypothyroidism etc.) Due to disorders of hemodynamics (coarctation of the aorta, heart valvular diseases, atherosclerosis) Neurogenic (brain commotion, tumor etc.) Complication of pregnancy Iatrogenic hypertensions induces Hormonal / oral contraceptive, corticosteroids etc.

32. Treatment Modification of life-style Diet (Decreased salt intake to 4-6 g/day, alkohol , animal fats). Diet (Decreased salt intake to 4-6 g/day, alkohol , animal fats). Decreased body weight. Avoiding of smoking. Dynamical physical examinations. Phytotherapy , acopuncture , psychtherapy , authotrening

33. Influence of modification of life-style of the course of the disease: Decreased body weight - 5-20 mm of Hg/10 kg of lost weight Decreased salt intake (6 g per day) – 2-8 mm of Hg Decreased salt intake (6 g per day) – 2-8 mm of Hg Physical activity (30 min per day) – 4-9 mm of Hg Decreased alcohol consumption (to 1 ounce per day) – 2-4 mm of Hg  

34. Aims of antihypertensive therapy Immediate: achieve target BP levels Intermediate: prevent target organs disfuction (TOD) or regression of TOD Final: improve long-term prognosis 

35. Treatment of arterial hypertension depending on grade

36. Main groups of antihypertensive drugs Diuretics β -blockers Ca- channels antagonists Angiotensine -converting enzyme inhibitors Blockers of angiotensine -II receptors ά 1- adrenoblochers