Hypertension

Definition, classification,risk factor,causes, treatment,prevention,

1. Dr.Kaushik Patel (PT) MPT,PhD Scholar Assistant Professor SPB Physiotherapy College, Surat

2. Hypertension also known as high or raised blood pressure ( WHO , 2015) Hypertension is the condition in which blood vessels have persistently raised pressure, putting them under increased stress.( WHO 2015) Hypertension , or high blood pressure is persistent SBP> 140 mmHg and DBP >90 mmHg ( American college of sports and medicine , 2015) INTRODUCTION

3. DEFINITION Having systolic blood pressure >140mmHg and diastolic blood pressure >90mmHg , taking antihypertensive medicine and being told by physician on at least 2 occasion that individual have HBP Condition in which the blood vessels have persistently raised pressure , putting them under increased stress (World Health Organization) The force of the blood flow is often high , the tissue that makes up the walls of the arteries gets stretched beyond its healthy limit and damage occurs

4. Understanding of hypertension To understand hypertension we must understand how the blood pressure occurs. O2 bound in the blood and is delivered to all the body part through the vessels When the heart beat it Creates pressure that pushes blood through arteries and veins Increase the serious health problem When some one has high blood pressure , the heart has to work more harder to pump the blood. BP must be within normal range to properly deliver O2 to all parts of the body BP is force of blood pushing against the blood vessel wall

5. Blood pressure = cardiac output * systemic vascular resistance Cardiac output = total blood flow through systemic or pulmonary circulation per minute CO= SV*HR SVR = force opposing the movement of blood in the vessels

6. Hypervolemia Renal artery stenosis Renal disease Hyperaldosteronism Hyper secretion of ADH Aortic Coarctation Pregnancy ( precalmpsia ) Stress Sympathetic activation Pheochromocytoma Increased catecholamine Stress Sympathetic activation Atherosclerosis Renal artery disease Increased angiotensin II Pheochromocytoma Increased catecolamines Thyroid dysfunction Diabetes Cerebral ischemia Cardiac output Systemic vascular resistance

7. Force that Blood exerts against Vessel walls. Pumping action of the heart. Flow is met by resistance from walls.

8. Maximum Pressure exerted by the Blood against the arterial walls. Results of ventricular Systole.

9. Lowest pressure in the artery. Results of Ventricular diastole.

10. PP=SBP-DBP

11. Classification of office BP levels (mmHg)* Category Systolic Diastolic Optimal <120 and <80 Normal 120–129 and/or 80–84 High normal 130–139 and/or 85–89 Grade 1 hypertension 140–159 and/or 90–99 Grade 2 hypertension 160–179 and/or 100–109 Grade 3 hypertension ≥180 and/or ≥110 Hypertension: SBP >140 mmHg ± DBP >90 mmHg

12. TYPES OF HYPERTENSION PRIMARY Also called “essential hypertension” Most cases the causes of this type is not known Majority of people with this type feel no different from those who have normal blood pressure. SECONDARY This is when high blood pressure is as a result of other medical problems (like kidney or liver problem) or medication

13. White coat hypertension  defined as blood pressure that is consistently elevated by office readings but does not meet diagnostic criteria for hypertension based upon out-of-office readings. Masked hypertension   is defined as blood pressure that is consistently elevated by out-of-office measurements but does not meet the criteria for hypertension based upon office readings Resistant hypertension refers to patients with blood pressure persistently >140/90 mmHg despite taking three or more antihypertensive agents, including diuretics , in reasonable condition and at full doses.

14. Malignant hypertension is extremely high blood pressure that develops rapidly and causes some type of organ damage. "Normal" blood pressure is below 140/90. A person with malignant hypertension has a blood pressure that's typically above 180/120. Malignant hypertension should be treated as a medical emergency.

15. Risk factors

16. CAUSES AND RISK FACTORS Age - Blood pressure rises with increasing age. Gender- Hypertension is more common in young adulthood men and middle aged men (<55 years of age). After the age of 55, it is more common in women. Family history- Having a close blood relative (parents or siblings) with hypertension increases your risk of developing hypertension. Ethnicity - The incidence of hypertension is twice as high in African Americans as they are in whites.

17. Obesity - Weight gain is highly associated with increased frequency of hypertension, especially with central abdominal obesity. Diabetes Mellitus- Hypertension is more common in diabetic patients Elevated Cholesterol and Triglycerides- High levels of cholesterol and triglycerides are primary risk factors for atherosclerosis (plaque build up in your blood vessels). Too much salt in your diet- High sodium intake contributes to high blood pressure and causes water retention.

18. Alcohol - Excessive alcohol intake is associated with hypertension Cigarette smoking- Smoking increases your risk for cardiovascular disease. If you have hypertension and smokes, have a greater risk for cardiovascular disease and blood clots. Sedentary lifestyle- Inactivity and weight gain are associated with high blood pressure and increases the risk for heart disease. Stress- People exposed to repeated stress may develop hypertension more frequently than others.

19. SIGNS AND SYMPTOMS Hypertension is often called the “Silent killer” because it is frequently asymptomati c- meaning “without symptoms” until it has become severe and damage to organs have occurred. A person with severe hypertension may have symptoms caused by the effects on the blood vessels which my be: Fatigue Reduced activity tolerance Dizziness Blurred visions Nape pain Palpitations Angina (chest pain) Difficulty breathing

20. 22 Complications The higher the BP and the longer an individual has hypertension, the higher the risk of complications which include: Hypertensive heart disease Cerebrovascular disease Peripheral vascular disease Kidney disease Retinal damage

21. 23 Complications Heart  resistance   workload  left ventricular hypertrophy CAD, angina, MI Heart failure

22. 24 Brain Atherosclerosis, stroke

23. 25 Peripheral vascular disease Aortic aneurysm or dissection Retinal damage damage to blood vessels of the eye Kidney disease vessels less elastic  decreased perfusion  renal failure

24. 26 Acute Complications Hypertensive Crisis: Severe and abrupt elevation of BP Diastolic over 120mm hg High Mortality Sx : progressive renal failure, encephalopathy Most common cause is untreated hypertension Goal: slowly decrease BP

25. 27 Classifications Hypertensive Crisis Hypertensive crisis is categorized by the degree of organ damage Hypertensive emergency: BP is severely elevated and there is evidence of target organ damage Especially brain Hypertensive urgency: BP is elevated but there is no evidence of target organ damage

26. TREATMENT Step 1: lifestyle modifications Diet and exercise Limit alcohol and tobacco use Reduce stress factors Step 2: seek medical advise If lifestyle changes are not enough, drug therapy will be introduced

27. Step 3: If previous steps did not work, drug dose or type will be changed or another drug is added Step 4: More medications are added until blood pressure is controlled

28. LIFESTYLE CHANGES FOR HYPERTENSIVE PATIENTS * Unless contraindicated. BMI, body mass index. RECOMMENDATIONS TO REDUCE BP AND/OR CV RISK FACTORS Salt intake Restrict 5-6 g/day Moderate alcohol intake Limit to 20-30 g/day men, 10-20 g/day women Increase vegetable, fruit, low-fat dairy intake BMI goal 25 kg/m 2 Waist circumference goal Men: <102 cm (40 in.)* Women: <88 cm (34 in.)* Exercise goals ≥ 30 min / day , 5-7 days /week (moderate, dynamic exercise ) Quit smoking

29. Pharmacological therapy Drug Therapy Reduce SVR Decrease volume of circulating blood

30. DRUG THERAPY

31. Thiazide-type Diuretics Inhibit NaCl reabsorption Side effects: Electrolyte imbalances: ↓ Na, ↓ Cl , ↓ K** (advise K rich foods) Fluid volume depletion (monitor for orthostatic hypotension) Impotence, decreased libido D I U R E T I C S

32. Adrenergic Inhibitors Reduce sympathetic effects that cause HTN by: Reducing sympathetic outflow Blocking effects of sympathetic activity on vessels Side effects Hypotension Varied, depending on specific drug A D R E N E R G I C I N H

33. β – adrenergic blockers (suffix “ olol ”) ( metoprolol , propranolol) Block β – adrenergic receptors ↓ HR, ↓ inotropy , reduces sympathetic vasoconstriction) Side effects Bradycardia, hypotension, heart failure, impotence β – B L O C K E R S

34. ACE Inhibitors (suffix “ pril ) Enalapril , captopril Prevents conversion of angiotensin I to angiotensin II, thereby preventing the vasoconstriction associate with A II. Side effects Hypotension, cough ACE I N H I B I T O R S

35. Calcium Channel Blockers Block movement of calcium into cells, causing vasodilation Side effects Brdaycardia , heart block Ca++ Channel B L O C K E R S

36. P R E V E N T I O N