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Hypertension
• Blood pressure levels are a function of cardiac
output multiplied by peripheral resistance (the
resistance in the blood vessels to the flow of
blood)
• BP = CO X PVR
• It is commonest CVD
• It is a major Risk Factor for CV mortality, CHD, CVA,
CHF, and Renal Failure
• The relationship between BP and risk of CVD
events is continuous, consistent, and independent
of other RFs.
• The higher the BP the greater the chance of heart
attack, HF, stroke, and kidney diseases.
• It affects about 25% of adult population
• About 75% of hypertensive individuals are
unaware of being diseased
• About 50% of hypertensive patients who knew
they are diseased are either not on treatment
or taking treatment but not controlled.
Risk Factors of HTN
1.Hereditary factors : positive family history
2.Genetic factors: certain genes as ACE gene
3.Early life exposure to certain events: as LBW
4.Certain childhood predictors: as BP response to
exercise, weight gain, LV mass…
Risk Factors of HT5.Body weight: overweight individual has 2-6 times higher risk
having HT compared to a normal weight individual.
6.Central Obesity and Metabolic Syndrome: high waist/hip ratio
is positively associated with HT
7.Nutritional factors: positive association between Nacl intake and HT, negative association between potassium intake and HT, and no relation with other nutrients.
Risk Factors of HT
8.Alcohol intake : causes acute and chronic increase in BP level
9.Physical Inactivity : Sedentary unfit individual has 20-50% excess risk to have HT
10.Heart rate : Ht patients have HR than normotensive individuals
11.Psychological factors: acute mental stress causes increase in BP level
12.Environmental factors: noise, air pollution
Hypertension
• The major factors which help maintain blood
pressure (BP) include the sympathetic nervous
system and the kidneys.
• Optimal healthy blood pressure is a systolic blood
pressure of <120 mmHg and a diastolic blood
pressure of <80
• <120/80.
HypertensionCategory Systolic Blood
PressureDiastolic Blood Pressure
Normal < 120 <80
Pre-hypertension 120-139 80-89
Hypertension – Stage 1
140-159 90-99
Hypertension – Stage 2
>160 >100
Hypertension
• Approximately one in four American adults
has hypertension.
• As many as 2.8 million children also have high
blood pressure.
• The prevalence of hypertension increases
with age.
Prevalence of Hypertension by Age
• Age
– 18-29
– 30-39
– 40-49
– 50-59
– 60-69
– 70-79
– 80+
• % Hypertensive
– 4
– 11
– 21
– 44
– 54
– 64
– 65
Hypertension
• When the normal regulatory mechanisms fail,
hypertension develops.
• Hypertension is so dangerous because it gives
off no warning signs or symptoms.
Untreated hypertension can result in: Arteriosclerosis --Kidney damage Heart Attack --Stroke Enlarged heart --Blindness
Factors Influencing the Development of Hypertension
• High-normal blood pressure
• Family history of hypertension
• African-American ancestry
• Overweight
Factors Influencing the Development of Hypertension
• Excess Consumption of Sodium Chloride
• Certain segments of the population are ‘salt
sensitive’ because their blood pressure is
affected by salt consumption
• 30-50% of Hypertensive individuals and ~ 25% normotensive
individuals
Factors Influencing the Development of Hypertension
• Exercise• Less active individuals are 30-50% more likely to
develop hypertension.
Factors Influencing the Development of Hypertension
• Other Dietary Factors
• Potassium:
• Calcium:
• Magnesium:
General Approach to the Patient
• Confirm that the patient’s blood pressure (BP) has been accurately measured using – Correct positioning with
an appropriately sized cuff
General Approach to the Patient
• Important to review – The patient’s diet and
medication use for other potential causes of HT
• Excessive consumption of – Sodium, – Licorice (Hindi: Jethimadh,
Mulhathi), or – Alcohol is known to increase BP
General Approach to the Patient
• Many drugs affect BP – A trial period off of a potentially offending medication may be all that
is needed to reduce BP
General Approach to the Patient
• If these potential contributors to hypertension
have been excluded and
• Concern for secondary hypertension remains,
the physician can investigate for potential
physiologic causes
Most Common Causes of Secondary Hypertension by Age*
Must remember that these are not absolute categories; There may be overlap of causes between age groups
Factors influencing BP level:
– Age:
– Sex: early in life, there is no difference between
– Ethnicity: Blacks have higher BP level than others