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The document discusses hypertension (high blood pressure). It defines hypertension as a blood pressure reading of 140/90 mmHg or higher. Factors that influence blood pressure include heart rate, sympathetic nervous system activity, vasoconstriction/vasodilation, and fluid volume. The main types of hypertension are primary (essential) and secondary, with primary hypertension making up 90-95% of cases and having no known cause. Complications of uncontrolled hypertension affect the heart, brain, kidneys, and eyes. Lifestyle modifications and medications are recommended to treat hypertension and reduce risks of health complications.

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Hypertension Hanna K. Al-Makhamreh, MD FACC Interventional Cardiology
Factors Influencing Blood Pressure Blood Pressure = Cardiac Output x Systemic Vascular Resistance
Factors Influencing BP Hear rate Sympathatic/Parasympathatic Vasoconstriction/vasodilation Fluid volume Renin-angiotensin Aldosterone ADH
Hypertension Definition Hypertension is sustained elevation of BP Hypertension is sustained elevation of BP Systolic blood pressure 140 mm Hg Diastolic blood pressure 90 mm Hg
Blood Pressure Classification BP BP Classification Classification SBP mmHg SBP mmHg DBP mmHg DBP mmHg Normal Normal < 120 and < 120 and < 80 < 80 Pre-hypertension* Pre-hypertension* 120-139 or 120-139 or 80-89 80-89 Stage 1 Hypertension Stage 1 Hypertension 140-159 or 140-159 or 90-99 90-99 Stage 2 Hypertension Stage 2 Hypertension > > 160 or 160 or > > 100 100 *newly recognized, requiring *newly recognized, requiring lifestyle modifications lifestyle modifications
Hypertension For persons over age 50, SBP is more important than DBP as a CVD risk factor Starting at 115/75 mmHg, CVD risk doubles with each increment of 20/10 mmHg throughout the BP range
Classification of Hypertension Primary (Essential) Hypertension Primary (Essential) Hypertension - - Elevated BP with unknown cause Elevated BP with unknown cause - 90% to 95% of all cases - 90% to 95% of all cases Secondary Hypertension Secondary Hypertension - Elevated BP with a specific cause - Elevated BP with a specific cause - 5% to 10% in adults - 5% to 10% in adults
Classification of Hypertension Primary Hypertension - Contributing factors: Sympathatic NS activity Periphral Vascular Resistence
Classification of Hypertension Secondary Hypertension - Contributing factors: Coarctation of aorta Renal disease Endocrine disorders Neurologic disorders - Rx: Treat underlying cause
Risk Factors for Primary Hypertension Age (> 55 for men; > 65 for women) Alcohol Cigarette smoking Diabetes mellitus Elevated serum lipids Excess dietary sodium Gender
Risk Factors for Primary Hypertension Family history Obesity (BMI > 30) Ethnicity (African Americans) Sedentary lifestyle Socioeconomic status Stress
Hypertension Clinical Manifestations Frequently asymptomatic until severe Frequently asymptomatic until severe and target organ disease has occurred and target organ disease has occurred Fatigue, reduced activity tolerance Dizziness Palpitations, angina Dyspnea
Hypertension: Complications Complications are primarily related to development of atherosclerosis (hardening of arteries), or fatty deposits that harden with age
Hypertension Complications The common complications are The common complications are target organ diseases occurring in the target organ diseases occurring in the Heart Heart Brain Brain Kidney Kidney Eyes Eyes
Hypertension Complications Hypertensive Heart Disease Coronary artery disease Left ventricular hypertrophy Heart failure
Left Ventricular Hypertrophy Fig. 32-3
Hypertension Complications Cerebrovascular Disease Stroke Peripheral Vascular Disease Nephrosclerosis Retinal Damage
Hypertension Diagnosis Diagnosis requires two reading at two different clinic visits BP measurement in both arms - Use arm with higher reading for subsequent measurements Measure BP following 5min of rest in the sitting position with good back support
Hypertension Diagnosis Ambulatory BP Monitoring For white coat phenomenon, hypotensive or hypertensive episodes, apparent drug resistance
Treatment Goals Goal is to reduce overall cardiovascular risk factors and control Diabetes, chronic kidney disease, and every one less than age 60 BP < 140/90 For those 60 years and older < 150/90
Benefits of Lowering BP Average Percent Reduction Stroke incidence 3540% Myocardial infarction 2025% Heart failure 50%
Hypertension 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
Hypertension Nutritional Therapy: DASH Diet = Dietary Approahes to Stop HTN - Sodium restriction - Rich in vegetables, fruit, and nonfat dairy products - Calorie restriction if overweight
Hypertension Drug Therapy - Reduce Systemic Vascular Resistence - Decrease volume of circulating blood

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HTN.pdf

  • 1. Hypertension Hanna K. Al-Makhamreh, MD FACC Interventional Cardiology
  • 2. Factors Influencing Blood Pressure Blood Pressure = Cardiac Output x Systemic Vascular Resistance
  • 3. Factors Influencing BP Hear rate Sympathatic/Parasympathatic Vasoconstriction/vasodilation Fluid volume Renin-angiotensin Aldosterone ADH
  • 4. Hypertension Definition Hypertension is sustained elevation of BP Hypertension is sustained elevation of BP Systolic blood pressure 140 mm Hg Diastolic blood pressure 90 mm Hg
  • 5. Blood Pressure Classification BP BP Classification Classification SBP mmHg SBP mmHg DBP mmHg DBP mmHg Normal Normal < 120 and < 120 and < 80 < 80 Pre-hypertension* Pre-hypertension* 120-139 or 120-139 or 80-89 80-89 Stage 1 Hypertension Stage 1 Hypertension 140-159 or 140-159 or 90-99 90-99 Stage 2 Hypertension Stage 2 Hypertension > > 160 or 160 or > > 100 100 *newly recognized, requiring *newly recognized, requiring lifestyle modifications lifestyle modifications
  • 6. Hypertension For persons over age 50, SBP is more important than DBP as a CVD risk factor Starting at 115/75 mmHg, CVD risk doubles with each increment of 20/10 mmHg throughout the BP range
  • 7. Classification of Hypertension Primary (Essential) Hypertension Primary (Essential) Hypertension - - Elevated BP with unknown cause Elevated BP with unknown cause - 90% to 95% of all cases - 90% to 95% of all cases Secondary Hypertension Secondary Hypertension - Elevated BP with a specific cause - Elevated BP with a specific cause - 5% to 10% in adults - 5% to 10% in adults
  • 8. Classification of Hypertension Primary Hypertension - Contributing factors: Sympathatic NS activity Periphral Vascular Resistence
  • 9. Classification of Hypertension Secondary Hypertension - Contributing factors: Coarctation of aorta Renal disease Endocrine disorders Neurologic disorders - Rx: Treat underlying cause
  • 10. Risk Factors for Primary Hypertension Age (> 55 for men; > 65 for women) Alcohol Cigarette smoking Diabetes mellitus Elevated serum lipids Excess dietary sodium Gender
  • 11. Risk Factors for Primary Hypertension Family history Obesity (BMI > 30) Ethnicity (African Americans) Sedentary lifestyle Socioeconomic status Stress
  • 12. Hypertension Clinical Manifestations Frequently asymptomatic until severe Frequently asymptomatic until severe and target organ disease has occurred and target organ disease has occurred Fatigue, reduced activity tolerance Dizziness Palpitations, angina Dyspnea
  • 13. Hypertension: Complications Complications are primarily related to development of atherosclerosis (hardening of arteries), or fatty deposits that harden with age
  • 14. Hypertension Complications The common complications are The common complications are target organ diseases occurring in the target organ diseases occurring in the Heart Heart Brain Brain Kidney Kidney Eyes Eyes
  • 15. Hypertension Complications Hypertensive Heart Disease Coronary artery disease Left ventricular hypertrophy Heart failure
  • 17. Hypertension Complications Cerebrovascular Disease Stroke Peripheral Vascular Disease Nephrosclerosis Retinal Damage
  • 18. Hypertension Diagnosis Diagnosis requires two reading at two different clinic visits BP measurement in both arms - Use arm with higher reading for subsequent measurements Measure BP following 5min of rest in the sitting position with good back support
  • 19. Hypertension Diagnosis Ambulatory BP Monitoring For white coat phenomenon, hypotensive or hypertensive episodes, apparent drug resistance
  • 20. Treatment Goals Goal is to reduce overall cardiovascular risk factors and control Diabetes, chronic kidney disease, and every one less than age 60 BP < 140/90 For those 60 years and older < 150/90
  • 21. Benefits of Lowering BP Average Percent Reduction Stroke incidence 3540% Myocardial infarction 2025% Heart failure 50%
  • 22. Hypertension 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
  • 23. Hypertension Nutritional Therapy: DASH Diet = Dietary Approahes to Stop HTN - Sodium restriction - Rich in vegetables, fruit, and nonfat dairy products - Calorie restriction if overweight
  • 24. Hypertension Drug Therapy - Reduce Systemic Vascular Resistence - Decrease volume of circulating blood