Cardiovascular System II

How do we measure blood pressure ?

Stroke volume (and hence, blood pressure) are strongly influenced by the EDV The regulation of blood pressure

The baroreceptor reflex The regulation of blood pressure

Hypertension

Where to draw the limit of “normality” ? Mortalidad por enfermedad coronaria (x 1,000 pacientes) Usual BP (mmHg) Age Age Age Age Age Relationship between BP and CV risk Metaanalysis of more than 60 observational studies Lancet 2002; 360: 1903–13

System/organ Impact of HT CNS Stroke, dementia Myocardium Left ventricular hypertrophy Hypertensive nephropathy Kidney Hypertensive retinopathy Eye Via heart failure All body systems Impact of chronic hypertension on body systems

Demographic Cardiac HTA Sex Age Genetic Angiotensinogen gene Hyperaldosteronism Cardiac output Sodium retention Caloric intake / overweight Renal Gastrointestinal Psychological Stress Central Nervous System Sympathetic hyperactivity Vascular Smooth muscle insulin sensitivity Endothelial function Why do some people develop hypertension while others don’t ? Factors involved:

Atherosclerosis

Normal histology of the arterial wall

Infiltration of lipoproteins and monocytes

Cell proliferation and differentiation in the wall

Formation of “cap” and “shoulders”

Rupture and thrombosis

Atherosclerosis

World Deaths in millions % of deaths Coronary heart disease Stroke and other cerebrovascular diseases Lower respiratory infections Chronic obstructive pulmonary disease Diarrheal diseases HIV/AIDS Tuberculosis Trachea, bronchus, lung cancers Road traffic accidents Prematurity and low birth weight Top 10 world causes of death