1. Pathophysiology
BMS 243
Hypertension
Dr. Aya M. Serry
2017

2. Blood Pressure
Blood is carried to all parts of the body in vessels called arteries.
Blood pressure is the force of blood pushing against the arteries.

3. When the heart is at rest, between beats, the blood pressure falls.
Each time the heart beats (about times a minute at rest), it pumps out blood into the arteries.
The blood pressure is at its highest level when the heart beats, pumping the blood.
When the heart is at rest, between beats, the blood pressure falls.
This is called SYSTOLIC pressure.
120/
Top number 80
This is called DIASTOLIC pressure.
Bottom number
The blood pressure is always given as these two numbers with one above or before the other.

4. “Normal” blood pressure is when both numbers are lower than 120/80.
Category
Systolic
(Top Number)
Diastolic
(Bottom Number)
Normal
Less than 120
Less than 80
“Normal” blood pressure is when both numbers are lower than 120/80.
Doctors classify blood pressures under 140/90 as either "normal," or "prehypertension."
"Normal" blood pressures are lower than 120/80.

5. Unless he takes ACTION to prevent it!
“Prehypertension”
NEW!!!
If the blood pressure is in the prehypertensive range:
Prehypertension
80-89
It means that the patient does not have high blood pressure now, but he is likely to develop it in the future.
Unless he takes ACTION to prevent it!
WE’LL TALK ABOUT SOME OF THOSE ACTIONS HERE IN A FEW MINUTES.

6. High Blood Pressure
When blood pressure stays elevated over a long period of time it is called high blood pressure or “hypertension”.
TENSE, SUDDEN EXERTION – CAN ELEVATE YOUR BP TEMPORARILY,
EX: “WHITECOAT HYPERTENSION”
HIGH BP IS WHEN IT IS ELEVATED OVER A LONG PERIOD OF TIME
CHECK REGULARLY - RECORD WHAT YOUR BP IS.
SHOW BP CARDS
High blood pressure is dangerous because it makes the heart work too hard and contributes to hardening of the arteries .

7. High Blood Pressure “Hypertension”
A blood pressure of 140/90 is considered high blood pressure.
High Blood Pressure
Systolic
Diastolic
Stage 1
90-99
LIKE MANY DISEASES…THERE ARE STAGES, OR LEVELS. HIGH BP ALSO HAS STAGES.
STAGE 1 – NEED TO GET REGULAR MEDICAL CARE FROM DOCTOR
STAGE 2 – URGENCY HERE – SHOULD GET IN TO SEE YOUR DOCTOR THIS WEEK. GREATER RISK FOR STROKE, HEART ATTACK HERE.
* For adults 18 and older who:
Are not on medicine for high blood pressure
Are not having a short-term serious illness
Do not have other conditions such as diabetes and kidney disease
Note: When systolic and diastolic blood pressures fall into different categories, the higher category should be used to classify blood pressure level. For example, 160/80 would be stage 2 high blood pressure. There is an exception to the above definition of high blood pressure. A blood pressure of 130/80 or higher is considered high blood pressure in persons with diabetes and chronic kidney disease.
Stage 2
160 or higher
100 or higher

8. High Blood Pressure Warning Signs: “Silent Killer” 1. 2. 3. 4.
If undetected or left untreated it can cause:
Heart failure
Heart attack
Kidney disease
Blindness

9. Hypertension etiology
The exact causes of high blood pressure are not known, but several factors and conditions may play a role in its development, including:
Smoking
Being overweight or obese
Lack of physical activity
Too much salt in the diet
alcohol consumption

10. Stress
Older age
Genetics (Family history of high blood pressure)
Chronic kidney disease
Adrenal and thyroid disorders.

11. Hypertension Complications
Increases your risk for :
Heart disease & Stroke
If left uncontrolled, hypertension can also cause:
Heart failure
Heart Attack
Kidney disease
Blindness

12. Complications of Hypertension
High blood pressure is the most important risk factor for stroke. Very high pressure can cause a break in a weakened blood vessel, which then bleeds in the brain. This can cause a stroke. If a blood clot blocks one of the narrowed arteries, it can also cause a stroke.
Stroke
Heart Attack
High blood pressure is a major risk factor for heart attack. The arteries bring oxygen-carrying blood to the heart muscle. If the heart cannot get enough oxygen, chest pain, can occur. If the flow of blood is blocked, a heart attack results.
Blindness
High blood pressure can eventually cause blood vessels in the eye to bleed. Vision may become blurred or otherwise impaired and can result in blindness.
Heart failure
The heart is unable to pump enough blood to supply the body's needs.
Heart Attack - High blood pressure is a major risk factor for heart attack. The arteries bring oxygen-carrying blood to the heart muscle. If the heart cannot get enough oxygen, chest pain, can occur. If the flow of blood is blocked, a heart attack results.
Heart Failure -
As people get older, arteries throughout the body "harden," especially those in the heart, brain, and kidneys. High blood pressure is associated with these "stiffer" arteries. This, in turn, causes the heart to work harder.
Arteries
Kidney disease
Kidneys act as filters to rid the body of waste. High blood pressure can narrow and thicken the blood vessels of the kidneys. The kidneys filter less fluid and waste builds up in the blood. The kidneys may fail altogether.

13. Pathophysiology of hypertension1
Renin angiotensin aldosteron System(RAAS) 2
Sympathetic control 3
Endothelial control

14. Renin-Angiotensin-Aldosterone System
Renin is a proteolytic enzyme produced by cells of kidney.
It is secreted in response to:
Decrease in arterial blood pressure.
Decrease Na+ .
Increased sympathetic nervous activity.
Renin acts on a protein ( Angiotensinogen) and cleaves it
to produce Angiotensin-I.
Angiotensin-I is rapidly converted to Angiotensin-II by ACE (angiotensin converting enzyme)
Angiotensin-II stimulates Aldosterone secretion from Adrenal Cortex which causes sodium and water retention..

15. Renin-Angiotensin-Aldosterone System
From liver
Angiotensinogen
From
kidney
Renin
Angiotensin I
ACE
Angiotensin II
Vasoconstriction
Aldosterone
secretion
Sodium & fluid
retention

16. Sympathetic control of blood pressure
Sympathetic stimulation and catcholamines
(Adrenaline and nor adrenaline )
Stimulation of
Beta receptors
vasodilatation BP
Stimulation of
Alpha receptors
vasoconstriction BP
Vasoconstriction activated by  -adrenergic receptors would override vasodilatation by  -adrenergic receptors.

17. Endothelial control Endothelin BP Thromboxane A2 BP Vasoconstriction
Vasodilatation
Prostacyclin
Histamine BP
Bradykinin

18. Treatment of hypertension

19. Treatment of hypertension
Different categories of antihypertensive drugs are used as:
Diuretics: Acts on Kidneys to increase excretion of Na and H2O – decrease in blood volume – decreased BP.
Angiotensin-converting Enzyme (ACE) inhibitors:
Inhibit synthesis of Angiotensin II –decreased BP.
α-adrenergic blockers:
Bind to alpha adrenergic receptors and blocks the activity, vasodilatation- decreased BP.

20. Non pharmacological prevention of
Hypertension
You can take action to prevent getting high blood pressure or take steps to control it!
See your doctor for regular blood pressure check ups
Maintaining a healthy weight
Choose and prepare foods with less salt x
Eat a healthy diet rich in vegetables and fruits, and low fat dairy foods
Get physically active
If you smoke, think about quitting
Drinking too much alcohol can raise blood pressure. It also can harm the liver, brain, and heart. Alcoholic drinks also contain calories, which matter if you are trying to lose weight. If you drink alcoholic beverages, have only a moderate amount — one drink a day for women; two drinks a day for men.
What counts as a drink?
12 ounces of beer (regular or light, 150 calories), or 5 ounces of wine (100 calories), or 1 ounces of 80-proof whiskey (100 calories).
SALT
A key to healthy eating is choosing foods lower in salt and sodium. Most Americans consume more salt than they need. The current recommendation is to consume less than 2.4 grams (2,400 milligrams[mg] ) of sodium a day. That equals 6 grams (about 1 teaspoon) of table salt a day. The 6 grams include ALL salt and sodium consumed, including that used in cooking and at the table. For someone with high blood pressure, the doctor may advise eating less salt and sodium, as recent research has shown that people consuming diets of 1,500 mg of sodium had even better blood pressure lowering benefits. These lower-sodium diets also can keep blood pressure from rising and help blood pressure medicines work better.
Losing even 10 pounds can lower blood pressure

21. Live Healthy Our heart health depends on it!
1. GET YOUR BLOOD PRESSURE CHECKED.
2. EAT HEALTHY FOODS.
3. GET PLENTY OF EXERCISE.
MAIN MESSAGE – 1,2,3,
PREVENTION, PREVENTION, PREVENTION!!
YOU ARE IN CONTROL MOST HEART DISEASE RISK FACTORS
NOT IN CONTROL OF:
AGE
FAMILY HX
Our heart health depends on it!
Source: Your Guide To Lowering Blood Pressure,