1. Cardiovascular System II

2. How do we measure blood pressure ?

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

7. The baroreceptor reflex The regulation of blood pressure

10. Hypertension

11. Where to draw the limit of “normality” ? 1 2 4 8 16 32 64 128 256 Mortalidad por enfermedad coronaria (x 1,000 pacientes) 120140160180 Usual BP (mmHg) Age 80-89 Age 70-79 Age 60-69 Age 50-59 Age 40-49 Relationship between BP and CV risk Metaanalysis of more than 60 observational studies Lancet 2002; 360: 1903–13

12. 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

13. 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:

14. Atherosclerosis

15. Normal histology of the arterial wall

16. Infiltration of lipoproteins and monocytes

17. Cell proliferation and differentiation in the wall

18. Formation of “cap” and “shoulders”

19. Rupture and thrombosis

20. Atherosclerosis

21. World Deaths in millions % of deaths Coronary heart disease7.2012.2 Stroke and other cerebrovascular diseases5.719.7 Lower respiratory infections4.187.1 Chronic obstructive pulmonary disease3.025.1 Diarrheal diseases2.163.7 HIV/AIDS2.043.5 Tuberculosis1.462.5 Trachea, bronchus, lung cancers1.322.3 Road traffic accidents1.272.2 Prematurity and low birth weight1.182.0 Top 10 world causes of death