1. Dr. Atapour Nephrologist

3. 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

4. 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.

5. 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.

6. 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…

7. Risk Factors of HT 5.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.

8. 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

9. 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.

10. Hypertension CategorySystolic Blood Pressure Diastolic Blood Pressure Normal< 120<80 Pre-hypertension120-13980-89 Hypertension – Stage 1 140-15990-99 Hypertension – Stage 2 >160>100

11. 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.

12. 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

13. Hypertension When the normal regulatory mechanisms fail, hypertension develops. Hypertension is so dangerous because it gives off no warning signs or symptoms.

14. Untreated hypertension can result in: Arteriosclerosis--Kidney damage Heart Attack--Stroke Enlarged heart--Blindness

15. Factors Influencing the Development of Hypertension High-normal blood pressure Family history of hypertension African-American ancestry Overweight

16. 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

17. Factors Influencing the Development of Hypertension Alcohol consumption – 5-7% of the hypertension

18. Factors Influencing the Development of Hypertension Exercise Less active individuals are 30-50% more likely to develop hypertension.

19. Factors Influencing the Development of Hypertension Other Dietary Factors Potassium: Calcium: Magnesium:

20. 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

21. If white coat hypertension suspected – Ambulatory BP monitoring can be useful to rule out

22. 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

23. 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

24. 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

25. 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

26. Signs and Symptoms That Suggest Specific Causes of Secondary Hypertension

27. Am Fam Physician 2010 Dec 15;82(12):1471-8.

28. Factors influencing BP level: – Age: – Sex: early in life, there is no difference between – Ethnicity: Blacks have higher BP level than others

29. Goals: Increase population awareness that HT is a major PH problem Help in detection of HT patients or those at risk Advocate life –style that eliminate controllable RFs