1. وزارة التعليم العلي والبحث العلمي جامعة الكوفة مركز تطوير التدريس والتدريب الجامعي Hypertension & Its Impacts on Human Health الدكتور سامر نعمة ياسين الفتلاوي بكالوريوس طب و جراحة عامة / كلية الطب – جامعة الكوفة دبلوم عالي في الطب الباطني / جامعة الكوفة – كلية الطب شهادة البورد ( الدكتوراه ) في الطب الباطني / المجلس العراقي للاختصاصات الطبية bananis83@gmail.com ‎facebook.com/samir.alfatlawy.9

2. بسم الله الرحمن الرحيم وَإِذَا مَرِضْتُ فَهُوَ يَشْفِينِ صدق الله العظيم الشعراء 80

3. Hypertension Definition Hypertension is sustained elevation of BP – Systolic blood pressure  140 mm Hg – Diastolic blood pressure  90 mm Hg

4. Blood Pressure Grades BP gradesSBP mmHgDBP mmHg optimum< 120< 80 Normal< 130< 85 Pre-hypertension130-13985-89 grade 1 mild140-15990-99 Grade 2 moderate160-179100-109 Grade 3 severe> 180> 110

5. Classification of Hypertension Primary (Essential) Hypertension Primary (Essential) Hypertension - Elevated BP with unknown cause - 90% to 95% of all cases Secondary HypertensionSecondary Hypertension - Elevated BP with a specific cause - 5% to 10% in adults

6. Risk Factors for Primary Hypertension Age, Gender, Family history & Ethnicity (African Americans) Alcohol & Cigarette smoking Diabetes mellitus & Elevated serum lipids Excess dietary sodium Obesity (BMI > 30) & sedentary lifestyle Stress & Socioeconomic status

7. Classification of Hypertension Secondary Hypertension - Contributing factors: Coarctation of aorta Renal disease Endocrine disorders Neurologic disorders Secondary Hypertension - Contributing factors: Coarctation of aorta Renal disease Endocrine disorders Neurologic disorders

8. Hypertension Clinical Manifestations Frequently asymptomatic until severe and target organ disease has occurred –Fatigue, reduced activity tolerance –Dizziness –Palpitations, angina –Dyspnea –Headache is due to stress rather due to hypertension Frequently asymptomatic until severe and target organ disease has occurred –Fatigue, reduced activity tolerance –Dizziness –Palpitations, angina –Dyspnea –Headache is due to stress rather due to hypertension

9. Hypertension Complications The common complications are target organ diseases occurring in the  Heart  Brain  Kidney  Eyes The common complications are target organ diseases occurring in the  Heart  Brain  Kidney  Eyes

10. Retina Normal and Hypertensive Retinopathy Normal RetinaHypertensive Retinopathy A: Hemorrhages B: Exudates (Fatty Deposits) C: Cotton Wool Spots (Micro Strokes) A B C

11. Hypertension Diagnosis Diagnosis requires several elevated readings over several weeks (unless > 180/110) BP measurement in both arms - Use arm with higher reading for subsequent measurements Diagnosis requires several elevated readings over several weeks (unless > 180/110) BP measurement in both arms - Use arm with higher reading for subsequent measurements

12. Treatment Goals Goal is to reduce overall cardiovascular risk factors and control BP by the least intrusive means possible –BP < 140/90 –In patients with diabetes or renal disease, goal is < 130/80

13. Hypertension Lifestyle Modifications 1. Weight reduction 2. Dietary changes (DASH diet) Dietary Approaches to Stop HTN - Sodium restriction -Rich in vegetables, fruits & nonfat dairy products -Calorie restriction if overweight 3. Limitation of alcohol intake 4. Regular physical activity 5. Avoidance of tobacco use 6. Stress management

14. Hypertension Drug Therapy Diuretics ACE Inhibitors Calcium channel blockers Adrenergic inhibitors β - Adrenergic blockers Drug Therapy Diuretics ACE Inhibitors Calcium channel blockers Adrenergic inhibitors β - Adrenergic blockers