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Slide 1 - BLOOD PRESSURE & HYPERTENSION Dijana Vidović Mentor: A. Žmegač Horvat
Slide 2 - Blood pressure Force exerted by circulating blood on the arterial walls One of principal vital signs Maximum (systolic) pressure – pressure in the artery when the left ventricle is contracting to force the blood into aorta and other arteries Minimum (diastolic) pressure – pressure in the artery when the ventricles are relaxing and the heart is filling up, receiving blood from veins Sphygmomanometer
Slide 3 - SPHYGMOMANOMETER Uses the height of a column of mercury to reflect the circulating pressure Blood pressure values – millimeters of mercury (mm/Hg) Aneroid and electronic devices do not use mercury
Slide 4 - sphygmomanometer
Slide 5 - Sphygmomanometer
Slide 6 - BLOOD PRESSURE VALUES
Slide 7 - REGULATION OF BLOOD PRESSURE Baroreceptor reflex – changes in arterial pressure – medulla (brain stem) Location : left and right carotid sinuses, aortic arch Renin – angiotensin system (RAS) Long – term adjustment of arterial pressure Kidney - compensation Endogenous vasoconstrictor – angiotensin I Aldosterone release (adrenal cortex) Stimulates sodium retention and potassium excretion by the kidney Increases fluid retention and indirectly arterial pressure
Slide 8 - HYPERTENSION Chronic medical condition in which blood pressure is elevated Systemic, arterial hypertension Essential (primary) hypertension Secondary hypertension
Slide 9 - PRIMARY HYPERTENSION No medical cause Risk factors : Sedentary lifestyle Obesity ( body mass index greater than 25) Salt ( sodium) sensitivity Alcohol, smoking Family history
Slide 10 - SECONDARY HYPERTENSION High blood pressure is a result of another condition Adrenal cortical abnormalities : Cushing’s syndrome ( adrenal glands overproduce the hormone cortisol) More than 85 % of patients with Cushing’s syndrome have hypertension Primary aldosteronism ( overproduction of aldosterone by adrenal glands) Aldosteronism causes sodium and water retention, potassium excretion in the kidneys - arterial hypertension Diseases of the kidney (polycystic kidney disease – genetic disorder of the kidneys) Diseases of the renal arteries supplying the kidney – RENOVASCULAR HYPERTENSION Neuroendocrine tumors (pheochromocytoma) Medication side effects (NSAID)
Slide 11 - pathophysiology Inability of the kidneys to excrete sodium An overactive renin – angiotensin system, vasoconstriction and retention of sodium and water – hypertension An overactive sympathetic nervous system
Slide 12 - SIGNS AND SYMPTOMS No symptoms – many people unaware they have hypertension, accidentally found; complications: Non–specific symptoms – mild symptoms Headache Morning headache Tinnitus – ringing in ears Dizziness Confusion Fatigue Shortness of breath Changes in vision - blindness Nausea
Slide 13 - SIGNS AND SYMPTOMS Anxiety Nose bleeds Heart palpitations Flushed skin Pale skin Chest pain
Slide 14 - COMPLICATIONS OF HYPERTENSION
Slide 15 - DIAGNOSIS History Physical examination Measuring blood pressure – diagnosis of hypertension is based on a persistently high blood pressure
Slide 16 - TREATMENT Antihypertensive drugs – act by lowering blood pressure Aim of treatment - <140/ 90 Reduction of blood pressure by 5-6 mm/Hg decreases the risk of stroke by 40%, coronary heart disease by 15- 20%, heart failure and mortality from vascular disease Groups of antihypertensive drugs: ACE inhibitors (captopril, ramipril, lisinopril) Angiotensin II receptor antagonist (losartan, valsartan) Calcium channel blockers (amlodipine) Diuretics (hydrochlorothiazide) Additional diuretics such as furosemide or spironolactone Alpha blockers Beta blockers (atenolol, propranolol) Renin inhibitors (aliskiren)
Slide 17 - PREVENTION Weight reduction Aerobic exercise (e.g. walking) Reducing sugar intake Reducing sodium (salt) Fruits, vegetables Lowfat or fatfree food Stopping smoking Reducing stress (relaxation therapy – meditation)
Slide 18 - conclusion High blood pressure - major public health problem Affects approximately one in three adults in the United States – 73 million people Affects about 2 million American teens and children (many underdiagnosed) Normalize blood pressure and prevent complications!
Slide 19 - references http://en.wikipedia.org/wiki/Blood_pressure Kumar P. i sur. Clinical medicine VI izd. Elsevier- Saunders, Edinburgh 2005 Vrhovac B. i sur. Interna medicina IV izd. Naklada Ljevak, Zagreb 2008