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Source: Your Guide To Lowering Blood Pressure, www.nhlbi.nih.govc
PathophysiologyBMS 243
HypertensionDr. Aya M. Serry
2015/2016
Source: Your Guide To Lowering Blood Pressure, www.nhlbi.nih.govc
Blood Pressure
Blood pressure is the force of blood pushing against
the arteries.
Blood is carried to all parts of the body in vessels called arteries.
Source: Your Guide To Lowering Blood Pressure, www.nhlbi.nih.govc
Each time the heart beats (about 60-70 times a
minute at rest), it pumps out blood into the arteries.
Blood Pressure
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.
The blood pressure is always given as these two numbers with one above or before the other.
This is called SYSTOLIC pressure.120/To
p
num
ber
80This is called DIASTOLIC pressure.
Bottom number
Source: Your Guide To Lowering Blood Pressure, www.nhlbi.nih.govc
CategorySystolic
(Top Number)Diastolic
(Bottom Number)
Normal Less than 120 Less than 80
Normal Blood Pressure
“Normal” blood pressure is when both numbers are lower than 120/80.
Source: Your Guide To Lowering Blood Pressure, www.nhlbi.nih.govc
If the blood pressure is in the prehypertensive range:
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!
“Prehypertension”
Prehypertension 120-139 80-89
NEW!!!
Source: Your Guide To Lowering Blood Pressure, www.nhlbi.nih.govc
High Blood PressureWhen blood pressure stays elevated over a long period of time it is called high blood pressure or “hypertension”.
High blood pressure is dangerous because it makes the heart work too hard and contributes
to hardening of the arteries .
Source: Your Guide To Lowering Blood Pressure, www.nhlbi.nih.govc
High Blood Pressure
A blood pressure of 140/90 is considered high blood pressure.
High Blood Pressure Systolic Diastolic
Stage 1 140-159 90-99
Stage 2 160 or higher 100 or higher
“Hypertension”
Source: Your Guide To Lowering Blood Pressure, www.nhlbi.nih.govc
High Blood Pressure
Warning Signs:
1.2.3.4.“Silent Killer”
“Silent Killer”
Source: Your Guide To Lowering Blood Pressure, www.nhlbi.nih.govc
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:
1. Smoking
2. Being overweight or obese
3. Lack of physical activity
4. Too much salt in the diet
5. alcohol consumption
6. Stress
7. Older age
8. Genetics (Family history of high blood pressure)
9. Chronic kidney disease
10.Adrenal and thyroid disorders.
Source: Your Guide To Lowering Blood Pressure, www.nhlbi.nih.govc
Hypertension Complications
Increases your risk for :
Heart disease & StrokeHeart disease & Stroke
If left uncontrolled, hypertension can also cause:
Heart failure
Heart Attack
Kidney disease
Blindness
Source: Your Guide To Lowering Blood Pressure, www.nhlbi.nih.govc
Complications of Hypertension
Heart AttackHigh 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. BlindnessHigh blood pressure can eventually cause blood
vessels in the eye to bleed. Vision may become blurred or otherwise impaired and
can result in blindness.
Kidney diseaseKidneys 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.
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
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
Heart failureThe heart is unable to pump enough blood to supply the body's
needs.
Source: Your Guide To Lowering Blood Pressure, www.nhlbi.nih.govc
Pathophysiology of hypertension
1
•Renin angiotensin aldosteron System(RAAS)
2
•Sympathetic control
3
•Endothelial control
Source: Your Guide To Lowering Blood Pressure, www.nhlbi.nih.govc
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..
Source: Your Guide To Lowering Blood Pressure, www.nhlbi.nih.govc
Vasoconstriction
Renin-Angiotensin-Aldosterone System
Angiotensinogen
Angiotensin I
Angiotensin II
ACE
Renin
Aldosterone secretionSodium & fluid
retention
Fromkidney
From liver
Sympathetic control of blood pressure
Sympathetic stimulation and catcholamines
(Adrenaline and nor adrenaline )
Stimulation of Beta receptors
vasodilatation
Stimulation ofAlpha receptors vasoconstriction
Vasoconstriction activated by -adrenergic receptors would override vasodilatation by -adrenergic receptors.
BP
BP
Endothelial control
Endothelin
Thromboxane A2
Vasoconstriction
BP
Prostacyclin
Bradykinin
Histamine
Serotonin
Vasodilatation
BP
Treatment of hypertension
Source: Your Guide To Lowering Blood Pressure, www.nhlbi.nih.govc
1. Diuretics: Acts on Kidneys to increase excretion of Na and H2O – decrease in blood volume – decreased BP.
2. Angiotensin-converting Enzyme (ACE) inhibitors:
Inhibit synthesis of Angiotensin II –decreased BP.
3. α-adrenergic blockers:
Bind to alpha adrenergic receptors and blocks the activity, vasodilatation- decreased BP.
Treatment of hypertension
Source: Your Guide To Lowering Blood Pressure, www.nhlbi.nih.govc
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
Get physically active
Eat a healthy diet rich in vegetables and fruits, and low fat dairy foodsChoose and prepare foods with less salt
If you smoke, think about quitting
Source: Your Guide To Lowering Blood Pressure, www.nhlbi.nih.govc
1. GET YOUR BLOOD PRESSURE CHECKED.
2. EAT HEALTHY FOODS.
3. GET PLENTY OF EXERCISE.
Our heart health depends on it!
Live Healthy
Source: Your Guide To Lowering Blood Pressure, www.nhlbi.nih.govc
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