Dr. Atapour

Nephrologist

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

• 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.

• 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.

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…

Risk Factors of HT5.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.

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

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.

HypertensionCategory Systolic Blood

PressureDiastolic Blood Pressure

Normal < 120 <80

Pre-hypertension 120-139 80-89

Hypertension – Stage 1

140-159 90-99

Hypertension – Stage 2

>160 >100

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.

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

Hypertension

• When the normal regulatory mechanisms fail,

hypertension develops.

• Hypertension is so dangerous because it gives

off no warning signs or symptoms.

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

Factors Influencing the Development of Hypertension

• High-normal blood pressure

• Family history of hypertension

• African-American ancestry

• Overweight

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

Factors Influencing the Development of Hypertension

• Alcohol consumption– 5-7% of the hypertension

Factors Influencing the Development of Hypertension

• Exercise• Less active individuals are 30-50% more likely to

develop hypertension.

Factors Influencing the Development of Hypertension

• Other Dietary Factors

• Potassium:

• Calcium:

• Magnesium:

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

• If white coat hypertension suspected–Ambulatory BP

monitoring can be useful to rule out

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

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

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

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

Signs and Symptoms That Suggest Specific Causes of Secondary Hypertension

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

Factors influencing BP level:

– Age:

– Sex: early in life, there is no difference between

– Ethnicity: Blacks have higher BP level than others

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