Hypertension sequel - 2

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HYPERTENSION Sequel of Hypertension - 2 Mohammad Ilyas, M.D. Assistant Clinical Professor University of Florida / Health Sciences Center Jacksonville, Florida USA 1

Transcript of Hypertension sequel - 2

HYPERTENSION

Sequel of Hypertension - 2

Mohammad Ilyas, M.D.

Assistant Clinical Professor

University of Florida / Health Sciences Center

Jacksonville, Florida USA 1

Outline

1. Definition, Regulation and Pathophysiology

2. Measurement of Blood Pressure, Staging of Hypertension and Ambulatory Blood Pressure Monitoring

3. Evaluation of Primary Versus Secondary

4. Sequel of Hypertension and Hypertension Emergencies

5. Management of Hypertension (Non-Pharmacology versus Drug Therapy)

6. The Relation Between Hypertension: Obesity, Drugs, Stress and Sleep Disorders.

7. Hypertension in Renal diseases and Pregnancies

8. Pediatric, Neonatal and Genetic Hypertension

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1. Nervous System

• Transient ischemic attack (TIA)

• Stroke, intracerebral and subaracnoid hemorrhage.

• Cerebral atrophy and dementia

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1a. Transient Ischemic Attack (TIA)

• Sometimes called a mini-stroke, a transient ischemic attack is a brief,

temporary disruption of blood supply to brain.

• It's often caused by atherosclerosis or a blood clot — both of which can

arise from high blood pressure.

• A transient ischemic attack is often a warning that patient is at risk of a full-

blown stroke.

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1b. Stroke

• A stroke occurs when part of brain is deprived of oxygen and nutrients,

causing brain cells to die.

• Uncontrolled high blood pressure can lead to stroke by damaging and

weakening brain's blood vessels, causing them to narrow, rupture or leak.

• High blood pressure can also cause blood clots to form in the arteries

leading to brain, blocking blood flow and potentially causing a stroke.

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Intracerebral Hemorrhage (ICH) Cerebral Aneurysm

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Stroke mortality related to blood pressure and age

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1c. Dementia

• Dementia is a brain disease resulting in problems with thinking, speaking,

reasoning, memory, vision and movement. There are a number of causes of

dementia.

• One cause, vascular dementia, can result from narrowing and blockage of

the arteries that supply blood to the brain. It can also result from strokes

caused by an interruption of blood flow to the brain.

• In either case, high blood pressure may be the culprit.

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1d. Mild Cognitive Impairment

• Mild cognitive impairment is a transition stage between the changes in

understanding and memory that come with aging and the more-serious

problems caused by Alzheimer's disease.

• Like dementia, it can result from blocked blood flow to the brain when high

blood pressure damages arteries.

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2. Effects on Kidneys

• High blood pressure can injure both the blood vessels in and leading to

kidneys, causing several types of nephropathy.

• Having diabetes in addition to high blood pressure can worsen the damage.

• Glomerular sclerosis leading to impaired kidney function and finally end

stage kidney disease.

• Ischemic kidney disease especially when renal artery stenosis is the cause of

HTN

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2a. Hypertensive Nephropathy

• Arterial hypertension leads to hyaline accumulation in the wall of small arteries and arterioles, producing the thickening of their walls and the narrowing of the lumina — hyaline arteriolosclerosis.

• Consequent ischemia will produce tubular atrophy, interstitial fibrosis, glomerular alterations and periglomerular fibrosis.

• Glomerular damage resulting in proteinuria and hematuria.

• In advanced stages, renal failure will occur. Functional nephrons have dilated tubules, often with hyaline casts in the lumens.

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Hypertensive nephropathy

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2b. Glomerulosclerosis

• Glomerulosclerosis is caused by scarring of the glomeruli due to

hypertension

• Glomerulosclerosis can progress and leading to kidney failure.

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2c. Kidney Failure

• High blood pressure is one of the most common causes of

kidney failure.

• That's because it can damage both the large arteries leading to

kidneys and the tiny blood vessels (glomeruli) within the kidneys.

• Damage to either makes it so kidneys can't effectively filter waste

from blood.

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2d. Kidney Artery Aneurysm

• An aneurysm is a bulge in the wall of a blood vessel.

• When it occurs in an artery leading to the kidney, it's known as a kidney

(renal) artery aneurysm.

• One potential cause is atherosclerosis, which weakens and damages the artery

wall. Over time, high blood pressure in a weakened artery can cause a section

to enlarge and form a bulge — the aneurysm.

• Aneurysms can rupture and cause life-threatening internal bleeding.

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Kidney artery aneurysm

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3. The Eyes

• Retinopathy, retinal hemorrhages and impaired vision.

• Vitreous hemorrhage, retinal detachment

• Neuropathy of the nerves leading to extraoccular muscle paralysis and

dysfunction

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3a. Retinopathy

• High blood pressure can damage the vessels supplying blood to retina,

causing retinopathy.

• This condition can lead to bleeding in the eye, blurred vision and complete

loss of vision.

• If patient has both diabetes and high blood pressure, he is at an even greater

risk.

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Retina Normal and Hypertensive Retinopathy

Normal Retina Hypertensive Retinopathy A: Hemorrhages

B: Exudates (Fatty Deposits)

C: Cotton Wool Spots (Micro

Strokes)

A B

C

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Stage I- Arteriolar Narrowing

Arteriolar Narrowing

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Stage II - AV Nicking

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3b. Choroidopathy

• In this condition, fluid builds up under retina because of a leaky blood vessel

in a layer of blood vessels located under the retina.

• Choroidopathy (kor-oid-OP-uh-thee) can result in distorted vision or in

some cases scarring that impairs vision.

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Stage III- Hemorrhages (H), Cotton Wool Spots and Exudates (E)

H

E

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Punctate

Choroidopathy

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3c. Optic Neuropathy

• Optic nerve damage

• This is a condition in which blocked blood flow damages the optic nerve.

• It can kill nerve cells in eyes, which may cause bleeding within eye or vision

loss.

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4. Sexual dysfunction

• In men, high blood pressure damages the lining of blood vessels in penis

and causes arteries to harden and narrow (atherosclerosis), limiting blood

flow makes it difficult to achieve and maintain erections lead to erectile

dysfunction.

• In women, high blood pressure can reduce blood flow to vagina leads to a

decrease in sexual desire or arousal, vaginal dryness, or difficulty achieving

orgasm.

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5. Other complications of HTN

• 5a. Osteoporosis. High blood pressure can increase the amount of calcium that's in urine. That excessive elimination of calcium may lead to loss of bone density (osteoporosis), which in turn can lead to broken bones. The risk is especially increased in older women.

• 5b. Obstructive sleep apnea. Trouble sleeping occurs in more than half of those with high blood pressure. It's now thought that high blood pressure itself may help trigger sleep apnea.

• Sleep deprivation resulting from sleep apnea can raise your blood pressure.

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6. Hypertensive Crises

• Hypertensive Urgencies: No progressive target-organ dysfunction. (Accelerated Hypertension)

• Hypertensive Emergencies: Progressive end-organ dysfunction. (Malignant Hypertension)

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6a. Hypertensive Urgencies

• Severe elevated BP in the upper range of stage II hypertension.

• Without progressive end-organ dysfunction.

• Examples: Highly elevated BP without severe headache, shortness of breath or chest pain.

• Usually due to under-controlled HTN.

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6b. Hypertensive Emergencies

• Severely elevated BP (>180/120mmHg).

• With progressive target organ dysfunction.

• Require emergent lowering of BP.

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Summery

• Hypertensive encephalopathy.

Problems with your brain, marked

by memory loss, personality

changes, trouble concentrating,

irritability or progressive loss of

consciousness Stroke

• Acute left ventricular failure with pulmonary edema

• Acute MI or unstable angina pectoris

• Dissecting aortic aneurysm

• Preeclampsia or eclampsia

• Acute renal failure

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Quiz 8. Hypertension can cause all of the following

Nervous System symptoms EXCEPT?

A. Transient ischemic attack (TIA)

B. Alzheimer disease

C. Seizure

D. Intracerebral and subaracnoid hemorrhage.

E. Cerebral atrophy and dementia

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Quiz 8. Hypertension can cause all of the following

Nervous System symptoms EXCEPT?

A. Transient ischemic attack (TIA)

B. Alzheimer disease

C. Seizure

D. Intracerebral and subaracnoid hemorrhage.

E. Cerebral atrophy and dementia

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Quiz 9. All of the following statement are true about Stroke,

EXCEPT?

A. A stroke occurs when part of brain is deprived of oxygen and nutrients.

B. Uncontrolled high blood pressure can lead to stroke by damaging and weakening brain's

blood vessels, causing them to narrow, rupture or leak.

C. High blood pressure can also cause blood clots to form in the arteries leading to brain,

blocking blood flow and potentially causing a stroke.

D. Stroke mortality decreases with increasing age.

E. A transient ischemic attack is often a warning for a full-blown stroke.

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Quiz 9. All of the following statement are true about Stroke,

EXCEPT?

A. A stroke occurs when part of brain is deprived of oxygen and nutrients.

B. Uncontrolled high blood pressure can lead to stroke by damaging and weakening brain's

blood vessels, causing them to narrow, rupture or leak.

C. High blood pressure can also cause blood clots to form in the arteries leading to brain,

blocking blood flow and potentially causing a stroke.

D. Stroke mortality decreases with increasing age.

E. A transient ischemic attack is often a warning for a full-blown stroke.

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Quiz 10. Which of the following statement is false about the effects

of HTN on Kidneys

A. High blood pressure can injure both the blood vessels in and leading to kidneys, causing

several types of nephropathy.

B. Having diabetes in addition to high blood pressure can worsen the damage.

C. Glomerular sclerosis leading to impaired kidney function and finally end stage kidney

disease.

D. Ischemic kidney disease especially when renal artery stenosis is the cause of HTN

E. HTN is the number one cause of renal failure worldwide

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Quiz 10. Which of the following statement is false about the effects

of HTN on Kidneys

A. High blood pressure can injure both the blood vessels in and leading to kidneys, causing

several types of nephropathy.

B. Having diabetes in addition to high blood pressure can worsen the damage.

C. Glomerular sclerosis leading to impaired kidney function and finally end stage kidney

disease.

D. Ischemic kidney disease especially when renal artery stenosis is the cause of HTN

E. HTN is the number one cause of renal failure worldwide

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Quiz 11. Following Eyes changes has been described

in patient with hypertension except?

A. Retinopathy

B. Vitreous hemorrhage

C. Uveitis

D. Retinal detachment

E. Neuropathy

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Quiz 11. Following Eyes changes has been described

in patient with hypertension except?

A. Retinopathy

B. Vitreous hemorrhage

C. Uveitis

D. Retinal detachment

E. Neuropathy

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Quiz 12. TRUE & FALSE about Hypertensive Urgencies

1. Urgent HTN is a severe elevated BP in the upper range of stage II hypertension.

2. Urgent HTN is with progressive end-organ dysfunction.

3. Highly elevated BP with severe headache, shortness of breath or chest pain.

4. Usually due to poor-controlled HTN.

5. Urgent HTN is often needs hospitalizations

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Quiz 12. TRUE & FALSE about Hypertensive Urgencies

1. Urgent HTN is a severe elevated BP in the upper range of stage II hypertension. TRUE

2. Urgent HTN is with progressive end-organ dysfunction. FALSE

3. Highly elevated BP with severe headache, shortness of breath or chest pain. FALSE

4. Usually due to poor-controlled HTN. TRUE

5. Urgent HTN is often needs hospitalizations. FALSE

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