1: HYPERTENSION

HYPERTENSION (High Blood Pressure)

It is the blood pressure elevated enough to perfuse tissues and organs

greater than or 140 mmHg

• Systolic:

• Diastolic: equal to or greater than 90 mmHg

HYPERTENSION (High Blood Pressure)

• Persistent elevation in arterial pressure (consistent)

• Increased pressure into the walls of the arteries

Sphygmomanometer

device used to measure blood pressure

• equal to or greater than 90 mmHg

• Systolic: greater than or 140 mmHg

• Diastolic:

Peak value (heart contraction- The numerator)

In arterial blood pressure

Systolic BP =

Diastolic BP = Nadir value (heart relaxation- The denominator) - when the heart is relaxed, it fills blood that is why there is still pressure.

Nadir value (heart relaxation- The denominator) - when the heart is relaxed, it fills blood that is why there is still pressure.

In arterial blood pressure

Systolic BP = Peak value (heart contraction- The numerator)

Diastolic BP =

JNC/Joint National Commission 7

The table of hypertensionn is based on?

Mmhg: ≤ 120/80

Category:Normal

Mmhg: 120-139/80—89

Category: Prehypertension

Mmhg: ≥140/90

Category: Hypertension

Mmhg: 140-159/90—99

Category: Stage 1

Mmhg: ≥160/100

Category:Stage 2

SBP >180 or DBP > 120 mmHg

Hypertensive Emergency-

Systolic and Dystolic?

Hypertensive Emergency

End-Organ function or Organ damage

SBP> 160-180 mmHg or DBP2 100-120 mmHg

Asymptomatic Markedly Elevated Blood Pressure (formerly Hypertensive urgency)

SBP and DBP?

Asymptomatic markedly elevated blood pressure

Formerly hypertensive urgency

Primary, Essential or Idiopathic hypertension

No specific cause can be identified

Primary, Essential or Idiopathic hypertension

The average age of onset is about 35 years (90%)

renal artery constriction,

coarctation of the aorta,

pheochromocytoma,

Cushing's disease,

and primary aldosteronism.

Secondary hypertension is identifiable cause such as?

ages of 30 and 50 (10%)

Secondary hypertension develops between ages?

Renal artery constriction

kidney damage can also result to cardiovascular disorders

Pheochromocytoma

Tumor in the adrenal medulla wherein the NE is converted to Epinephrine which is the primary neurotransmitter of the sympathetic nervous system (fight or flight). Results in tachycardia in heart, vasoconstriction in vessels contributing to the increase of blood pressure

Cushing’s disease

excess of cortisol (sodium and water retention increasing blood volume at the same time, blood pressure.)

Primary aldosteronism

excess of aldosterone (sodium and water retention increasing blood volume at the same time, blood pressure.)

Age and Ethnicity

Smoking

High salt intake

Health problems

Inactive lifestyle

Alcohol

High stress level

Obesity

PREDISPOSING FACTORS IN PRIMARY HYPERTENSION

5-10 mmhg nicotine that is deposited and flows to the blood leading to obstruction of blood flow

HBP in smoking is due to?

Due to salt attracts water causing edema (water retention) resulting in high blood pressure

HBP due to high salt intake is because of?

Sedentary lifestyle that the excess energy s being used too much in heart contraction

HBP in inactive lifestyle is due to?

High cholesterol levels

HBP in Obesity is due to?

Angiotensinogen

ACE (Angiotensin converting enzyme)

B2 A drenoceptor

Alpha Adducin

Functional variation of genes that may contribute to essential Hypertension

ACE (Angiotensin converting enzyme)

Used for the conversion of Angiotensin 1 to 2 which is a potent vasoconstrictor.

BP = TPR x CO

Determinants of Blood Pressure

TPR is Total Peripheral Resistance

resistance as the heart pumps out blood

blood pressure

TPR is directly proportional to the ___

arteries
primary resistance vessels

TPR is that the ___ are the involved vessels which are also known as ____ which keep blood from coming back to the heart

10 resistance vessels

Tone of arterioles in TPR

Downward resistance (decrease BP)

TPR when dilated

Upward resistance (Increased BP)

TPR when constricted

Cardiac output

CO is?

pumped blood per minute

Cardiac output

CO = SV x HR

Equation of CO

Cardiac output

is the volume of the blood pumped by the heart per minute

Stroke volume

volume of the blood pumped by the heart every beat.

(60-80 mL)

How many mL of SV?

Heart Rate

number of beats per minute

(60-100 bpm)

How many bpm for Heart rate?

3.6 L to 8 L per minute.

How many Liters per minute?

Inotropic activity of the heart

Preload/Venous return

Factors Affecting Stroke Volume:

Strength of cardiac contraction (inotropism)

Inotropic activity of the heart

tone of veins / capacitance vessels

contain highly elastic blood

Preload / Venous Return

downward venous return

When Venous return is dilated?

upward venous return

When the venous return is constricted

1. Resistance Arterioles

2. Capacitance Venules

3. Pump output Heart

4. Volume Kidneys

CNS sympathetic nerve in BP

Baroreceptor reflex arc

Renin angiotensin-aldosterone system

Mosaic theory

Fluid volume reulation

BLOOD PRESSURE REGULATION IN THE BODY

Kidneys are responsible for volume regulation. When the amount of blood pumped by the heart decreases the kidneys will retain salt and water to be able to increase the venous return back to the heart.

When a patient has edema and HTN, salt and water must be excreted to be able to manage the high blood pressure

Explain the fluid volume regulation

1. Important in the moment-moment control of BP

2. Such as in transition from a reclining to an upright posture

3. In orthostatic hypotension, the baroreceptors will be activated to bring the blood pressure back to normal.

Baroreceptor reflex arc mechanism

Baroreceptor

It is a stretch receptor.

increase volume

increase pressure

Baroreceptors is activated in the presence of factors that distend its tissues such as:

Found in the carotid and aortic arch

Baroreceptor is found in the?

Respond to blood pressure

Influence - Arteriolar dilation & Constriction.

Baroreceptor responds to? and influence?

Affector

Central integrating area

Effector

Inhibitory interneuron

COMPONENTS OF BARORECEPTOR REFLEX ARC

AFFECTOR

Made up of carotid baroreceptors

Affector

It brings stimuli to the central area

Central integrating area

It is the central vasomotor area and It interprets the stimuli and appropriate responses

Effector

It is composed of blood vessels and the heart and It performs the function of central integrating area.

inhibitory effect

decrease sympathetic discharges.

Inhibitory interneuron when it is stimulated, it can cause an ___ on the central area to _____

Renin

an enzyme which can be secreted from the Juxtaglomerular apparatus

Renin angiotensin-aldosterone system

It is important in LONG TERM blood pressure regulation.

Kidney

In the R.A.A.S. which is responssible for the long term blood pressure control

Angiotensin II

Causing:

• Increased sodium reabsorption

• Fluid volume

• Blood pressure

In stimulates the aldosterone that can cause?

Renin is secreted juxtaglomerular apparatus then Angiotensin 1 will be converted to angiotensin 2 by the angiotensin converting enzyme (ACE) increasing the SVR for vasoconstriction. Along with them is the aldosterone which is a hormone responsible for water and sodium retention increasing the blood volume and cardiac output.

Explain the flow of the picture

When the BP becomes low the BARORECEPTOR REFLEX ARC (upper part of the diagram) will act first which results in increased sympathetic activity. Adrenoceptors have B1 activation which is located in the heart in which when activated, the heart will contract, increasing the cardiac output resulting in an increase in blood pressure. Another adrenoceptor is Alpha 1 receptor which is located in blood vessels resulting in vasoconstriction increasing TPR/PVR which also results in an increase in blood pressure.

In RAAS (lower part of the diagram)the kidneys will act by lowering the renal blood flow and glomerular filtration rate to retain the water and sodium. This will reabsorb water and salt, increasing the blood pressure. Kidneys can also form Renin from JGA producing the angiotensin 2 which is a potent vasoconstrictor resulting in an increase in TPR/PVR which leads to increasing blood pressure. Angiotensin 2 can also activate aldosterone which aids in water and salt retention increasing the blood volume.

Explain the difference in between the baroreceptor and RAAS

Mosaic Theory

multiple factors responsible for sustaining blood pressure.

the sympathetic nervous system

renin- angiotensin aldosterone system and potential defects in the sodium transport within and outside the cell may play a role in long term hypertension

Vasoactive Substances that are involved in the normal maintenance of normal blood pressure

Mosaic theory is the interaction between?

Nitric oxide

Endothelin

Bradykinin

The mosaic theory has a vasoactive substance that includes?

Nitric Oxide

The vasodilating factor

Nitric Oxide

Potent vasodilator and Decrease TPR

EDRF or Endothelium Derived Relaxing Factor

Nitric Oxide Formerly known as_____

Endothelin

This can increase TPR and a vasoconstrictor peptide

Bradykinin

Potent vasodilator inactivated by ACE and DECREASE TPR

Bradykinin

An atrial natriuretic peptide (naturally occurring diuretic)

Cardiac effects

Renal effects

Cerebral effects

Retinal Effects

COMPLICATIONS OF HYPERTENSION

Angina pain

Left ventricular hypertrophy

In the cardiac effects it includes?

Angina pain

chest pain which can radiate into the left arm

Left ventricular Hypertrophy

resulting to edema of extremities

The size of the left ventricle decreases which limits its capacity to hold oxygenated blood resulting in lower cardiac output.

Results to edema since the kidneys will retain more water and salt.

Explain the cardiac effect of the left ventricular hypertrophy

Polyuria

Nocturia

Diminished ability to concentrate urine and red blood cells in urine

Elevated serum creatine

Complication of renal effects includes the?

Polyuria

This is the urinary incontinence and an excessive urination due to HBP

Nocturia

Urination at night

Elevated serum creatinine

This complication indicated renal failure

Transient ischemic attacks

Development of aneurysm with hemmorrhage

Cerebral thrombosis

Cerebral effects can cause?

Transient ischemic attack

numbness in the half part of the body due to low oxygen supply in the brain caused by obstructed blood vessels.

Development of Aneurysm with hemorrhage

severe lack of oxygen due to blockade

Blurred vision

Spots

Blindness

Retinal effects affects the visual defects such as?

Weight reduction

Adopt DASH eating plan

Dietary sodium reduction

Physical activity

Moderation of alcohol consumption

Give the enumeration of Non-pharmacologic intervention

5-20mmHg blood pressure

every 10kg weight loss reduces _____

Adopt DASH eating plan

Consume a diet rich in fruits, vegetables, and low-fat dairy products with a reduced content of saturated fat and total fat

100mEq/d (2.4 g sodium or 6g sodium chloride)

Dietary Sodium reduction is reduce dietary sodium intake to no more than ____

(at least 30mins per day, most days of the week)

In physical activity engage in regular aerobic physical activity, such as brisk walking _____