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My Blood Pressure is Through the Roof, Pathophysiology of Hypertension,…
My Blood Pressure is Through the Roof
Hemodynamics
is
how blood flows through the vessels & the forces/factors affecting the flow
factors include
Flow (amount)
blood flows down a pressure gradient
flow can be
Turbulent
characterized by Reynold number
Laminar
Resistance
constriction - increases resistance dilation - decreases resistance
Velocity (speed)
velocity depends on total cross-sectional area of vessel
Pressure
affects blood pressure
which is
the force that blood exerts against blood vessel walls
which is measured by
sphygmomanometer
regulated
Short-term
by
Chemoreceptors reflexes
Baroreceptors reflexes
Intermediate-term
by
Capillary fluid shift
adrenal medulla (epi +norepi)
Atrial Natriuretic Peptide
Long-term
by
Renal system - RAAS
Complications of hypertension
complications
include
Heart
Include
Enlarged left heart
Enlarged left heart
Brain
Include
Transient ischemic attack
Stroke
Peripheral Blood Vessels
Include
Damaged and narrowed arteries.
Aneurysm
Kidneys
include
Glomeruloschlerosis
Intermittent Claudication
is
muscle pain that happens when you’re active and stops when you rest.
Retina
include
Retinopathy
Anatomy of blood vessels
General organization
Inner : tunica intima
Middle : tunica media
Outer: tunica externa
Made of
Collagen fibres
Made of
Smooth muscle
Made of
Endothelium and CT
Arteries
Elastic arteries
Tunica media
Contains
Elastic fibres
Thickest of the 3 layers
Examples
Aorta
Subclavian
Brachiocephalic
Tunica externa
Thinner than media
Contains collagen and vasa vasorum
Tunica intima
Thicker in elastic arteries than other arteries
Muscular arteries
Tunica media Contains most dominantly smooth muscle cells and few collagen fibres
Examples
Radial artery
Femoral artery
Tunica externa thicker than tunica media
Tunica intima
Has a prominent internal elastic lamina
Arterioles
Tunica media has 1-3 layers
Tunica externa and intima are thin and poorly developed
Veins
Tunica media
Thin and poorly developed
More collagen and less elastic tissue
Tunica intima
More prominent than media
Tunica externa
Thicker than media
Unlike arteries there is no clear distinction between the layers in histology
Diagnosis
History
Look for
BMI
Family History
Risk Factors
Lab Tests
Glucose
Because
Glycation -> AGEs -> Stiff Vesseles
Also for
Hyperinsulinemia
Causes
Na+ H2O reabsorbtion
Sympathetic
HR & Narrowing -> Hypertrophy
Urinalysis
Protiens: Renal function
Sediment: abnormal subs. Also indicates renal function
Creatinine
HT -> Renal obstruction > HT
Scans
ECG
LVH altered signals, LAD
You look for these because
HT is a risk factor for many coronary diseases
Clinical Signs
Moon Facies
symptom for
Cushing's syndrome
Tend to have hypercholesteremia
Abdominal bruit
Due to
Renal Art. Stenosis
Causing
Less Epinephrine clearance
Less renal blood flow
Hypertensive Emergency
Severe hypertension with BP > 180/120 mmHg
Associated with signs of target-organ damage.
Causes
Noncompliance with antihypertensive medications
Tumor of the adrenal gland
Medication interactions
patients already diagnosed with chronic hypertension.
Initial laboratory and tests
Imaging studies
CXR
Head VT/MRI (brain)
Chest ct aortic angiography
Other tests
Toxicology screen
Pregnancy test when indicated
ECG
Lab studies
Urinalysis
Creatinine
Electrolytes
Cardiac enzymes
CBC
Managements
The goal would be to lower the mean arterial pressure by 20% to 25% within the first 1 to 2 hours
Treatment options
Calcium channel Blockers
Direct vasodilators
Beta-Blockers
Epidemiology of hypertension
An estimated 1.28 billion adults aged 30-79 years worldwide have hypertension
atherosclerosis
is
the buildup of fats, cholesterol and other substances in and on the artery walls.
Pathogenesis
Endothelial injury or dysfunction
which lead to inflammatory Response
Smooth muscle cells proliferate in intima
by
Key growth factor: PDGF
Lipids
Including
LDL accumulation in intima oxidized by free radicals
Oxidized LDL engulfed by macrophages
Macrophages become foam cells
Compilations
are
Ischemia
Plaque rupture
Exposes thrombogenic substances
Clot formation
May cause acute vessel closure (STEMI)
Thrombus may embolize (stroke from carotid plaque)
Management of hypertension
Non-pharmacological approaches to HTN
Controlling Blood Pressure
Anti-hypertensive drugs
Diuretics
B-blockers
ACEIs
ARBs
Renin inhibitor
CCBs
2 more items...
Aliskiren
1 more item...
Losartan, Irbesartan
Block the AT1 receptors
1 more item...
Captopril, Enalapril, Lisinopril
Propranolol, Metoprolol, Atenolol, Nebivolol
Reduce blood pressure by decreasing cardiac output
Thiazide diuretics
Loop diuretics
K + sparing
(Amiloride, Triamterene)
(Spironolactone, Eplerenone)
Inhibitors of of epithelial sodium transport at late distal and collecting ducts (amiloride, triamterene)
Aldosterone receptor antagonists(spironolactone, eplerenone)
Furosemide
Torsemide
Blocks sodium, potassium, and chloride reabsorption in the kidneys
Hydrochlorothiazide
Chlorothalidone
Lower blood pressure initially by increasing sodium and water excretion
DASH diet
Regular exercise
Lose weight , if obese
Reduce salt and high fat diets
Pathophysiology of Hypertension
Types
Primary
due to
Hypersensitive sympathetic nervous system
Low renin hypertension
Secondary
due to
Renal parenchymal causes
*Diabetic nephropathy
*Polycystic kidney disease
*Glomerular nephritis:
Renal vascular causes
*Renal artery stenosis
Vasculitis
*Fibromascular dysplasia
Endocrine causes
Cushing syndrome
Pheochromocytoma
Conn syndrome
Hyperthyroidism/ Hypothyroidism
Hyperparathyroidism
Coarctation of the aorta
medications
Sympathomimetic drugs
Antidepressants
Oral contraceptives
Monoamine oxidase inhibitors with tyramine
Risk factors
High salt intake
Excessive alcohol
Physical inactivity
Diabetes
• Dyslipidemia
• Personality traits
Age
• Family history
Race
• Obesity
Assessed by measuring
Bodyweight
Waist circumference
Waist - hip ratio
Body mass index
.
