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- 1. HYPERTENSION Sequel of Hypertension Mohammad Ilyas, M.D. Assistant Clinical Professor University of Florida / Health Sciences Center Jacksonville, Florida USA 1
- 2. 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 2
- 3. Who is at Risk? Poorly controlled blood pressure (systolic) Afro-American Male Poorly adherent Pre-existing target organ damage CVA, MI, HF, CKD
- 4. Hypertension Hypertension is a well-established risk factor for adverse cardiovascular outcomes, including CHD mortality and stroke. In the worldwide INTERHEART study of patients from 52 countries, hypertension accounted for 18 percent of the population-attributable risk of a first MI.
- 5. Hypertension (cont.) Systolic blood pressure is at least as powerful a coronary risk factor as the diastolic blood pressure, particularly in older patients, and isolated systolic hypertension is now established as a major hazard for coronary heart disease and stroke . There is also evidence that the pulse pressure, which is determined primarily by large artery stiffness, is a predictor of risk
- 6. Hypertension (cont.) Although blood pressure at the time of risk assessment (current blood pressure) is typically used in most prediction algorithms, this does not accurately reflect an individual's past blood pressure experience. Past blood pressure duration as well as the degree of hypertension are both risk factors.
- 7. Hypertension (cont.) Ambulatory blood pressure measurements may be more predictive in outcome assessment. A separate issue is the goal blood pressure in patients who already have or are at high-risk for cardiovascular disease. Epidemiologic studies in the general population have shown that the risk of cardiovascular disease increases progressively at blood pressures above 110/75 mmHg .
- 8. Benefit of Rx of mild HTN
- 9. Target Organ Damage Heart Left ventricular hypertrophy Heart failure Angina Myocardial infarction Brain Transient ischemic attack (TIA) Stroke Peripheral artery disease Intermittent claudication Aortic atherosclerosis Aortic aneurysm Aortic dissection Chronic kidney disease Retinopathy
- 10. General principles Atherosclerosis, hardening and narrowing of the arteries, is primarily responsible for most complications. Atherosclerosis starts when high blood pressure damage the endothelium. This insidious process begins with endothelial dysfunction, cholesterol streak formation, these lesions progress into plaques in early adulthood, and culminate in thrombotic occlusions and coronary events in middle age and later life.
- 11. Plaques from atherosclerosis 1. They can stay within the artery wall. There, the plaque grows to a certain size and stops. Because they don't block blood flow, these plaques may never cause any symptoms 2. They can grow in a slow, controlled way into the path of blood flow. Eventually, they cause significant blockages. Pain on exertion (in the chest or legs) is the usual symptom. 3. The worst-case scenario: plaques can suddenly rupture, allowing blood to clot inside an artery, this causes a stroke or a heart attack.
- 12. The plaques to cardiovascular disease Coronary artery disease: Stable plaques in the heart's arteries cause angina. Sudden plaque rupture and clotting causes heart attack, or myocardial infarction. Cerebrovascular disease: Ruptured plaques in the brain's arteries causes strokes, with the potential for permanent brain damage. Temporary blockages in an artery can also cause transient ischemic attacks (TIAs), which are warning signs of stroke; however, there is no brain injury. Peripheral artery disease: Narrowing in the arteries of the legs caused by plaque. Peripheral artery disease causes poor circulation.
- 13. Risk factors on cardiovascular disease
- 14. HTN & CVD Hypertension is quantitatively the most important risk factor for premature cardiovascular disease, being more common than cigarette smoking, dyslipidemia, and diabetes, which are the other major risk factors. Hypertension accounts for an estimated 54 percent of all strokes and 47 percent of all ischemic heart disease events globally
- 15. HTN CVD Systolic blood pressure and isolated systolic hypertension are major risk factors at all ages in either sex. In patients
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