hypertension by alexandre sloukgi
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Hypertension
By Alexandre Sloukgi
More than ¼ of the world’s population is hypertensive
Africa
Europe
Oceania
Asia
America
Worldwide
0% 5% 10% 15% 20% 25% 30% 35%
33%
29%
26%
25%
22%
27%
2World Health Organization, 2012. (http://www.who.int/gho).
Hypertension: a growing disease
Kearney PM, Whelton M, Reynolds K, Muntner P, Whelton PK, He J. Lancet. 2005;365(9455):217-223.
2000 20250
200400600800
10001200140016001800
972 M
1560 M
Num
ber
of h
yper
tens
ives
(m
illio
n)
•Increased population
•Increased life-expectancy
+60%
Risk factors•Obesity•Diabetes•…
Hypertension: a growing disease
Kearney PM, Whelton M, Reynolds K, Muntner P, Whelton PK, He J. Lancet. 2005;365(9455):217-223.
2000 20250
200400600800
10001200140016001800
972 M
1560 M
Num
ber
of h
yper
tens
ives
(m
illio
n)
•Increased population
•Increased life-expectancy
+60%
Risk factors•Obesity•Diabetes•…
Prevalence: 26%
Prevalence: 30%
DefinitionChronic medical condition in which the blood
pressure of the arteries is persistently elevated.
Arterial hypertension example:
Systolic blood pressure(SBP)= 158mmHgDiastolic blood pressure(DBP)=99mmHg
While normal blood pressure: 120/80 mmHg
Signs and symptoms
Headaches, lightheadedness, vertigo, tinnitus(buzzing or hissing of the ears), fainting episodes.
Hypertensive crisis: severe elevated blood pressure(180/110) is categorized as hypertensive emergency or urgency according to presence or absence of end organ damage.
Pathophysiology1. Renin-angiotensin system : Ang II acts on
musculature of arteries and raises resistance=> blood pressure.
2. Endothelial dysfunction3. Autonomic nervous system: regulating
peripheral vasculature and kidney function. Excessive activity of sympathetic nervous system increases blood pressure=> hypertension
Risk factors Age Heredity Gender(male) Obesity
Smoking High cholesterol Diabetes Physical inactivity
EtiologyPrimary hypertension :
BP rises with aging mostly.
Environmental factors that influence :Stress, depression...
Events in early life can influence as well :low birth weight, maternal smoking.
Secondary hypertension :results from identifiable cause :
Kidney disease (most common)
Endocrine conditions such as :hyper/hypothyroidism, hyperaldosteronism,
hyperparathyroidism
Other causes: illegal drugs, pregnancy, obesity, sleep apnea, narrowing of aorta
Consequences of hypertension
End organ damage
Prevention Maintain normal body weight Reduce dietary sodium(<6g of NaCl/day) Engage in physical activities(>30 mins/day) Limit alcohol consumption (2-3 units/day =>
20-30 mL of pure alcohol /day ) Consume a diet rich in fruit and vegetables (at
least 5 portions a day)
Treatment
Dietary program for patients: limiting wine, meat, pastries, low-energy diet
Antihypertensive agents : calcium channel blockers, angiotensin converting enzyme (ACE) inhibitors, angiotensin receptor blockers and renin inhibitors, beta blockers, diuretics.
ACE inhibitors: a complete mode of action on RAAS and kallikrein-kinin system
Ang II
VasodilationAntiremodeli
ngAntioxidant
Antithrombotic
Ang I
Renin Angiotensin
AT1 AT2
ChymasesCathepsin G
CAGE
Dominyak and Unger (eds) in Ang II-AT1- Receptor Antagonists. Steinkopff ;1997.
Inactive peptides
Bradykinin
ACEinhibitor
Sartan
++
+
Effective 24 h bloodpressure control
Controls central aorticblood pressure
Prevents cardiacremodeling
Corrects left ventricularhypertrophy
Restores endothelialfunction
Early prevention ofatherosclerotic plaques
Reduces arterialstiffness
Stiff artery Elastic artery
References
https://www.drinkaware.co.uk/understand-your-drinking
http://www.heart.org/HEARTORG/Conditions/HighBloodPressure/WhyBloodPressureMatters/Why-Blood-Pressure-Matters_UCM_002051_Article.jsp
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