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1/27/2016

Hypertension
&
OrthostaticHypotension

Physiology 2016

Hypertension:

Detection,Evaluation,and
Treatment.

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Arterial blood pressure: normal range

BP Systolic Diastolic Follow-up


Category (mmHg) (mmHg)
Optimal < 120 and < 80 Recheck
2 years
Normal < 130 and < 85 Recheck 2
years

High 130-139 or 85-89 Recheck 1


Normal year

Range of elevated (abnormal) arterial


blood pressure: Hypertension

BP Systolic Diastolic
Follow-up
Category (mmHg) (mmHg)
Stage 1
Confirm within
(mild HTN) 140-159 or 90-99
months

Stage 2 Evaluate within


(moderate 160-179 or 100-109
1 month
HTN)

Stage 3 Evaluate
180 or > or 110 or >
(severe HTN) immediately

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FactorsAffectingHypertension
Age/sex
Morecommoninyoungermenthanyoungerwomen
Morecommonintheelderly
Race
Morecommoninblacksthanwhites
Socioeconomicgroup
Morecommoninlowersocioeconomicgroups

CategoriesofHypertension

Primaryhypertension(essentialhypertension)
Chronicelevationinbloodpressurethatoccurswithout
evidenceofotherdisease. unknown diseases

Secondaryhypertension
Elevationofbloodpressurethatresultsfromsomeother
disorder,suchaskidneydisease.

Malignanthypertension
Anacceleratedformofhypertension.

Systolichypertension
Systolicpressureof140mmHgorgreaterandadiastolic
pressureoflessthan90mmHg

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ClassificationsofEssentialHypertension
Hypertension is characterized by a persistent arterial blood
pressure in excess of 140/90 mm Hg

Systolic/diastolichypertension
Boththesystolicanddiastolicpressuresareelevated.
Diastolichypertension
Thediastolicpressureisselectivelyelevated.
Systolichypertension
Thesystolicpressureisselectivelyelevated

RiskFactorsforHypertension
Familyhistory
Agerelatedchangesinbloodpressure
Race
Insulinresistanceandmetabolicabnormalities
Circadianvariations
Lifestylefactors

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LifestyleFactorsContributingto
Hypertension

Highsaltintake
Obesity
Excessalcoholconsumption
Dietaryintakeofpotassium,calcium,and
magnesium
Oralcontraceptivedrugs
Stress

TargetOrganDamage
Heart
Hypertrophy
Brain
Dementiaandcognitiveimpairment
Peripheralvascular
Atherosclerosis
Kidney
Nephrosclerosis
Retinalcomplications

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Complications
The long-term effects of sustained hypertension are most significant
in the heart, kidneys and cerebral blood vessels.

The heart: The major morphologic feature of hypertensive heart


disease is an enlarged heart, characterized by concentric
hypertrophy of the left ventricle. This hypertrophy correlates with
a twofold to fourfold increase in the weight of the heart.
The volume of the ventricular cavity is decreased by the cardiac
hypertrophy.
When the heart no longer can compensate for its increased work
load by hypertrophy alone, cardiac dilatation and failure may
occur (in about 40% of cases). Congestive heart failure is the most
important cause of death in hypertensive patients.
Coronary atherosclerosis, which is exacerbated by the
hypertension, increases the risk for cardiac ischaemia and
infarction and for heart failure.

DrugsUsedintheTreatmentof
Hypertension

Diuretics
adrenergicblockingdrugs
Angiotensinconvertingenzyme(ACE)inhibitors
AngiotensinIIreceptorblockers
Calciumchannelblockingdrugs
Central2adrenergicagonists
1adrenergicreceptorblockers
Vasodilators

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Hypertension:
ReasonstoTreat

Reducedincidenceofstroke(3540%)
ReducedincidenceofMI(2025%)
Reducedincidenceofheartfailure(50%)

SecondaryHypertension

Mostcommoncauses:
main cause: increase in Total peripheral resistance
Kidneydisease(renovascularhypertension)
Adrenalcorticaldisorders
Pheochromocytoma(tumorofadrenalglandmedulla)
Coarctationoftheaorta(narrowingofaorta)
Sleepapnea

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sitting/ lying down > standing
BP change: decrease
systolic: 20 mmHg fall
diastolic: 10 mmHg fall

OrthostaticHypotension
Definition
Anabnormaldecreaseinbloodpressureonassumptionof
theuprightposition.20mmHgfallinsystolicblood
pressureOR10mmHgfallindiastolicbloodpressurewithin
2minutesofstanding
Causes
Decreaseinvenousreturntotheheartduetopoolingof
bloodinlowerpartofbody
compensation
Inadequatecirculatoryresponsetodecreasedcardiac
outputandadecreaseinbloodpressure

CausesofOrthostaticHypotension
Conditionsthatdecreasevascularvolume
Dehydration
Conditionsthatimpairmusclepumpfunction
Bedrest
Spinalcordinjury

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CausesofOrthostaticHypotension

Conditionsthatinterferewith
cardiovascularreflexes
Medications
Disordersofautonomicnervoussystem
Effectsofagingonbaroreflexfunction

CommonCausesofOrthostaticHypotension
RelatedtoHypovolemia

Lossofgastrointestinalfluidsthrough
vomitinganddiarrhea
Lossoffluidvolumeassociatedwith
prolongedbedrest

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ComplaintsAssociatedWithOrthostatic
Intolerance

Visualchanges
Headandneckdiscomfort
Poorconcentrationwhilestanding
Palpitations
Tremor,anxiety
Presyncope,andinsomecasessyncope

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