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Hypertension

First of all we start with basic physiological information that you should know before we start with the main topic which is hypertension. Regulation of blood pressure, it is subdivided into short term regulation and long term regulation.

*SHORT TERM REGULATION


Short term regulation is about moment to moment regulation which means changing of blood pressure during changing of position: sleeping to sitting, sitting to standing. Now what is involved in controlling blood pressure is the barrow receptors which are located in the arch of the aorta and internal carotid artery (barrow receptors are collection of neurons in the mentioned areas), when there is decrease in the blood flow (blood pressure: because what maintains and control blood pressure is either cardiac output or total peripheral resistance) hypotension which also means decreased cardiac output will affect these barrow receptors and will order them to send impulse to the vasomotor center in the medulla oblongata , now vasomotor center will stimulate the sympathetic nervous system to increase the heart rate and the cardiac output which will cause peripheral vasoconstriction so by the end the blood pressure will increase.And vice versa except that vasomotor center will block sympathetic innervation (pay attention that it will not stimulate parasympathetic because the dominant system is the sympathetic nervous system not the parasympathetic)

*Long term regulation The purpose of this mechanism is to maintain volume of blood, so if there is hypotension due to severe bleeding or loss of fluid rennin which is secreted by the kidneys due to decrease in blood flow will convert angiotensinogen which is plasma protein made in the liver to angiotensin (I) then angiotensin (I) will be converted in the lungs by angiotensin converting enzymes to angiotensin (II) (because angiotensin (I) is inactive and angiotensin(II) is the active form), now the functions of angiotensin (II): 1. It is the most potent vasoconstrictor in the body. 2. It enhances the release of aldosterone from the cortex of the supra renal gland, and aldosterone will lead to sodium-water tension. 3. It increases the reabsorption of sodium and water from the proximal tubules of the kidneys. 4. It blocks bradykinnen which is a vasodilator. So the main function is to increase blood pressure. But keep in mind that when we talk about long term regulation we mean that there is a compensated blood loss (it is about losing (0.5 -1) liter of blood). Now those two mechanisms are involved in the maintenance of blood pressure in the normal conditions (short term which is nervous and control cardiac output and long term which is renal and control blood volume). Now those two mechanisms are really important to know because most of the hypotensive drugs are working as

ace inhibitors (they prevent formation of angiotensin (II) from angiotensin (I)). *Hyper tension Hypertension: - it is sustained (not continuous ) elevation of blood pressure beyond the normal average. Now as you know the normal average of blood pressure: Systolic (contraction of the left ventricle) 120139 mm. Diastolic (recoil of the aorta) 80-89mm. And you have to consider the age because a 70 year old man is not like a 20 year old man. *The symptoms of hypertension Usually there is no a sign or symptoms for hypertension, mostly it is discovered accidently, and that is why it is called a silent killer. But rarely it shows some symptoms like : 1. Headache. 2. Blurry vision. 3. Chest Pain. 4. Frequent urination at night ( to decrease volume ) *Blood Pressure Measurement We use sphygmomanometer: Systolic pressure= pressure when 1st sound is heard Diastolic pressure= pressure when last sound is heard

Blood Pressure Cuff Size: 1. Small children and small adults. 2. Average. 3. Large overweight and large adults. Recommended Blood Pressure Levels

BP Category Optimal

Systolic (mmHg) < 120 and

Diastolic (mmHg) < 80

Follow-up

Recheck 2 years

Normal

< 130

and

< 85

Recheck 2 years Recheck 1 year

High Normal

130-139

or

85-89

The American heart association

*Causes of hypertension There are two situations; first one which is in (90 95) % is called primary and it is because of unknown reasons, the second one is only in (5 10) % and is called secondary and might be cardiac, renal or endocrine because these three systems are involved in the

maintenance of blood pressure, so hyper tension is due to : Major factors: 1. Kidney Abnormalities. 2. Narrowing of certain arteries. 3. Rare tumors (chromocytoma). 4. Adrenal gland abnormalities. 5. Pregnancy. Controllable factors: 1. Increased salt intake. 2. Obesity (defined by the waste circumference). 3. Alcohol. 4. Stress. 5. Lack of exercise. *Women and High Blood Pressure There are some points which are considering women only which are: 1. Birth Control Pill. 2. Pregnancy. 3. Overweight. 4. After Menopause. 5. African Americans. Now the hypertension is the cardiac output multiplied by total peripheral resistance so if there is increase in cardiac output, the blood pressure will increase. And if there is increase in peripheral resistance, the blood pressure will increase. Because blood pressure is the force exerted on a unit area of blood vessel.

*Complications of hyper tension Hypertension will lead to: 1. Ischemic heart diseases. 2. Myocardial infarction. 3. Stroke(thrombosis or bleeding in the brain). 4. Congestive heart failure. 5. Kidney failure. 6. Heart attack. 7. Heart rhythm problems. 8. Aneurysm. *What Can I Do? High blood pressure is a lifelong disease blood pressure can be controlled but not cured, controlling blood pressure will reduce the risk of stroke, heart attack, heart failure and kidney disease. And there are some points will much more help in controlling blood pressure which are: 1. Lose weight if your overweight. 2. Get regular physical activity. 3. Avoid excessive alcohol. 4. Stop smoking. 5. Manage your stress. 6. Decrease salt intake. 7. Eat for heart health. 8. Discuss the use of oral contraceptives with your doctor. 9. Discuss the use of some medications with your doctor.

*Medication of hypertension 1. Diuretics:Rid the body of excess fluids and salt. 2. Beta-blockers: Reduce the heart rate and the work of the heart. 3. Calcium antagonists: Reduce heart rate and relax blood vessels. 4. Angiotensin II receptor blockers (ACE): Interfere with the bodies production of angiotensin, a chemical that causes the arteries to constrict (narrow). 5. Vasodilators: Cause the muscle in the wall of the blood vessels to relax, allowing the vessel to dilate (widen). Now hyper tension is two types according to responding to those medications: 1. Malignant: highly developed (suddenly) and if it is not treated, it will be fatal. 2. Resistant:does not respond to a treatment of three medications one of them is diuretic.