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Hypertension

Perseptor: Riardi Pramudiyo, dr.,SpPD-KR

M.Ilham Akbar Matoha


Windhi Ayudhia
Vanessa Natasha
Veshegan A/L Ranganathan
Definition
• Persistenly high blood pressure
Staging(JNC VII)
Mechanism
Mechanism
Mechanism
INTRAVASCULAR VOLUME

When NaCl intake exceeds the capacity of the kidney to excrete


sodium, vascular volume may initially expand and cardiac output may
increase.
Mechanism
AUTONOMIC NERVOUS SYSTEM

• Sympathetic stimulate the a1 receptor result in vasoconstriction.


 increase Resistence
• β1 receptors stimulates the rate and strength of cardiac contraction
and consequently increases cardiac output.
• Baroreflex mechansim
Mechanism
RENIN-ANGIOTENSIN-ALDOSTERONE
Mechanism
VASCULAR MECHANISMS
• Remodeling refers to geometric alterations in the vessel wall without
a change in vessel volume.
• Hypertrophic, or eutrophic vascular remodeling results in decreased
lumen size and, hence, increased peripheral resistance
• Vessels with a high degree of elasticity can accommodate an increase
of volume with relatively little change in pressure
PRIMARY HYPERTENSION
• 80–95% of hypertensive patients are diagnosed as having primary
hypertension.
• tends to be familial
• likely to be the consequence of an interaction between
environmental and genetic factors.
OBESITY AND THE METABOLIC SYNDROME
Free fatty acids (FFAs) are released in abundance from an expanded adipose
tissue mass

In the liver, FFAs result in increased production of glucose

The increase in circulating glucose, and to some extent FFAs, increases


pancreatic insulin secretion, resulting in hyperinsulinemia.

Hyperinsulinemia may result in enhanced sodium reabsorption and


increased sympathetic nervous system (SNS) activity and contribute to
hypertension
RENAL PARENCHYMAL DISEASES
• Renal disease is the most common cause of secondary hypertension.
RENOVASCULAR HYPERTENSION
• In the initial stages, the mechanism of hypertension generally is
related to activation of the renin-angiotensin system
PRIMARY ALDOSTERONISM
CUSHING’S SYNDROME
PHEOCHROMOCYTOMA
MISCELLANEOUS CAUSES OF HYPERTENSION
MONOGENIC HYPERTENSION
APPROACH TO THE PATIENT
History Taking
• Most patients with hypertension have no specific symptoms referable
to their blood pressure elevation
• hypertensive headache occur in the morning and is localized to the
occipital region
• Other nonspecific symptoms that may be related to elevated blood
pressure include:dizziness, palpitations, easy fatigability and
impotence.
APPROACH TO THE PATIENT
History Taking
APPROACH TO THE PATIENT
Physical Examination
• Vital sign Heart rate ,Respiratory rate, temperature and Especially
Measurement of Blood Pressure
• weight and height
• Palpate Thyroid Gland
• Funduscopic Examination(increased arteriolar light reflex, arteriovenous
crossing defects, hemorrhages, exudates, papilledema)
• palpation of femoral and pedal pulses
• auscultation for bruits over the carotid and femoral arteries
• Examination of the heart
APPROACH TO THE PATIENT
Laboratory Examination