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Definitions

— Elevated arterial blood pressure is a major


cause of premature vascular disease leading
to cerebrovascular events, ischemic heart
disease and peripheral vascular disease.
— Blood pressure is a characteristic of each
individual, like height and weight, with
marked interindividual variation, and has a
continuous distribution.
Definitions

— › pertension (› or high blood pressure is a


chronic medical condition in which the s stemic
arterial blood pressure is elevated.
— It is classified as either primar (essential or
secondar .
— About 90±95% of cases are termed "primar
h pertension", which refers to high blood pressure
for which no medical cause can be found.
— he remaining 5±10% of cases (Secondar
h pertension are caused b other conditions that
affect the kidne s, arteries, heart, or endocrine
s stem.
Definitions

— › pertension is ver common in the


developed world;
— Is present in 20-30% of the adult population;
— › pertension rates are much higher in black
Africans (40-45% of adults.
‰ ssifictionof  eve s
(W   ssinecommendtions
‰  
 



Ôptimal BP <120 <80
ormal BP 120-129 80-84
›igh normal BP 130-139 85-89
› pertension 1 degree 140-159 90-99
› pertension 2 degree 160-179 100-109
› pertension 3 degree 3180 3110
Isolated s stolic h pertension 3140 <90
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]en>55 ears; › pertroph of left Cardiovascular
Women>65 ears; ventricular; diseases: ischemic or
Smoking; Proteinuria or hemorrhagic stroke,
Cholesterol>5,0 creatininemia 1.2-2.0 transient ischemic
mmol/l; mg/dl; stroke;
Famil anamnesis of Atherosclerosis ›eart diseases:
earl CVD; plaque; m ocardial infarction,
Diabetes mellitus Retina arteries stenocardia, coronar
constriction revascularization, heart
insufficienc ;
Kidne diseases:
diabetic nephropath ,
renal failure
Peripheral arteries
damage
Retinopath



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Definitions:mesingof 
— he blood pressure (BP of all adult patients should be
assessed at all appropriate visits for determination of
cardiovascular risk and monitoring of antih pertensive
treatment b health care professionals who have been
specificall trained to measure BP accuratel .
— BP must be measured after 5 minutes¶ resting in seating
position with appropriate cuff size.
— Standing BP should be measured in diabetic and elderl
subjects to exclude orthostatic h potension.
— When assessing the cardiovascular risk, the average BP
at separate visits is more accurate than measurements
taken at a single visit.
‰ses:geneticfctos

— BP tends to run in families and children of


h pertensive parents tend to have higher BP.
— here still remains a large unidentified
genetic component.
‰ses:fet fctos

— mow birth weight is associated with


subsequent high BP. his relationship ma
be due to fetal adaptation to intrauterine
undernutrition with long-term changes in
blood vessel structure or in the function of
crucial hormone s stem.
‰ses:envionment fctos

— Ô Fat people have higher BP than thin


people. BP must be measured with big cuff.
— |  
here is close relationship
between the consumption of alcohol and BP
level.
—  
Populations with higher
sodium intakes have higher average BP than
those with lower sodium intake.
—  
‰ses:

— ›     Autonomic nervous


s stem, renin-angiotensin, natriuretic peptide
and kallikrein-kinin s stem pla a role in the
ph siological regulation of short-term
changes in BP.
— V    here is association
between h perinsulinemia, glucose tolerance,
reduced levels of ›Dm cholesterol,
h pertrigl ceridemia, central obesit and
h pertension.

econdetension

— Is where BP elevation is the result of a


specific and potentiall treatable cause.

econdetension:cses
— Renal diseases (80%: diabetic nephropath ,
chronic glomerulonephritis, adult pol c stic
disease, chronic tubulointerstitial nephritis,
renovascular disease ± due to sodium and
water retention, elevation of plasma renin
levels.
— Endocrine causes: Conn¶s s ndrome, adrenal
h perplasia, phaeochromoc toma, Cushing¶s
s ndrome, acromegal .
— Congenital: coarctation of the aorta

econdetension:cses

— Drugs: SAIDs, oral contraceptives, steroids,


s mpathomimetics, vasopressin.
— Pregnanc : when the BP increases to >
160/100 mm›g treatment is warranted for the
protection of the mother. It is the most
common causes of maternal death (10 per
milliom pregnancies.

ignsndsmtoms

— Accelerated h pertension is associated with


headache, drowsiness, confusion, vision
disorders, nausea, and vomiting s mptoms
which are collectivel referred to as
h pertensive encephalopath .
— › pertensive encephalopath is caused b
severe small blood vessel congestion and
brain swelling, which is reversible if blood
pressure is lowered.
tosio og
— Ë               
         
               
      
- Inabilit of the kidne s to excrete sodium, resulting in
natriuretic factors such as Atrial atriuretic Factor
being secreted to promote salt excretion with the
side effect of raising total peripheral resistance;
- An overactive Renin-angiotensin s stem leads to
vasoconstriction and retention of sodium and water.
he increase in blood volume leads to
h pertension;
- An overactive s mpathetic nervous s stem, leading
to increased stress responses.
tosio og
tosio og

— Changes in the large arteries: thickening of


the media, an increase in collagen,
secondar deposition of calcium, more
pronounced arterial pressure wave;
— meft ventricular h pertroph , which results
from increased peripheral vascular resistance
and increased left ventricular load, is a
significant prognostic indicator of future
cardiovascular events.
tosio og
‰om ictions

— Cerebrovascular — Fundus showing


disease h pertensive changes
— Coronar arter
disease
— Renal failure
— Peripheral vascular
disease
— Retinopath
get-ogndmgendend-stgedisese.
mintion

— First stage ± obligator examinations all the


patients with h pertension: estimation of
organ-damage and cardio-vascular risk,
exclusion of secondar h pertension;
— Second stage ± exposure additional risk
factors and organ-damage, form of
secondar h pertension.
 | D  || | 


  
|  
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— urinal sis
— blood chemistr (potassium, sodium, and creatinine
— fasting blood glucose
— fasting total cholesterol and high densit lipoprotein cholesterol,
low densit lipoprotein cholesterol and trigl cerides
— standard 12-lead electrocardiograph
— Assess urinar albumin excretion in patients with diabetes
— An echocardiogram for assessment of left ventricular h pertroph
is useful in selected cases to help define the future risk of
cardiovascular events
— Examination of fundus
— Ultrasound of abdominal cavit
— Indirect automatic BP
measurements can be
made over a 24-hour
period using a measuring
device worn b the
patient.
— he are used to confirm
µwhite-coat¶ h pertension,
to monitor the response
of patients to drug
treatment etc.
p 

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— For nonh pertensive individuals (to reduce
the possibilit of becoming h pertensive or
for h pertensive patients (to reduce blood
pressure prescribe the accumulation of 30
min to 60 min of moderate intensit d namic
exercise (such as walking, jogging, c cling or
swimming 4 -7 da s per week, in addition to
the routine activities of dail living. ›igher
intensities of exercise are no more effective.
p 

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— ›eight, weight, and waist circumference (WC should be measured
and bod mass index (B]I calculated for all adults.
— ]aintenance of a health bod weight (B]I 18.5 kg/m² to 24.9 kg/m²
and waist circumference of less than 102 cm for men and less than
88 cm for women; 

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  is
recommended for nonh pertensive individuals to prevent
h pertension and for h pertensive patients to reduce blood
pressure. All overweight h pertensive individuals should be advised
to lose weight.
— Weight loss strategies should use a multidisciplinar approach that
includes dietar education, increased ph sical activit and
behavioural intervention.
p 

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— o reduce blood pressure, alcohol consumption
should be in both normotensive and h pertensive
individuals$ ›ealth adults should limit alcohol
consumption to 2 drinks or less per da , and
consumption should not exceed 14 standard drinks
per week for men and 9 standard drinks per week
for women (one standard drink is considered 13.6 g
or 17.2 ml of ethanol, or approximatel 44 mm of 80
proof (40% spirits, 355 mm of 5% beer or 148 mm of
12% wine.
p 

| | 

    

— It is recommended that h pertensive patients
and normotensive individuals at increased
risk of developing h pertension consume a
diet that emphasizes fruits, vegetables and
low-fat dair products, dietar and soluble
fiber, whole grains and protein from plant
sources that is reduced in saturated fat and
cholesterol.
p 

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— For prevention of h pertension, in addition to
a well-balanced diet, a dietar sodium intake
of less than 100 mmol (2,300 mg per da is
recommended.
— In h pertensive patients, dietar sodium
intake should be limited to 65 mmol to 100
mmol (1495 mg to 2300 mg per da .
p 

| | 
   
— In h pertensive patients in whom stress ma
be contributing to blood pressure elevation,
stress management should be considered as
an intervention. Individualized cognitive
behavioural interventions are more likel to
be effective when relaxation techniques are
used.
eimoftetment

— Decrease the risk of cardiovascular diseases


and chronic renal failure, rate of mortalit ;
— Influence on risk factors
— reatment of concomitant diseases
— Correction of high BP
mco ogic teso de
sedontefo owing:
mco ogic teso de
sedontefo owing:
|dvntgesnddisdvntgesofdgssedin
etensionwitesecttossocitedconditions
Dietics

— hiazide diuretics reduces the risk of stroke in


patients with h pertension but the have adverse
metabolic effects ± increase serum cholesterol,
impair glucose tolerance, h peruricaemia and
h pokalaemia (h potiazide 12,5-25mg, arifon
2,5mg.
— Furosemide is not routinel used in treatment of
h pertension.
— Spironolactone (potassium-sparing diuretic is used
in the treatment of h pertension and h pokalaemia
assocaited with primar h peraldosteronism.
|ngiotensin-convetingenzme(|‰
iniitos
— Block the conversion of angiotensin I to
angiotensin II, which is a potent
vasoconstrictor, also block the degradation of
brad kinin, a potent vasodilator.
— Potential side-effects: profound h potension
following the first dose, dr cough,
deterioration of renal function in case of
severe bilateral renovascular disease.
— Enalapril (10-20 mg, ramipril (2.5-10mg,
lisinopril (10-20 mg etc.
‰ cim-cnne  ockes

— Cause arteriolar dilatation, reduce the force


of cardiac contraction
— Useful with concomitant I›D
— Side-effects: short-acting agents, headache,
sweating, swelling of the ankles, palpitations,
flushing.
— Amlodipine (5-10mg, felodipine (5-20mg,
long-acting nifedipine (20-90mg.
et-denoceto ockes

— Side-effects: brad cardia, bronchospasm,


cold extremities, fatigue, bad dreams,
hallucinations.
— Are useful in treatment of patients with both
h pertension and angina, in ounger people
with intolerance to ACE inhibitors and
angiotensin-II receptor antagonists, women of
child-bearing potential.
— Bisoprolol (10-20mg, metoprolol (100-
200mg, propranolol (160-320mg.
|ngiotensin-ecetontgonists

— Selectivel block the receptors for


angiotensin II.
— he share man of actions of ACE
inhibitors, don¶t have an effect on
brad kinin, do not cause cough.
— mosartan (50-100mg, candersartan (up to 32
mg, telmisartan (20-80mg.
eotegents

— Alpha-blockers: cause posts naptic a1-


receptor blockade with resulting
vasodilatation. F.e. doxazosin (1-4mg,
longer-acting agent.
— Centrall acting drugs: clonidine, moxonidine;
reserve therap .
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etensivecisis

— is severe h pertension (high blood pressure


with acute impairment of an organ s stem
(especiall the central nervous s stem,
cardiovascular s stem and/or the renal
s stem and the possibilit of irreversible
organ-damage. In case of a h pertensive
emergenc , the blood pressure should be
lowered aggressivel over minutes to hours
with an antih pertensive agent.
‰ inic esenttionsofetensive
emegencies:
— cerebral infarction (24.5%,
— pulmonar edema (22.5%,
— h pertensive encephalopath (16.3%,
congestive heart failure (12%.
— intracranial hemorrhage
— aortic dissection
— eclampsia
— acute renal failure or insufficienc
— retinopath
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ekinetic ciseste

— Sudden onset, excitation, more vegetative


features (h peremia, tachicardia, pol uria,
moisture of skin
— Beta-blockers (anaprolin 20-40 mg or egilok
50mg sublinguall
— Calcium-channel blockers (nifedipine 10 mg
sublinguall
— Relanium 5 mg (1-2ml i/m
okinetic ciseste

— Against a background of late disease stages


with gradual development and hard current;
cerebral and cardiac s mptoms are shown
— Calcium-channel blockers (nifedipine 10 mg
sublinguall
— ACE (capoten 12,5 mg sublinguall
— Clofelin 0,15 mg sublinguall
‰isiswitdistncesincee 
vesse s
— Dibasol 1% 6-10 ml i/v
— Euphillin 2,4%-10ml i/v
— ]gSÔ4 25%-10ml i/v slowl (vasodilating,
sedative, anticonvulsant mechanism
‰isiscom ictedwit mon
edem
— itrogl cerine 20 mg (1%-2ml i/v tin ver
slowl 8 drops in min: Initial dose 5 g/min
(]ax dose 100 g/min
— itroprusside 30 mg i/v tin : Initial dose 0.3
g/kg/min (]ax dose 10 g/kg/min
— Promedol 2%-1ml i/v
— masix 80-120 mg i/v
— Capoten 25-50mg