Dijana VidovićMentor: A. Žmegač Horvat

Force exerted by circulating blood on the arterial walls

One of principal vital signs Maximum (systolic) pressure – pressure in the artery

when the left ventricle is contracting to force the blood into aorta and other arteries

Minimum (diastolic) pressure – pressure in the artery when the ventricles are relaxing and the heart is filling up, receiving blood from veins

Sphygmomanometer

Uses the height of a column of mercury to reflect the circulating pressure

Blood pressure values – millimeters of mercury (mm/Hg)

Aneroid and electronic devices do not use mercury

Baroreceptor reflex – changes in arterial pressure – medulla (brain stem) Location : left and right carotid sinuses, aortic arch

Renin – angiotensin system (RAS) Long – term adjustment of arterial pressure Kidney - compensation Endogenous vasoconstrictor – angiotensin I

Aldosterone release (adrenal cortex) Stimulates sodium retention and potassium excretion by the kidney Increases fluid retention and indirectly arterial pressure

Chronic medical condition in which blood pressure is elevated

Systemic, arterial hypertension

Essential (primary) hypertension Secondary hypertension

High blood pressure is a result of another condition Adrenal cortical abnormalities :

Cushing’s syndrome ( adrenal glands overproduce the hormone cortisol)

More than 85 % of patients with Cushing’s syndrome have hypertension

Primary aldosteronism ( overproduction of aldosterone by adrenal glands)

Aldosteronism causes sodium and water retention, potassium excretion in the kidneys - arterial hypertension

Diseases of the kidney (polycystic kidney disease – genetic disorder of the kidneys)

Diseases of the renal arteries supplying the kidney – RENOVASCULAR HYPERTENSION

Neuroendocrine tumors (pheochromocytoma) Medication side effects (NSAID)

Inability of the kidneys to excrete sodium

An overactive renin – angiotensin system, vasoconstriction and retention of sodium and water – hypertension

An overactive sympathetic nervous system

No symptoms – many people unaware they have hypertension, accidentally found; complications:

Non–specific symptoms – mild symptoms Headache Morning headache Tinnitus – ringing in ears Dizziness Confusion Fatigue Shortness of breath Changes in vision - blindness Nausea

Anxiety Nose bleeds Heart palpitations Flushed skin Pale skin Chest pain

History

Physical examination

Measuring blood pressure – diagnosis of hypertension is based on a persistently high blood pressure

Antihypertensive drugs – act by lowering blood pressure

Aim of treatment - <140/ 90 Reduction of blood pressure by 5-6 mm/Hg

decreases the risk of stroke by 40%, coronary heart disease by 15- 20%, heart failure and mortality from vascular disease

Groups of antihypertensive drugs: ACE inhibitors (captopril, ramipril, lisinopril) Angiotensin II receptor antagonist (losartan, valsartan) Calcium channel blockers (amlodipine) Diuretics (hydrochlorothiazide) Additional diuretics such as furosemide or spironolactone Alpha blockers Beta blockers (atenolol, propranolol) Renin inhibitors (aliskiren)

Weight reduction Aerobic exercise (e.g. walking) Reducing sugar intake Reducing sodium (salt) Fruits, vegetables Lowfat or fatfree food Stopping smoking Reducing stress (relaxation therapy – meditation)

High blood pressure - major public health problem Affects approximately one in three adults in the

United States – 73 million people Affects about 2 million American teens and children

(many underdiagnosed) Normalize blood pressure and prevent

complications!

http://en.wikipedia.org/wiki/Blood_pressure Kumar P. i sur. Clinical medicine VI izd. Elsevier-

Saunders, Edinburgh 2005 Vrhovac B. i sur. Interna medicina IV izd. Naklada

Ljevak, Zagreb 2008