,Hypertension (HT) High Blood Pressure (HBP),Introduction,Definition: Hypertension is defined as elevated arterial blood pressure. Hypertension is one of the most common disease in the world In our country, 160 million people over the age of 15 have established or borderline HP HP Essential HP (95%) Secondary HP (5%),Etiology,Genetic EnvironmentDietary: Salt intakeAlcohol intakeObesityInfant dysnutrition,Pathogenesis,High activity of the SNS (Sympathetic Nervous System) RAAS (Renin-Angiotension Aldosterone System) Renal Sodium Handling Vascular Remodelling Endothelial Cell Dysfunction Insulin Resistance,Pathological consequences,target organs hemorrhage the CNS stroke thrombosisLVH HF HBP the Heart CHD AP MI HF arrhythmia the Kidney progressive renal nephrosclerosisprogressive scarring of the glomerularenal failurethe Arteriosclerosis stenosis thrombosis occlusiondilatation rapture hemorrhage,The pathological changes of small artery,The pathological change of the Heart,Left ventricular hypertrophy (LVH)Heart failureCoronary artery atherosclerosis Myocardial infarction,Pathological change of the Brain,Stroke: Ischemic stroke Hemorrhagic stoke,Arterial Aneurysm,Pathological change of Renal,Hypertension induced nephrosclerosis, atrophy of renal cortex,Clinical Features,The blood pressure varies widely over time, depending on many variables, including SNS activity, posture, state of hydration, and skeletal muscle tone. Symptoms:Always asymptomaticSymptoms often attributed to hypertension: headache, tinnitus, dizziness, fainting,Clinical Features,Complications of Hypertension Heart: LVH, CHD,HF Brain: TIA, Stroke Renal: Microalbuminuria, renal dysfunction Ratinopathy,Laboratory Examination,Blood pressure measurement:Clinic Blood PressureHome Blood PressureAmbulatory monitoring,Ambulatory Measurement,Ambulatory monitoring can provide: readings throughout day during usual activities readings during sleep to assess nocturnal changes measures of SBP and DBP load Exclude white coat or office hypertension Ambulatory readings are usually lower than in clinic (hypertension is defined as 135/85 mm Hg),Laboratory Examination,Urinalysis Blood examination Chest X Ray EKG UCG (Ultrasound cardiography) Retina examination,The Keith-Wagner Criteria (change in retina),KW I: Minimal arteriolar narrowing, irregularityof the lumen, and increased light reflex KW II: More marked narrowing and irregularitywith arteriovenous nicking (crossing defects) KW III: Flame-shaped hemorrhages and exudates in addition to above arteriolar changes KW IV: Any of the above with addition of papilledema,Flame shaped hemorrhage,Pepilledema,Diagnosis & Differential Diagnosis,Classification of blood pressure for adult,Category SBP (mmHg) DBP (mmHg) Normal 120 80 High normal 120-139 80-89 Hypertension 140 90Stage 1 140-159 90-99 Stage 2 160-179 100-109 Stage 3 180 110 Systolic HBP 140 90 When the SBP and DBP fall into different categories, use the higher category,Evaluation Objectives,To identify cardiovascular risk factors To assess presence or absence of target organ damage To identify other causes of hypertensionThese evaluation may used in stratification of the hypertension patients,Cardiovascular Risk Factors,Blood pressure Age Gender Dyslipidemia Abdomen Obesity Family History of cardiovascular disease CRP 1mg/dl,Target Organ Damage,Left ventricular hypertrophy Echo shows IMT of carotid artery Plasma creatinine slight elevation Microalbuminuria,Associated Clinical Condition,Cerebrovascular diseases: Stroke, TIA Heart diseases: MI, AP, CHF, Coronary artery revasculation Kidney diseases: DN, Dysfunction of the kidney, Proteinuria, CRF Diabetes Peripheral artery disease Retinopathy,Evaluation Components,Medical history Physical examination Routine laboratory tests,Stratification of Hypertension patients,TOD-Target Organ Damage; ACC-Associated Clinical Conditions,Differential Diagnosis,Should exclude Secondary Hypertension,Secondary Hypertension Common Causes,Renal Glomerulonephritis Pyelonephritis Obstructive nephropathy Collagen diseases, Congenital diseases Diabetes nephropathy Renal tumor- renin secreting tumor Pheochromocytoma Primary aldosteronism,Phenochromocytoma,Ganglion-neurotomas and neuroblastomas Excretion of large amounts of catecholamines 90% arise in the adrenal medulla 10% are malignant. Paroxymal or persist HT Clinic features: Headache, sweating, palpitations, nervousness, weight loss, hypermetabolism, orthostatic hypotension, severe presser response,Primary Aldosteronism,Mild or moderate hypertension Hypokalemia, muscle weakness, paralysis Polyuria, nocturia and polydipsia, Hypochloremic alkalosis Urine aldosterone elevation Plasma renin active decrease,