Dr Atapour Nephrologist Hypertension Blood pressure levels are

Dr. Atapour Nephrologist

Hypertension • Blood pressure levels are a function of cardiac output multiplied by peripheral resistance (the resistance in the blood vessels to the flow of blood) • BP = CO X PVR

• It is commonest CVD • It is a major Risk Factor for CV mortality, CHD, CVA, CHF, and Renal Failure • The relationship between BP and risk of CVD events is continuous, consistent, and independent of other RFs. • The higher the BP the greater the chance of heart attack, HF, stroke, and kidney diseases.

• It affects about 25% of adult population • About 75% of hypertensive individuals are unaware of being diseased • About 50% of hypertensive patients who knew they are diseased are either not on treatment or taking treatment but not controlled.

Risk Factors of HTN 1. Hereditary factors : positive family history 2. Genetic factors: certain genes as ACE gene 3. Early life exposure to certain events: as LBW 4. Certain childhood predictors: as BP response to exercise, weight gain, LV mass…

Risk Factors of HT 5. Body weight: overweight individual has 2 -6 times higher risk having HT compared to a normal weight individual. 6. Central Obesity and Metabolic Syndrome: high waist/hip ratio is positively associated with HT 7. Nutritional factors: positive association between Nacl intake and HT, negative association between potassium intake and HT, and no relation with other nutrients.

Risk Factors of HT 8. Alcohol intake : causes acute and chronic increase in BP level 9. Physical Inactivity : Sedentary unfit individual has 2050% excess risk to have HT 10. Heart rate : Ht patients have HR than normotensive individuals 11. Psychological factors: acute mental stress causes increase in BP level 12. Environmental factors: noise, air pollution

Hypertension • The major factors which help maintain blood pressure (BP) include the sympathetic nervous system and the kidneys. • Optimal healthy blood pressure is a systolic blood pressure of <120 mm. Hg and a diastolic blood pressure of <80 • <120/80.

Hypertension Category Systolic Blood Pressure Diastolic Blood Pressure Normal < 120 <80 Pre-hypertension 120 -139 80 -89 Hypertension – Stage 140 -159 1 90 -99 Hypertension – Stage >160 2 >100

Hypertension • Approximately one in four American adults has hypertension. • As many as 2. 8 million children also have high blood pressure. • The prevalence of hypertension increases with age.

Prevalence of Hypertension by Age • Age • % Hypertensive – 18 -29 – 4 – 30 -39 – 11 – 40 -49 – 21 – 50 -59 – 44 – 60 -69 – 54 – 70 -79 – 64 – 80+ – 65

Hypertension • When the normal regulatory mechanisms fail, hypertension develops. • Hypertension is so dangerous because it gives off no warning signs or symptoms.

n. Untreated hypertension can result in: n. Arteriosclerosis n. Heart Attack n. Enlarged heart --Kidney damage --Stroke --Blindness

Factors Influencing the Development of Hypertension • High-normal blood pressure • Family history of hypertension • African-American ancestry • Overweight

Factors Influencing the Development of Hypertension • Excess Consumption of Sodium Chloride • Certain segments of the population are ‘salt sensitive’ because their blood pressure is affected by salt consumption • 30 -50% of Hypertensive individuals and ~ 25% normotensive individuals

Factors Influencing the Development of Hypertension • Alcohol consumption – 5 -7% of the hypertension

Factors Influencing the Development of Hypertension • Exercise • Less active individuals are 30 -50% more likely to develop hypertension.

Factors Influencing the Development of Hypertension • Other Dietary Factors • Potassium: • Calcium: • Magnesium:

General Approach to the Patient • Confirm that the patient’s blood pressure (BP) has been accurately measured using – Correct positioning with an appropriately sized cuff

• If white coat hypertension suspected – Ambulatory BP monitoring can be useful to rule out

General Approach to the Patient • Important to review – The patient’s diet and medication use for other potential causes of HT • Excessive consumption of – Sodium, – Licorice (Hindi: Jethimadh, Mulhathi), or – Alcohol is known to increase BP

General Approach to the Patient • Many drugs affect BP – A trial period off of a potentially offending medication may be all that is needed to reduce BP

General Approach to the Patient • If these potential contributors to hypertension have been excluded and • Concern for secondary hypertension remains, the physician can investigate for potential physiologic causes

Most Common Causes of Secondary Hypertension by Age* Must remember that these are not absolute categories; There may be overlap of causes between age groups

Signs and Symptoms That Suggest Specific Causes of Secondary Hypertension

Am Fam Physician 2010 Dec 15; 82(12): 1471 -8.

Factors influencing BP level: – Age: – Sex: early in life, there is no difference between – Ethnicity: Blacks have higher BP level than others

Goals: • Increase population awareness that HT is a major PH problem • Help in detection of HT patients or those at risk • Advocate life –style that eliminate controllable RFs