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

No medical cause
Risk factors :
Sedentary lifestyle
Obesity ( body mass index greater than 25)
Salt ( sodium) sensitivity
Alcohol, smoking
Family history




High blood pressure is a result of another condition
Adrenal cortical abnormalities :
Cushings syndrome ( adrenal glands overproduce the hormone cortisol)
More than 85 % of patients with Cushings 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:
Nonspecific 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