Professional Documents
Culture Documents
Hypertension
&
OrthostaticHypotension
Physiology 2016
Hypertension:
Detection,Evaluation,and
Treatment.
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1/27/2016
BP Systolic Diastolic
Follow-up
Category (mmHg) (mmHg)
Stage 1
Confirm within
(mild HTN) 140-159 or 90-99
months
Stage 3 Evaluate
180 or > or 110 or >
(severe HTN) immediately
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1/27/2016
FactorsAffectingHypertension
Age/sex
Morecommoninyoungermenthanyoungerwomen
Morecommonintheelderly
Race
Morecommoninblacksthanwhites
Socioeconomicgroup
Morecommoninlowersocioeconomicgroups
CategoriesofHypertension
Primaryhypertension(essentialhypertension)
Chronicelevationinbloodpressurethatoccurswithout
evidenceofotherdisease. unknown diseases
Secondaryhypertension
Elevationofbloodpressurethatresultsfromsomeother
disorder,suchaskidneydisease.
Malignanthypertension
Anacceleratedformofhypertension.
Systolichypertension
Systolicpressureof140mmHgorgreaterandadiastolic
pressureoflessthan90mmHg
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1/27/2016
ClassificationsofEssentialHypertension
Hypertension is characterized by a persistent arterial blood
pressure in excess of 140/90 mm Hg
Systolic/diastolichypertension
Boththesystolicanddiastolicpressuresareelevated.
Diastolichypertension
Thediastolicpressureisselectivelyelevated.
Systolichypertension
Thesystolicpressureisselectivelyelevated
RiskFactorsforHypertension
Familyhistory
Agerelatedchangesinbloodpressure
Race
Insulinresistanceandmetabolicabnormalities
Circadianvariations
Lifestylefactors
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1/27/2016
LifestyleFactorsContributingto
Hypertension
Highsaltintake
Obesity
Excessalcoholconsumption
Dietaryintakeofpotassium,calcium,and
magnesium
Oralcontraceptivedrugs
Stress
TargetOrganDamage
Heart
Hypertrophy
Brain
Dementiaandcognitiveimpairment
Peripheralvascular
Atherosclerosis
Kidney
Nephrosclerosis
Retinalcomplications
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1/27/2016
Complications
The long-term effects of sustained hypertension are most significant
in the heart, kidneys and cerebral blood vessels.
DrugsUsedintheTreatmentof
Hypertension
Diuretics
adrenergicblockingdrugs
Angiotensinconvertingenzyme(ACE)inhibitors
AngiotensinIIreceptorblockers
Calciumchannelblockingdrugs
Central2adrenergicagonists
1adrenergicreceptorblockers
Vasodilators
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1/27/2016
Hypertension:
ReasonstoTreat
Reducedincidenceofstroke(3540%)
ReducedincidenceofMI(2025%)
Reducedincidenceofheartfailure(50%)
SecondaryHypertension
Mostcommoncauses:
main cause: increase in Total peripheral resistance
Kidneydisease(renovascularhypertension)
Adrenalcorticaldisorders
Pheochromocytoma(tumorofadrenalglandmedulla)
Coarctationoftheaorta(narrowingofaorta)
Sleepapnea
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1/27/2016
sitting/ lying down > standing
BP change: decrease
systolic: 20 mmHg fall
diastolic: 10 mmHg fall
OrthostaticHypotension
Definition
Anabnormaldecreaseinbloodpressureonassumptionof
theuprightposition.20mmHgfallinsystolicblood
pressureOR10mmHgfallindiastolicbloodpressurewithin
2minutesofstanding
Causes
Decreaseinvenousreturntotheheartduetopoolingof
bloodinlowerpartofbody
compensation
Inadequatecirculatoryresponsetodecreasedcardiac
outputandadecreaseinbloodpressure
CausesofOrthostaticHypotension
Conditionsthatdecreasevascularvolume
Dehydration
Conditionsthatimpairmusclepumpfunction
Bedrest
Spinalcordinjury
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1/27/2016
CausesofOrthostaticHypotension
Conditionsthatinterferewith
cardiovascularreflexes
Medications
Disordersofautonomicnervoussystem
Effectsofagingonbaroreflexfunction
CommonCausesofOrthostaticHypotension
RelatedtoHypovolemia
Lossofgastrointestinalfluidsthrough
vomitinganddiarrhea
Lossoffluidvolumeassociatedwith
prolongedbedrest
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1/27/2016
ComplaintsAssociatedWithOrthostatic
Intolerance
Visualchanges
Headandneckdiscomfort
Poorconcentrationwhilestanding
Palpitations
Tremor,anxiety
Presyncope,andinsomecasessyncope
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