BLOOD PRESSURE

BLOOD PRESSURE IS DEFINED AS THE PRESSURE EXERTED BY THE WALL 0F THE ARTERIES DUE TO THE FLOW OF BLOOD.

BLOOD PRESSURE CAN BE EXPRESSED IN :SYSTOLIC BLOOD PRESSURE:- THE MAXIMUM PRESSURE EXERTED IN THE ARTERIES DURING THE SYSTOLE OF THE HEART. NORMAL 110-140 mm/Hg.

DISTOLIC BLOOD PRESSURE:- THE MINIMUM PRESSURE IN THE ARTERIES DURING THE DISTOLE OF THE HEART. NORMAL 60-80 mm/Hg

FACTORS MAINTAINING BLOOD PRESSURE

CENTRAL FACTORS:1) CARDIAC OUTPUT:-AMOUNT OF BLOOD PUMPED FROM EACH VENTRICLES. 2) HEART RATE PERREPHERAL FACTORS:3)PERIPHERAL RESISTANCE 4) BLOOD VOLUME 5) VELOSITY OF BLOOD FLOW 6) ELASTICITY OF BLOOD VESSELS 7) VENOUS RETURN

REGULATION OF BLOOD PRESSURE

REGULATION OF BLOOD PRESSURE

NERVOUS MECHANISM

RENAL MECHANISM

HORMONAL MECHANISM

LOCAL MECHANISM

BY VASOMOTOR CENTER & IMPULSES FROM PERIPHERY

BY REGULATION OF ECF VOLUME AND RENINANGIOTENSIN MECHANISM

BY VASOCONSTRICTION & VASODILATORS HORMONES

BY LOCAL VASOCONSTRICTORS & DILATORS

HYPERTENSION
Hypertension is a chronic medical condition in which the blood pressure is elevated to 140/90 mmHg. It is also referred to as high blood pressure.

Classification of BP

Normal 120 mmHg systolic and 80 mmHg diastolic Prehypertention 120 -139 mm Hg systolic and 80-90mm Hg diastolic Stage -1 Hypertension 140-159 mmHg systolic and 90- 99 mmHg diastolic Stage -2 Hypertention 160 mmHg systolic and 100 mmHg diastolic

CAUSES

Essential Hypertention (95 %):- B.P increases with age because of with increase of age the elasticity of the blood vessels decreases with result increase in peripheral resistance thus increase in B.P.

Secondary ( 5%)

1. DRUGS( steroids , Contraceptive pills,NSAIDS,carbenoxolone,Liquorice, sympathomimetics) 2. Cardiovascular (Coarctation of the aorta) 3. Renal (Renovascular i.e RAS and renal artery occlusion or Parenchymal i.e ch. Pyelonephritis,acute and ch.glomeronephritis,obstructive uropathy,polycystic kidney disease and hypernephromas.

4.Endocrine: ( pheochromocytoma,
1 aldosteronism, cushings,acromegaly, hyperparathyroidism and hypothyroidism).

5.Others
(brain tumors with increased intracranial pressure,bulbar poliomyelitis,connective tissue disorders i.e SLE and polyarteritis nodosa,DM nephropathy,Polycythemia rubra vera)

INITIAL or PRIMARY INVESTIGATIONS in HYPERTENSION Urinalysis Renal profile ECG Chest x-ray Renal ultrasound Urine culture FBS,s.lipids,s.urate Echocardiography

When to investigate for a secondary cause of hypertension

1.

2.
3. 4.

Clues from the history Clues from physical examination Clues from initial investigations Malignant stage hypertension

Complications of Hypertension

Cardiovascular(angina,MI,LVH,dissecting aortic aneurysm) Cerebrovascular(TIA,Thrombotic infarction,intracerebral hemorrhge,encephalopathy)

Peripheral vascular disease(atherosclorosis,

gangrene) Retinopathy(Grades1,2,3,4) Nephropathy(nephrosclerosis,fibrinoid necrosis) Malignant hypertension

Treatment of hypertension
1st. Non-pharmacological measures: 1. Diet 2. Weight reduction 3. Stopping smoking and excess alcohol consumption 4. Regular exercise ( behavioral, biofeedback therapy) 5. Treatment of other associated risk factors

B. Antihypertensive medications:
1. Diuretics + Thiazide, loop diuretics, K sparing 2. B-Blockers Non-cardioselective Cardioselective Alpha and Beta-blockers(labetolol)

2nd. Calcium-channel blockers: - Verapamil - Nifedipine - Amlodipine 3rd. ACE inhibitors : - Captopril - Enalapril - Lysinopril - Quinapril

3. Alpha-blockers ( prazosin) 4. Central acting drugs (reserpine, methyldopa,clonidine) 5. vasodilators: 1st. Direct relaxation of arteriolar smooth muscle: -Hydralazine -Minoxidil -Diazoxide -Na-nitroprusside

Parentral Drugs Used In Hypertensive Emergencies:

1. 2. 3. 4. 5. 6. 7.

Na-nitroprusside infusion Diazoxide i.v Hydralazine iv Furosemide i.v Phentolamine i.v Nifedipine s/L Labetolol i.v

( NOTE: B.P shouldnt be reduced to below diastolic of 100 mmHg )

References:K.Sembulingam E-medicine Wikipedia KDT

Thank You!