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    Cardiovascular disease is the leading cause of death worldwide. Hypertension, or high blood pressure, is the most common cardiovascular disease. Untreated hypertension damages blood vessels and contributes to diseases like heart disease and stroke. Hypertension is classified based on systolic and diastolic blood pressure. It is usually asymptomatic but can lead to organ damage if uncontrolled. Treatment involves lifestyle modifications and medications to lower blood pressure.

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    Cardiovascular disease is the leading cause of death worldwide. Hypertension, or high blood pressure, is the most common cardiovascular disease. Untreated hypertension damages blood vessels and contributes to diseases like heart disease and stroke. Hypertension is classified based on systolic and diastolic blood pressure. It is usually asymptomatic but can lead to organ damage if uncontrolled. Treatment involves lifestyle modifications and medications to lower blood pressure.

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    14 views11 pages

    Cardiovascular Disease: Epidemiology, 2018

    Uploaded by

    Princess Diannejane Murla
    Cardiovascular disease is the leading cause of death worldwide. Hypertension, or high blood pressure, is the most common cardiovascular disease. Untreated hypertension damages blood vessels and contributes to diseases like heart disease and stroke. Hypertension is classified based on systolic and diastolic blood pressure. It is usually asymptomatic but can lead to organ damage if uncontrolled. Treatment involves lifestyle modifications and medications to lower blood pressure.

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    CARDIOVASCULAR DISEASE

    EPIDEMIOLOGY, 2018

    Source:
    https://www.statista.com/statistics/1120528/philippi
    nes-leading-causes-mortality-by-disease/
    HYPERTENSION
    o Hypertension, also known as HIGH BLOOD PRESSURE, is a condition in which the blood vessels have persistently
    raised pressure (WHO).
    o Most common cardiovascular disease.
    o Untreated high blood pressure damages blood vessels, accelerates atherosclerosis, and produces left ventricular
    hypertrophy. These abnormalities contribute to the development of IHD, stroke, heart failure, renal failure, which
    are among the most common causes of death worldwide.

    PRIMARY HYPERTENSION SECONDARY HYPERTENSION


    Aka: ESSENTIAL HTN Approximately 10% of HTN cases
    90% of HTN cases with no clear cause With underlying cause (mostly reversible)
    Genetic and Lifestyle factors are implicated • Pheochromocytoma
    • Old age • Hyperaldosteronism
    • Obesity • Cushing’s disease/syndrome
    • Lack of exercise • Hyperthyroidism
    • Sedentary lifestyle • CKD
    • Elevated dietary sodium intake • Chronic alcohol use
    • Use of OCPs and NSAIDs
    • Use of illicit drugs (Cocaine)
    BLOOD PRESSURE
    ▪ Blood is carried from the heart to all parts of the body in the
    vessels. Each time the heart beats, it pumps blood into the
    vessels.
    SYSTOLE
    Indicates how
    BLOOD PRESSURE much pressure the
    is created by the force of blood pushing against the walls of blood is exerting
    blood vessels (arteries) as it is pumped by the heart. against the artery
    walls when the
    heart beats or
    contracts.

    DIASTOLE
    Indicates how
    DETERMINANTS:
    much pressure the
    • Cardiac Output blood is exerting
    • Peripheral Vascular Resistance against the artery
    • Elasticity of vessel walls walls while the heart
    is resting between
    beats.
    HYPERTENSION
    JNC 8 CLASSIFICATION
    SYSTOLIC BP DIASTOLIC BP
    CATEGORY
    (mmHg) (mmHg)

    Normal 120 80

    Pre-HTN 120-139 80-89

    HTN >140 >90


    Stage 1 140-159 90-99
    Stage 2 >160 >100

    SIGNS & SYMPTOMS


    Most common signs and symptoms include:
    • Headache
    • Blurred vision • Essential HTN: Asymptomatic (Silent Killer)
    • Chest pain → patients may have already experiencing occurring
    damages without feeling ill.

    • Secondary HTN: associated with the underlying cause


    HYPERTENSIVE CRISIS Conditions

    HYPERTENSIVE URGENCY HYPERTENSIVE EMERGECY/ MALIGNANT HTN


    → Systolic BP >180 mmHg; diastolic BP >120 mmHg → Systolic BP >180 mmHg; diastolic BP >120 mmHg
    → Asymptomatic → Symptomatic that may lead to organ damage
    → no target organ damage (brain, kidneys, heart) → Requires ICU admission
    Management: Management:
    • Rapid oral acting Antihypertensive Drugs • IV infusion of Antihypertensive Drugs (Nicardipine,
    (Clonidine, Nifedipine, Captopril, Labetalol) Esmolol, Fenoldopam, Phentolamine, Labetalol)
    HYPERTENSIVE CRISIS Conditions

    GESTATIONAL HYPERTENSION
    Feature Gestational HTN Pre-Eclampsia Eclampsia
    → Pre-Eclampsia + Tonic-clonic Seizures
    HTN + ++
    Management: IV Epsom Salt
    Proteinuria Negative Positive

    Gestational Usually, late Usually, early


    (after 20 weeks of (before 20 weeks of
    Age gestation) gestation)

    Antihypertensive drugs for pregnant patients:


    • Methyldopa
    • Labetalol
    • Nifedipine
    • Hydralazine
    HTN Blood Pressure Control and Regulation
    Hydraulic Equation

    BP = CO x PVR
    CARDIAC OUTPUT Determinants of Stroke Volume
    → volume of blood pumped out by the ventricle per minute (mL/ minute) A. HEART RATE
    → Positive and Negative Chromotropic agents
    STROKE VOLUME
    CO = HR x SV → Volume of blood pumped out by the
    ventricles per contraction/ beat
    → Volume (mL)/ beat
    HEART RATE B. INOTROPY
    → heart conductivity → defined as the strength or force of contraction
    → beats/minute
    HTN Blood Pressure Control and Regulation
    C. PRELOAD/ End Diastolic Volume
    → defined as the volume of blood in the ventricles prior to contraction (heart
    is relaxed; ventricles are being filled with blood)

    C.1. VENOUS TONE C.2. BLOOD VOLUME


    → Fluid content of the blood
    VENOCONSTRICTION
     Blood Volume = ___ Preload – Stroke Volume
    • Venous capacitance is reduced.
    • Blood is mobilized into the heart. __ Preload

    VENODILATION

    • Venous capacitance is increased.


    • Blood is de-mobilized by storage in
    veins. __ Preload
    HTN Blood Pressure Control and Regulation
    Hydraulic Equation

    BP = CO x PVR
    PERIPHERAL VASCULAR
    VENOCONSTRICTION
    RESISTANCE
    Aka: Total Vascular Resistance (TVR), Systemic
    __ Afterload → ___ BP
    Vascular Resistance (SVR), AFTERLOAD

    → Pressure required for the blood to be ejected VENODILATION


    from the heart or the resistance ventricles must
    overcome to circulate blood
    __ Afterload → ___ BP
    HTN Mechanisms of BP Regulation
    BARORECEPTOR REFLEX
    Stimulus:  BP Stimulus:  BP
    Response: _____________ Response: _____________

    CAROTID SINUS AORTIC ARCH


    Baroreceptors Baroreceptors

    Afferent Afferent
    Nerve IX Nerve X

    Vasomotor Center Vasomotor Center


    (Brain) (Brain)

    Efferent Pre-ganglionic
    Nerve X sympathetic fibers

    Parasympathetic Sympathetic
    Action Action
    HTN Mechanisms of BP Regulation
    RENIN-ANGIOTENSIN ALDOSTERONE SYSTEM (RAAS)

    ACE
    RENIN (Angiotensin Converting Enzyme)
    ANGIOTENSINOGEN ANGIOTENSIN I ANGIOTENSIN II
    AG II binds to AG IA receptors
    Kininase II
    Effects:
    Peptidyl Dipeptidase
    1. Stimulation of autonomic ganglia.
    Triggers of Renin Release 2. Triggers the release and synthesis
    1. Beta-1 stimulation ACE degrades Bradykinin
    and Substance P in the lungs of Aldosterone.
    2. Renal Hypoperfusion 3. Release of Vasopressin.
    3. Renal Hypotension

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