【高血压英文PPT精品课件】 Hypertension and Hyperlipidemia
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高血压英文PPT精品课件Antihypertensive
• Diagnosis is generally based on repeated, reproducible measurements of elevated blood pressure and not on patient symptoms. Patient compliance is a major obstacle to therapy
Kidney
Na loss
Thiazides
Summary of Long Term Renal Control of BP
Regulates BP by Changing:
1.
Directly – by allowing more or less fluid to enter kidney tubules
• Pakistan (NHSP):the prevalence of hypertension is 17.9%
• 24% of the USA adult population representing 43,186,000 persons had hypertension.
Diagnosis
CNS
BV
Na retention Clonidine
CO
Venous tone
NE release
Sympathetic tone
TPR
Arteriolar tone
dry mouth sexual dysfunction
The left ventricle is markedly thickened in this patient with severe hypertension that was untreated for many years. The myocardial fibers have undergone hypertrophy.
Kidney
Na loss
Thiazides
Summary of Long Term Renal Control of BP
Regulates BP by Changing:
1.
Directly – by allowing more or less fluid to enter kidney tubules
• Pakistan (NHSP):the prevalence of hypertension is 17.9%
• 24% of the USA adult population representing 43,186,000 persons had hypertension.
Diagnosis
CNS
BV
Na retention Clonidine
CO
Venous tone
NE release
Sympathetic tone
TPR
Arteriolar tone
dry mouth sexual dysfunction
The left ventricle is markedly thickened in this patient with severe hypertension that was untreated for many years. The myocardial fibers have undergone hypertrophy.
高血压英文PPT精品课件HypertensiveDisordersin_1
BP≥ 140/90mmHg for first time during pregnancy
No proteinuria
BP returns to normal < 12 weeks’ postpartum
Final diagnosis made only postpartum
May have other signs or symptoms of preeclampsia, for example, epigastric discomfort or thrombocytopenia
7
Severity of Preeclampsia
❖ Differentiation between mild & severe preeclampsia can be misleading
-because apparently mild disease may progress rapidly to severe disease
Hypertension first diagnosed after 20weeks’ gestation and persistent after 12weeks’ postpartum
2
Gestational Hypertension – 3.7% in 150,000
(National Center for Health Statics, 2001)
Pregnancy-related hypertension :
Pregnancy-related deaths(3201명 in US, 19911997)의 16% 차지
- Proteinuria 2.0g/24hrs or ≥2+dipstick - Serum creatinine >1.2mg/dl unless known to be previously
No proteinuria
BP returns to normal < 12 weeks’ postpartum
Final diagnosis made only postpartum
May have other signs or symptoms of preeclampsia, for example, epigastric discomfort or thrombocytopenia
7
Severity of Preeclampsia
❖ Differentiation between mild & severe preeclampsia can be misleading
-because apparently mild disease may progress rapidly to severe disease
Hypertension first diagnosed after 20weeks’ gestation and persistent after 12weeks’ postpartum
2
Gestational Hypertension – 3.7% in 150,000
(National Center for Health Statics, 2001)
Pregnancy-related hypertension :
Pregnancy-related deaths(3201명 in US, 19911997)의 16% 차지
- Proteinuria 2.0g/24hrs or ≥2+dipstick - Serum creatinine >1.2mg/dl unless known to be previously
--高血压英文PPT精品课件_5
Hypertension is often symptom less, so screening is vital - before damage is done. Many surveys continue to show that hypertension remains under diagnosed, undertreated and poorly controlled in the UK
Approximately 25% are due to Reno vascular disease - most frequently atheromatous (e.g. elderly cigarette smokers with peripheral vascular disease) or fibromuscular dysplasia (more common in younger females). Endocrine disease
Secondary hypertension 5% Underlying cause
Causes of Secondary Hypertension
Renal disease
Approximately 75% are from intrinsic renal disease: glomerulonephritis, polyarteritis nodosa, systemic sclerosis, chronic pyelonephritis, or polycystic kidneys.
Hypertension, Introduction.
Hypertension is one of the most important preventable causes of premature morbidity and mortality in the UK. Hypertension is a major risk factor for stroke (ischemic and haemorrhagic), myocardial infarction, heart failure, chronic kidney disease, cognitive decline and premature death. Untreated hypertension may result in vascular and renal damage that can culminate in a treatment-resistant state.
Approximately 25% are due to Reno vascular disease - most frequently atheromatous (e.g. elderly cigarette smokers with peripheral vascular disease) or fibromuscular dysplasia (more common in younger females). Endocrine disease
Secondary hypertension 5% Underlying cause
Causes of Secondary Hypertension
Renal disease
Approximately 75% are from intrinsic renal disease: glomerulonephritis, polyarteritis nodosa, systemic sclerosis, chronic pyelonephritis, or polycystic kidneys.
Hypertension, Introduction.
Hypertension is one of the most important preventable causes of premature morbidity and mortality in the UK. Hypertension is a major risk factor for stroke (ischemic and haemorrhagic), myocardial infarction, heart failure, chronic kidney disease, cognitive decline and premature death. Untreated hypertension may result in vascular and renal damage that can culminate in a treatment-resistant state.
高血压(英文版) ppt课件
Hypertension
Introduction
Hypertension is a major public health problem throughout the world because of its high prevalence and its association with increased risk of cardiovascular disease.
<90
130140-159 140-149
Epidemiology
Prevalence rate （ 患 病 率 ） China: In 1959, In 1979, 5.11% 7.73% of hypertension in
In 1991,
11.88%
The prevalence of high BP increases with age. Hypertension is more common in men than in women up to age 50, after that age, hypertension is more common in women. Hypertension is more common in northern China than in southern China.
For instance:
21/3 1st visit: 146/98mmHg, 150/98mmHg 23/3 2nd visit: 128/84, 126/80
27/3 3rd visit: 130/80, 130/82
Notes(continue)
4. Optimal BP with respect to cardiovascular risk is less than 120/80 mmHg. However, unusually low readings should be evaluated for clinical significance. For example, 70/50 mmHg is less than 120/80 mmHg, but it is not optimal.
Introduction
Hypertension is a major public health problem throughout the world because of its high prevalence and its association with increased risk of cardiovascular disease.
<90
130140-159 140-149
Epidemiology
Prevalence rate （ 患 病 率 ） China: In 1959, In 1979, 5.11% 7.73% of hypertension in
In 1991,
11.88%
The prevalence of high BP increases with age. Hypertension is more common in men than in women up to age 50, after that age, hypertension is more common in women. Hypertension is more common in northern China than in southern China.
For instance:
21/3 1st visit: 146/98mmHg, 150/98mmHg 23/3 2nd visit: 128/84, 126/80
27/3 3rd visit: 130/80, 130/82
Notes(continue)
4. Optimal BP with respect to cardiovascular risk is less than 120/80 mmHg. However, unusually low readings should be evaluated for clinical significance. For example, 70/50 mmHg is less than 120/80 mmHg, but it is not optimal.
高血压(英文版) ppt课件
arteriole structure Compliance of Vessel wall
ppt课件 6
Psychological factors Renin –angiotensin aldosterone system（RAAS） Sodium and hypertension Abnormality of vascular endothelium（ET，NO， AngII, PGI2, etc) Insulin resistance revascularization other（obesity，smoking，drinking，hypocalcium, hypomagnesium, hypopotassium）
Heart failure Systolic hypertension 长效） Diabetes, proteinuria Renal insufficiency(mild) Myocardial infarction ACEI Stable angina Disorder of lipid pregnancy Prostate proliferation
ppt课件
12
Risk factor of cardiovascular disease
male > 55, female> 65 smoking Total cholesterol> 5.72mmol/L (250mg/dl) diabetes Early cardiovascular family history（early onset of CV disease male<55；female <65)
Diuretics ß–blocker a-blocker Calcium channel blocker ACE inhibitor Angiotensin II receptor blocker compound anti-hypertensive agents
高血压英文PPT精品课件HYPERTENSIONANDVASCULAR
Moderation of alcohol consumption
Hale Waihona Puke Limit consumption to no more than 2 drinks (1 oz or 30 mL ethanol; eg, 24 2–4 mm Hg oz beer, 10 oz wine, or 3 oz 80-proof whiskey) per day in most men and to no more than 1 drink per day in women and lighter-weight persons.
(elevated serum creatinine,
▪(2) Renovascular disease
abnormal urinalysis),
(abdominal bruits)
▪(3) APKD-autosomal dominant
polycystic kidney disease (abdominal or flank masses)
Prehypertension:
recheck in 1 year
2. Stage 1 hypertension: SBP 140–159 or DBP 90–99
Stage 1 hypertension:
confirm within 2 months
2 separate office visits)
▪(5) Primary hyperaldosteronism
(hypokalemia)
7
JNC VII 2003 recommendations
Normal: recheck in 2 years (see Comments)
hypertension高血压全英语版--PPT课件
medical condition(医疗条件) or medication(药物).
High blood pressure that is caused by another
5-10%
Contents
1
Signs And Symptoms
4
2
Treatment
Complications
5
3
Medical Qigong
Hypertension – Stage 3
180
110
Classification Of Hypertension
ØPrimary or Essential Hypertension 原发性高血压
在的，根本的） medical cause.
high blood pressure with no obvious underlying（潜 90-95%
Causes And Pathogenesis
6
Precaution
Signs And Symptoms
üPotential üUnnoticed üThe Silent killቤተ መጻሕፍቲ ባይዱr
Signs And Symptoms
üHeadache üDizziness üShortness of breath üBlurred vision üEar noise or buzzing ünosebleed üFatigue üNausea üIrregular heartbeat
Complications
---Heart failure
uThe heart will get larger or weaker, which may lead to heart failure.
High blood pressure that is caused by another
5-10%
Contents
1
Signs And Symptoms
4
2
Treatment
Complications
5
3
Medical Qigong
Hypertension – Stage 3
180
110
Classification Of Hypertension
ØPrimary or Essential Hypertension 原发性高血压
在的，根本的） medical cause.
high blood pressure with no obvious underlying（潜 90-95%
Causes And Pathogenesis
6
Precaution
Signs And Symptoms
üPotential üUnnoticed üThe Silent killቤተ መጻሕፍቲ ባይዱr
Signs And Symptoms
üHeadache üDizziness üShortness of breath üBlurred vision üEar noise or buzzing ünosebleed üFatigue üNausea üIrregular heartbeat
Complications
---Heart failure
uThe heart will get larger or weaker, which may lead to heart failure.
【高血压精品英文课件】高血压 Hypertension
Definitions
Hypertensive Emergency
Acute, rapidly evolving end-organ damage associated with HTN (usu. DBP > 120)
BP should be controlled within hours and requires admission to a critical care setting
Take a good history
History of HTN and previous control Medications with dosage and compliance Illicit drug use, OTC drugs
Diagnosis and Recognition
Physical
Confirm BP in more than one extremity Ensure appropriate cuff size Pulses in all extremities Lung exam—look for pulmonary edema Cardiac—murmurs or gallops, angina, EKG Renal—renal artery bruit, hematuria Neurologic—focal deficits, HA, altered MS Fundoscopic exam—retinopathy, hemorrhage
That is >500,000 Americans per year Correct and quick diagnosis and
management is critical
Mortality rate of up to 90%
【高血压英文PPT精品课件】 Hypertension and Peripheral Vascular Disease
Small number curable with surgery
Hypertension Pathology
Increased BP inflammation, sclerosis of arteriolar walls narrowing of vessels decreased blood flow to major organs Left ventricular overwork hypertrophy, CHF Nephrosclerosis renal insufficiency, failure
20% of adult population • ~35,000,000 people 25% do not know they are hypertensive Twice as frequent in blacks than in whites 25% of whites and 50% of blacks > 65 y/o
Types
Primary (essential) hypertension Secondary hypertension
Primary Hypertension
85 - 90% of hypertensives Idiopathic More common in blacks or with positive family history Worsened by increased sodium intake, stress, obesity, oral contraceptive use, or tobacco use Cannot be cured
• Commonly used prehospital when targeting BP lowering only especially in AMI
Hypertension Pathology
Increased BP inflammation, sclerosis of arteriolar walls narrowing of vessels decreased blood flow to major organs Left ventricular overwork hypertrophy, CHF Nephrosclerosis renal insufficiency, failure
20% of adult population • ~35,000,000 people 25% do not know they are hypertensive Twice as frequent in blacks than in whites 25% of whites and 50% of blacks > 65 y/o
Types
Primary (essential) hypertension Secondary hypertension
Primary Hypertension
85 - 90% of hypertensives Idiopathic More common in blacks or with positive family history Worsened by increased sodium intake, stress, obesity, oral contraceptive use, or tobacco use Cannot be cured
• Commonly used prehospital when targeting BP lowering only especially in AMI
英文疾病介绍——Hypertension(高血压病)ppt课件
Hypertension
英文疾病介绍——Hypertension(高血压病)
What Is Hypertension?
➢Hypertension (HTN) is a chronic medical condition in which the blood pressure in the arteries is elevated(提高的).
In fact, one in five people with the condition don‘t know they have it. Internally([ɪnˈtɜ:nəlɪ],在体内地), it can quietly damage the heart, lungs, blood ve英ss文e疾l病s,介b绍r—a—inH,ypaerntednsiokni(d高n血e压y病s) if left untreated. It’s a major risk factor for strokes(中风/脑卒中) and heart attacks(心脏病).
Who is at risk?
➢ Anyone can have high blood pressure. Some people are more likeressure including:
• African Americans(more sensitive to salt) • People over age 55 • People with a family history of high blood pressure
Malignant Hypertension
(Chronic Hypertension)
(Accelerated Hypertension)
英文疾病介绍——Hypertension(高血压病)
What Is Hypertension?
➢Hypertension (HTN) is a chronic medical condition in which the blood pressure in the arteries is elevated(提高的).
In fact, one in five people with the condition don‘t know they have it. Internally([ɪnˈtɜ:nəlɪ],在体内地), it can quietly damage the heart, lungs, blood ve英ss文e疾l病s,介b绍r—a—inH,ypaerntednsiokni(d高n血e压y病s) if left untreated. It’s a major risk factor for strokes(中风/脑卒中) and heart attacks(心脏病).
Who is at risk?
➢ Anyone can have high blood pressure. Some people are more likeressure including:
• African Americans(more sensitive to salt) • People over age 55 • People with a family history of high blood pressure
Malignant Hypertension
(Chronic Hypertension)
(Accelerated Hypertension)
【高血压英文PPT精品课件】Hypertension (HT) -High Blood Pressure (HBP)
• Symptoms:
Always asymptomatic Symptoms often attributed to hypertension:
headache, tinnitus, dizziness, fainting
slide 10
Clinical Features
• Complications of Hypertension Heart: LVH, CHD,HF Brain: TIA, Stroke Renal: Microalbuminuria, renal dysfunction Ratinopathy
3. Renal Sodium Handling 4. Vascular Remodelling 5. Endothelial Cell Dysfunction 6. Insulin Resistance
slide 4
The pathological changes of small artery
• Ambulatory monitoring can provide:
– readings throughout day during usual activities – readings during sleep to assess nocturnal changes – measures of SBP and DBP load – Exclude white coat or office hypertension
KW II: More marked narrowing and irregularity with arteriovenous nicking (crossing defects)
KW III: Flame-shaped hemorrhages and exudates in addition to above arteriolar changes
Always asymptomatic Symptoms often attributed to hypertension:
headache, tinnitus, dizziness, fainting
slide 10
Clinical Features
• Complications of Hypertension Heart: LVH, CHD,HF Brain: TIA, Stroke Renal: Microalbuminuria, renal dysfunction Ratinopathy
3. Renal Sodium Handling 4. Vascular Remodelling 5. Endothelial Cell Dysfunction 6. Insulin Resistance
slide 4
The pathological changes of small artery
• Ambulatory monitoring can provide:
– readings throughout day during usual activities – readings during sleep to assess nocturnal changes – measures of SBP and DBP load – Exclude white coat or office hypertension
KW II: More marked narrowing and irregularity with arteriovenous nicking (crossing defects)
KW III: Flame-shaped hemorrhages and exudates in addition to above arteriolar changes
高血压英文PPT精品课件Hypertensionin
Trial
Viberti; JAMA 94 REIN, KI 98
POPULATION
Type 1 DM Nephrotic
DRUG
Captopril Ramipril
AASK; JAMA 02 AA pts w CKD Ramipril
IRMA 2; NEJM 01 Type 2 DM
Valsartan
how you get there • Multiple interventions are necessary in most
Hypertensive Emergencies
• Hypertension is a chronic outpatient disease with rare acute side effects
Home BP Monitoring
• Patients need to be taught proper methods
– No wrist cuffs – Semi-automated electronic cuffs
• Cuff needs to be checked against office readings
• Confirm 2 readings 5 minutes apart in both arms for initial diagnosis
• If taken in wrist or legs, the cuff must be at the level of the heart
BP Measurement
– Should be considered in all stages – If tolerated then reduced development of ESRD,
高血压英文PPT精品课件HYPERTENSIVE
In Young ...
Protein C levels Protein S levels Platelet Analysis Sr. & Urine for Homocysteine levels
Others ...
Hb Electrophoresis PT / PTT Anti-Phospholipid antibody Complete Cardiovascular evaluation
Microaneurysyms Optociliary vessels – collaterals between retinal & ciliary
vessels
Cilioretinal artery occlusion
Combined with CRVO
Cilioretinal artery occlusion
• HRVO (Hemi Retinal Vein Occlusion)
• BRVO (Branch Retinal Vein Occlusion) Constitutes 69.5 % of all RVO cases
CRVO ...
Classic Appearance
Mildest Form
CRVO
Combined with anterior ischaemic optic neuropathy
HRVO ...
HRVO ...
Superior & Inferior vein do not merge into Central Vein before entering into lamina cribrosa
Traditional Rx Options ...
高血压英文PPT精品课件HYPERTENSIVE
GRADE 2 HTR
SEVERE GENERALIZED AND FOCAL ARTERIOLAR CONSTRICTION
A-V CROSSING CHANGES (SALUS SIGN)
GRADE 3 HTR
Copper wiring of arterioles Venous banking distal to A-V
the arterial & venous circulation
Green et al – Thrombus formation in the region of lamina cribrosa is the primary event
GRADE 4 HTR
All changes of grade 3
Silver wiring of arterioles
Disc edema
Ocular associations of hypertension
Retinal vein occlusion
• CRVO (Central Retinal Vein Occlusion)
crossing (bonnet’s sn) Venous tapering on either
side of crossing (gunn’s sn) Right angle deflection of
veins. Flame shaped hemorrhages
cotton wool spots, hard exudates.
• HRVO (Hemi Retinal Vein Occlusion)
• BRVO (Branch Retinal Vein Occlusion) Constitutes 69.5 % of all RVO cases
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pulses
Lifestyle modification
Medication
A 56-year-old man undergoes a routine physical examination. A funduscopic examination is performed. What does the funduscopic photograph show? ( A ) Arteriolar sclerosis and hypertensive retinopathy ( B ) Diabetic proliferative retinopathy ( C ) Papilledema ( D ) Malignant hypertensive retinopathy
New diagnosis of HTN
Assess other cardiovascular risk factors
Look for reversible causes of HTN
Look for evidence of end organ damage
Renal Retinal Cardiac – check EKG, consider stress test if any
Hypertension, Hyperlipidemia: Are our children safe?
Patrick R
Who are my at risk patients – who should I be screening? (basically everyone!)
Obesity Dyslipidemia – all pts need fasting lipid profile DM Smoking Lack of exercise Age >55 for men, >65 for women FHx of premature cardiovascular disease Microalbuminuria in diabetics
history of angina type symptoms CNS – take full Hx and evaluate for previous TIA.
Check for carotid bruits Peripheral artery disease – check for AAA and distal
Hypertension
Management should be based on the “JNC-7” guidelines Treatment should be instituted at >140/90 in most pts or
>130/80 in pts with DM or chronic kidney disease Stage II HTN is >160/100 and only important to
distinguish because these patients usually need 2 drugs to control. Making 1st diagnosis needs 2 readings at least 5 mins apart and in both arms. Many doctors will actually get two readings a week or two apart in a previously undiagnosed patient, and many patients will be resistant to start therapy without more than one reading Ambulatory BP moniate for white coat HTN, and also helpful in assessing response to therapy, or persuading a pt that he needs treatment
Correct Answer = A
Characteristic changes are noted in the retinas of patients with longstanding hypertension. Narrowing of the terminal branches of retinal arterioles may be seen, as well as general narrowing of vessels with severe local constriction (as shown in this photograph). As the disease progresses, striate hemorrhages and soft exudates become visible. In a normal eye, retinal arterioles are transparent, so that blood flow is visible during ophthalmoscopy. A light streak from the ophthalmoscope will reflect from the convex wall of the healthy arteriole. In a sclerotic arteriole, thickening and fibrosis of the vessel wall develop as the sclerosis progresses. The central light reflex increases in width, and the walls of the vessel look like burnished copper, producing a "copper-wire" arteriole. With further progression and additional fibrosis, the entire width of the arteriole reflects the white stripe, producing "silver-wire" arteries. This patient's funduscopic photograph shows both the "copper and silver wires" characteristic of arteriolar sclerosis and the characteristic changes of hypertensive retinopathy.
Lifestyle modification
Medication
A 56-year-old man undergoes a routine physical examination. A funduscopic examination is performed. What does the funduscopic photograph show? ( A ) Arteriolar sclerosis and hypertensive retinopathy ( B ) Diabetic proliferative retinopathy ( C ) Papilledema ( D ) Malignant hypertensive retinopathy
New diagnosis of HTN
Assess other cardiovascular risk factors
Look for reversible causes of HTN
Look for evidence of end organ damage
Renal Retinal Cardiac – check EKG, consider stress test if any
Hypertension, Hyperlipidemia: Are our children safe?
Patrick R
Who are my at risk patients – who should I be screening? (basically everyone!)
Obesity Dyslipidemia – all pts need fasting lipid profile DM Smoking Lack of exercise Age >55 for men, >65 for women FHx of premature cardiovascular disease Microalbuminuria in diabetics
history of angina type symptoms CNS – take full Hx and evaluate for previous TIA.
Check for carotid bruits Peripheral artery disease – check for AAA and distal
Hypertension
Management should be based on the “JNC-7” guidelines Treatment should be instituted at >140/90 in most pts or
>130/80 in pts with DM or chronic kidney disease Stage II HTN is >160/100 and only important to
distinguish because these patients usually need 2 drugs to control. Making 1st diagnosis needs 2 readings at least 5 mins apart and in both arms. Many doctors will actually get two readings a week or two apart in a previously undiagnosed patient, and many patients will be resistant to start therapy without more than one reading Ambulatory BP moniate for white coat HTN, and also helpful in assessing response to therapy, or persuading a pt that he needs treatment
Correct Answer = A
Characteristic changes are noted in the retinas of patients with longstanding hypertension. Narrowing of the terminal branches of retinal arterioles may be seen, as well as general narrowing of vessels with severe local constriction (as shown in this photograph). As the disease progresses, striate hemorrhages and soft exudates become visible. In a normal eye, retinal arterioles are transparent, so that blood flow is visible during ophthalmoscopy. A light streak from the ophthalmoscope will reflect from the convex wall of the healthy arteriole. In a sclerotic arteriole, thickening and fibrosis of the vessel wall develop as the sclerosis progresses. The central light reflex increases in width, and the walls of the vessel look like burnished copper, producing a "copper-wire" arteriole. With further progression and additional fibrosis, the entire width of the arteriole reflects the white stripe, producing "silver-wire" arteries. This patient's funduscopic photograph shows both the "copper and silver wires" characteristic of arteriolar sclerosis and the characteristic changes of hypertensive retinopathy.