【高血压精品英文课件】高血压的运动治疗 Therapeutic role of exercise in treating hypertension
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【高血压英文PPT精品课件】Consumer Organisations and the WHO Global Strategy on Diet, Physical Activi
disease
60 and over
5823 Ischaemic heart disease 4692 Cerebrovascular disease 2399 Chronic obstruc. pulmonary disease 1398 Lower respiratory infections 929 Trachea, bronchus, lung 754 cancers 735 Diabetes mellitus 606 Hypertensive heart disease 496 Stomach cancer 478 Tuberculosis
FEMALES
8.4 Unipolar depressive disorders 7.3 HIV/AIDS 6.8 Maternal conditions 5.3 Ischaemic Heart disease 5.2 Cerebrovascular disease 3.2 Cataracts 2.8 Hearing loss, adult onset 2.8 Chron. obstruc. pulm. disease 2.6 Tuberculosis 2.0 Osteoarthritis
Fruit & vegetable intake High Body Mass Index Physical inactivity Alcohol Unsafe water, hygiene
Indoor smoke from fuels Iron deficiency
Urban air pollution Zinc deficiency
millions
250
Developed Developing
200
150
60 and over
5823 Ischaemic heart disease 4692 Cerebrovascular disease 2399 Chronic obstruc. pulmonary disease 1398 Lower respiratory infections 929 Trachea, bronchus, lung 754 cancers 735 Diabetes mellitus 606 Hypertensive heart disease 496 Stomach cancer 478 Tuberculosis
FEMALES
8.4 Unipolar depressive disorders 7.3 HIV/AIDS 6.8 Maternal conditions 5.3 Ischaemic Heart disease 5.2 Cerebrovascular disease 3.2 Cataracts 2.8 Hearing loss, adult onset 2.8 Chron. obstruc. pulm. disease 2.6 Tuberculosis 2.0 Osteoarthritis
Fruit & vegetable intake High Body Mass Index Physical inactivity Alcohol Unsafe water, hygiene
Indoor smoke from fuels Iron deficiency
Urban air pollution Zinc deficiency
millions
250
Developed Developing
200
150
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_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PPT精品课件Hypertensioninthe
– Cocaine/crack
– Amphetamines
– PCP
– Witdrawal from antihypertensive Rx
– MAOI interactions
Others
• Autonomic hyper-reactivity
– Guillan-Barre – Autonomic dysreflexia – Porphyria
Question 1
• Define hypertensive urgency and hypertension emergency. What are some clinical findings associated with hypertensive emergenices? (Ibrahim)
– Thyrotoxicosis/Thyroid storm, Hypothyroidism/Myxedema, goiter – HPT: hypercalcemia (psychosis, constipation, inc QTc, cataract,
nephrocalcinosis, N-DI, dystrophic calcifications of soft tissue (Xray) – Cushing’s: Cushinoid – Conn’s: hypokalemic metabolic alkalosis – Pheochromocytoma: perspiration, palpitation, pain (chest, h/a, AP), labile pressure (+/- orthostatic hypotension), pallor – RAS: Renal bruits – OSA/Pickwikian Syndrome: Obesity wt think/short neck, day time somnolence, apnea attacks – Pregnancy: HELLP, Ecclampsia (edema, protienuria, sz, inc DTR)
--高血压英文PPT精品课件Pediatric
azotemia Hypervolemia After surgical procedures on the genitourinary tract Pyelonephritis Renal trauma Leukemic infiltration of the kidney Obstructive uropathy associated with Crohn disease
Pediatric hypertension
Supervisor : VS. 邱元佑 Speaker : Int. 謝宜勳
Case information
Patient 1 Age/Gender 13 y/o, male
Patient 2 17 y/o, male
Diagnosis 2003/11
Age, sex and height
Obesity important independent risk
Measurement of BP in Children
Measurement
standard mercury sphygmo-manometer right arm bladder width: 40% of the circumference of the arm cuff size covered 80% to 100% of the circumference of the arm
(2) intrauterine environment In women: resting SBP↓4.27 mm Hg and DBP↓ 2.18 mm Hg per kilogram increase in birth weight in men: no associations!
Pediatric hypertension
Supervisor : VS. 邱元佑 Speaker : Int. 謝宜勳
Case information
Patient 1 Age/Gender 13 y/o, male
Patient 2 17 y/o, male
Diagnosis 2003/11
Age, sex and height
Obesity important independent risk
Measurement of BP in Children
Measurement
standard mercury sphygmo-manometer right arm bladder width: 40% of the circumference of the arm cuff size covered 80% to 100% of the circumference of the arm
(2) intrauterine environment In women: resting SBP↓4.27 mm Hg and DBP↓ 2.18 mm Hg per kilogram increase in birth weight in men: no associations!
高血压英文PPT精品课件Cerebrovascular
deficit that has a sudden onset, lasts more than 24 hours, and results from cerebrovascular disease.
A stroke occurs when there is a disruption
of blood flow to a region of the brain.
Dysphasia: difficulty in speaking and putting words into the correTATIONS
A stroke is usually characterized by the sudden onset of focal neurological impairment.
About one-fourth of strokes are hemorrhagic, resulting from hypertensive vascular disease (which causes an intracerebral hemorrhage), a ruptured aneurysm, or an arteriovenous malformation.
Risk factors for stroke include smoking, hypertension, obesity, cardiac disease, hypercholesterolemia, diabetes, and use of birth control pills.
Prevention efforts focus on lifestyle changes that can modify risk factors.
PATHOPHYSIOLOGY
A stroke occurs when there is a disruption
of blood flow to a region of the brain.
Dysphasia: difficulty in speaking and putting words into the correTATIONS
A stroke is usually characterized by the sudden onset of focal neurological impairment.
About one-fourth of strokes are hemorrhagic, resulting from hypertensive vascular disease (which causes an intracerebral hemorrhage), a ruptured aneurysm, or an arteriovenous malformation.
Risk factors for stroke include smoking, hypertension, obesity, cardiac disease, hypercholesterolemia, diabetes, and use of birth control pills.
Prevention efforts focus on lifestyle changes that can modify risk factors.
PATHOPHYSIOLOGY
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)
高血压(英文版) ppt课件
Etiology and pathogenesis of EH
No
cause can be established Possible mechanisms Genetic tendency
Spontaneous hypertension rat EH tends to cluster in families
Classification of Blood Pressure Levels (mmHg)
Category Systolic Diastolic Hypotension??? <60 Optimal <120 <80 Normal <130 <85 High-normal 139 85-89 Grade 1 hypertension(mild) 90-99 Subgroup: borderline 90-94
Optional investigations
Plasma renin( 肾 素 ) activity & aldosterone (醛固酮), urinary VMA（香草杏仁酸），to identify secondary hypertension Echocardiography, to detect ventricular hypertrophy Vascular ultrasonography should be performed if arterial disease is suspected. Renal ultrasonography should be performed if renal disease is suspected.
perhaps by catecholamines儿茶酚胺
高血压英文PPT精品课件Diseasesofthe
• CAD • Almost all from atherosclerotic narrowing
or complete obstruction • Depending on the degree & character of
the obstruction
– angina pectoris – MI – sudden cardiac death – chronic ischemic heart disease with CHF
Diseases of the Heart
Major Determinants of Disease
• Most heart disease is the result of atherosclerotic obstruction of the coronary arteries
• Congestive heart failure is mechanical failure of the heart to eject blood delivered to it
• Premature ventricular contractions
– occur in healthy people – chest palpitations & anxiety
• Ventricular tachycardia
– spontaneous, regular beating at > 120 beats/min
• Each year heart disease accounts for about 1/3 of deaths in the US, most of which are associated with coronary artery atherosclerosis. If cerebrovascular disease, vascular complications of diabetes, & other vascular diseases are included, the figure is over 40%. After age 40 the lifetime risk for developing symptomatic coronary artery disease is 50% in men & 40% in women.
or complete obstruction • Depending on the degree & character of
the obstruction
– angina pectoris – MI – sudden cardiac death – chronic ischemic heart disease with CHF
Diseases of the Heart
Major Determinants of Disease
• Most heart disease is the result of atherosclerotic obstruction of the coronary arteries
• Congestive heart failure is mechanical failure of the heart to eject blood delivered to it
• Premature ventricular contractions
– occur in healthy people – chest palpitations & anxiety
• Ventricular tachycardia
– spontaneous, regular beating at > 120 beats/min
• Each year heart disease accounts for about 1/3 of deaths in the US, most of which are associated with coronary artery atherosclerosis. If cerebrovascular disease, vascular complications of diabetes, & other vascular diseases are included, the figure is over 40%. After age 40 the lifetime risk for developing symptomatic coronary artery disease is 50% in men & 40% in women.
【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
高血压英文PPT精品课件Pediatric
(2) intrauterine environment In women: resting SBP↓4.27 mm Hg and DBP↓ 2.18 mm Hg per kilogram increase in birth weight in men: no associations!
Loos RJ, Fagard R, Beunen G, et al.: Birth weight and blood pressure in young adults: a prospective twin study. Circulation 2001;104:1633–1638
azotemia Hypervolemia After surgical procedures on the genitourinary tract Pyelonephritis Renal trauma Leukemic infiltration of the kidney Obstructive uropathy associated with Crohn disease
Prenatal cause
(1) children with intrauterine growth retardation (IUGR) had significantly higher mean values of systolic, diastolic, and mean blood pressure
Secondary hypertension
Most common in the period of infant and younger children
Underlying disease: - Renal and renovascular disease - coarctation of the aorta - endocrine disorder - medication
Loos RJ, Fagard R, Beunen G, et al.: Birth weight and blood pressure in young adults: a prospective twin study. Circulation 2001;104:1633–1638
azotemia Hypervolemia After surgical procedures on the genitourinary tract Pyelonephritis Renal trauma Leukemic infiltration of the kidney Obstructive uropathy associated with Crohn disease
Prenatal cause
(1) children with intrauterine growth retardation (IUGR) had significantly higher mean values of systolic, diastolic, and mean blood pressure
Secondary hypertension
Most common in the period of infant and younger children
Underlying disease: - Renal and renovascular disease - coarctation of the aorta - endocrine disorder - medication
高血压英文PPT精品课件_3
BPLTTC Meta-analysis: Stroke and CHD
Relative Risk of Stroke Relative Risk of CHD
Stroke
1.50
CHD
1.50
1.25
1.25
1.00
1.00
0.75
0.75
0.50
0.50
0.25
0.25
-10 -8 -6 -4 -2 0 2 4
2 mm Hg decrease in mean SBP
7% reduction in risk of CHD mortality
10% reduction in risk of stroke mortality
Prospective Studies Collaboration. Lancet. 2002;360:1903-1913.
No Compelling Indications
Stage 1 140-159/90-99 Diuretics for most;
consider ACEI, ARB, B, CCB
Stage 2 BP 160/100 2-drug combo for
most (diuretic + ACEI, or ARB, or BB, or CCB)
What Is Hypertension?
JNC 7 Definitions
Blood Pressure (mm Hg)
Systolic
Diastolic
<120
and <80
120-139
or 80-89
140-159
or 90-99
≥160
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
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
【高血压英文PPT精品课件】 Improving Blood Pressure Treatment
100 80
66.5
60 40 20
0
84**
8*9* 8*3*.4
89**.3
68
70.9
65.9
73.4
No-Disease Dyslipidemia Mets DM CKD Stroke CHF PAD CAD
*P<0.05, **P<0.01 when compared to No-Disease group Treatment is in persons with HTN
53.7
55
50
48.3
40 30
30.7 33.3
35.2 28.2
35.4 28.5
39.1 28.9
27.8 26.5
20
10
0 Men
Women White
Black Hispanic
Prevalence Treatment Control
10
Prevalence (%) of HTN in US Adults, by Disease Status (Wong et al, Arch Intern Med 2007, in press)
Prevalence of HTN (%)
100 80 60 40
23.1
20 Mean age0(y): 53.5
51.*8*
7*6*.8 6*1*.5
59.3
54.8 60.5
81**.8 6*9*.5
** **
71.4 73.7
7**3
76.1 65.9 68.2 69.3 67.2
No-Disease Dyslipidemia Mets DM CKD Stroke CHF PAD CAD
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Hypertension & CVD Outcomes
Increased BP has a positive and continuous association with CV events Within DBP range of 70-110 mm Hg, there is no threshold below which lower BP does not reduce stroke and CVD risk A 15/6 mm Hg BP reduction reduced stroke by 34% and CHD by 19% over 5 years
Prevalence of Other Risk Factors With Hypertension
Risk Factor Smoking LDL Cholesterol >140 mg/dl HDL Cholesterol < 40 mg/dl Obesity Diabetes Hyperinsulinemia Sedentary lifestyle
1997 JNC VI Classification of Blood Pressure
Blood Pressure Category Optimal Normal High Normal Hypertension
Stage 1 (Mild) Stage 2 (Moderate) Stage 3 (Severe)
35% of hypertensive patients are unaware of their condition
High-normal BP is associated with an incresed risk of cardiovascular disease
N Eng J Med 2001; 345; 129பைடு நூலகம்-7
Cardiovascular Consequences
of Hypertension
Increased cardiac afterload leads to left ventricular hypertrophy and reduced early diastolic filling Increased LV mass is positively associated with CV morbidity and mortality independent of other risk factors High BP also promotes coronary artery calcification, a predictor of sudden death
Pathophysiology of Hypertension
Essential hypertension is characterized by increased DBP and related arteriolar vasoconstriction leading to increased SBP BP is mainly determined by cardiac output and total peripheral resistance High blood pressure may be linked to age-related vascular stiffening
Therapeutic role of exercise in treating hypertension
Dalynn T. Badenhop, Ph.D., FACSM Professor of Medicine
Director , Cardiac Rehabilitation Medical College of Ohio
Pathophysiology of Hypertension
High blood pressure is also associated with obesity, salt intake, low potassium intake, physical inactivity, heavy alcohol use and psychological stress Intra-abdominal fat and hyperinsulinemia may play a role in the pathogenesis of hypertension
Kaplan NM. Dis Mon 1992; 38:769-838
Percent 35 40 25 40 15 50 >50
Cardiovascular Consequences of Hypertension
Individuals with BP > 160/95 have CAD, PVD & stroke that is 3X higher than normal HTN may lead to retinopathy and nephropathy HTN is also associated with subclinical changes in the brain and thickening and stiffening of small blood vessels
Systolic <120 <130 130-139
140-159 160-179 > 180
Diastolic <80 <85 85-89
90-99 100-109 > 110
Overview of Hypertension
Joint National Committee VI (JNC VI) on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (1997)
50 million hypertensive patients in the U.S.
National Health and Nutrition Examination Survey III (NHANES III) (1995)
only 21% of treated hypertensive patients have BP controlled to <140/90 mm Hg