【高血压英文PPT精品课件】Hypertension in CKD
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--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.
【高血压精品英文课件】Hypertension and Kidney
RENAL SCARRING
MAJOR RISK FACTORS FOR CARDIOVASCULAR DISEASE
HYPERTENSION HYPERLIPIDEMIA SMOKING FAMILY HISTORY
Байду номын сангаас
OBESITY
DIABETES
CHRONIC KIDNEY DISEASE
PHYSICAL INACTIVITY
of endovascular health
Miettinen H et al, Stroke 27:2033, 1996
Prevalence of HTN in CKD
80% of patients with glomerulonephritis and 30% of patients with chronic interstitial disease are hypertensive.
Hypertension and renal function
%
90 80 70 60 50 40 30 20 10
0 stage 1
stage 2
normal hypertension
stage 3 stage 4
1 0.9 0.8 0.7 0.6 0.5 0.4 0.3 0.2 0.1
0
stage 1
Hypertension in CKD
Pathophysiology thought to be both pressor- and volumerelated, thus CKD patients respond to both vasodilators as well as diuretics/sodium restriction.
【高血压精品英文课件】高血压 Hypertension_
Pathophysiology
Hypertensive Emergency
Failure of normal autoregulatory function Leads to a sharp increase in systemic
vascular resistance Endovascular injury with arteriole necrosis Ischemia, platelet deposition and release of
Epidemiology
Hypertensive Emergency
Estimates are that about 1% of those with hypertension will present with hypertensive emergency each year
That is >500,000 Americans per year Correct and quick diagnosis and
Risk Factors
If >50, systolic BP > 140 is a more concerning risk factor for cardiovascular disease than diastolic BP.
The risk of cardiovascular disease doubles for every increase in BP of 20/10 over 115/75.
140-159/90-99
Stage II HTN
>160/>100
(Severe HTN
>180/>110)
Severe HTN is not a JNC VII defined entityDefinitions
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
【高血压精品英文课件】Hypertension in CKD
• 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
Home BP Monitoring
• Self readings or continuous ambulatory monitoring • Helpful adjunct to office readings • More readings in patients usual environment • Better correlated with cardiovascular outcomes • Improves patient compliance • Helps clarify symptoms • Defines masked and white coat hypertension
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
Hypertension in CKD
Michael J Casey, MD Wake Nephrology Associates
Hypertension Stats
• HTN affects approximately 1 billion worldwide • $500 billion in direct costs • Continuous, consistent and independent relationship
• If taken in wrist or legs, the cuff must be at the level of the heart
BP Measurement
Home BP Monitoring
• Self readings or continuous ambulatory monitoring • Helpful adjunct to office readings • More readings in patients usual environment • Better correlated with cardiovascular outcomes • Improves patient compliance • Helps clarify symptoms • Defines masked and white coat hypertension
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
Hypertension in CKD
Michael J Casey, MD Wake Nephrology Associates
Hypertension Stats
• HTN affects approximately 1 billion worldwide • $500 billion in direct costs • Continuous, consistent and independent relationship
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)
【高血压精品英文课件】Hypertension and the Kidney
Fig. 4. Steady-state relationships between arterial pressure and urinary sodium ecreation and sodium intake for normal kidney and four types of renal dysfunction that cause hypertension: decreased kidney mass, increased reabsorption in distal and collecting tubules, reduction in glomerular capillary filtration coefficient(Kf), and increased preglomerular resistance.
Fig. 3. Proposed mechanism of pressure natriuresis
Pressure-natriuresis(2)
(Medullary Blood Flow)
Medullary blood flow(MBF) comprise only 1% of RBF, but important effect on pressure-natriuresis Endocrine & paracrine factors(renal nerve, Ang II prostaglandin, ANP, NO, kinin, vasopressin modulate RPP & urine excretion by regulation of medullary blood flow Reduce MBF; sympathetic N stimulation, CO inhibition, kinin antagonist, NO synthase inhibition, Ang II, AVP---> raise BP Increase MBF; ANP, prostaglandin, bradykinin, acetylcholine, CEI, Ca blocker--->lowering BP
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 ...
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• 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
Evaluation of the Hypertensive Pt
• Evidence of Volume status
– Edema – Heart & lung exam for CHF
• End Organ Damage
– Albuminuria/Proteinuria (MACR, 24 hr urine) – LVH (ECG, Echo) – CKD
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
how you get there • Multiple interventions are necessary i Hypertension is a chronic outpatient disease with rare acute side effects
Measurement of Blood Pressure
• Seated position with arm supported ideal • Allow patient to settle for several minutes • Proper sized cuff
– Bladder to encircle 80 – 100% arm – Bladder width 40-50% of arm
– <130/80 if DM, CKD, CVDz – <125/75 if CKD with proteinuria
• SBP is the issue in the old • Diastolic HBP is a problem of the young • Reaching the target is more important than
Prevalence of HTN in CKD
Hypertension in CKD
• 80% of patients with CKD have HBP • Most start with essential hypertension • As GFR decreases it is more dependent on
Hypertension in CKD
Michael J Casey, MD Wake Nephrology Associates
Evaluation of the Hypertensive Pt
• Age and rapidity of HBP onset • Accurate measurement of BP • Medication review • Family History • H/O CVD or kidney disease • EtOH and tobacco • Sleep history
• Frequency of monitoring can vary • All current outcome data/guidelines/trails
are from office readings
Ambulatory BP Monitoring
Ambulatory BP Monitoring
salt/water retention from decreased GFR • CKD patients also have derangements in the
Renin/Angiotensin/Aldosterone system
Treatment of Hypertension
• Goal depends on disease state
Home BP Monitoring
• Self readings or continuous ambulatory monitoring • Helpful adjunct to office readings • More readings in patients usual environment • Better correlated with cardiovascular outcomes • Improves patient compliance • Helps clarify symptoms • Defines masked and white coat hypertension
Ambulatory BP Monitoring
• More reproducible than office measurements
• Helpful in early diagnosis • Unexplained microalbuminuria or LVH • White Coat Hypertension • Resistant Hypertension • No long term studies yet
• Headache, MS changes, ICH, Papilledema, CHF, Angina, Renal failure with hematuria, Hemorrhage are emergencies require hospitalization
• Otherwise treat asymptomatic severe HBP over days/weeks
• If taken in wrist or legs, the cuff must be at the level of the heart
BP Measurement
Evaluation of the Hypertensive Pt
• Evidence of Volume status
– Edema – Heart & lung exam for CHF
• End Organ Damage
– Albuminuria/Proteinuria (MACR, 24 hr urine) – LVH (ECG, Echo) – CKD
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
how you get there • Multiple interventions are necessary i Hypertension is a chronic outpatient disease with rare acute side effects
Measurement of Blood Pressure
• Seated position with arm supported ideal • Allow patient to settle for several minutes • Proper sized cuff
– Bladder to encircle 80 – 100% arm – Bladder width 40-50% of arm
– <130/80 if DM, CKD, CVDz – <125/75 if CKD with proteinuria
• SBP is the issue in the old • Diastolic HBP is a problem of the young • Reaching the target is more important than
Prevalence of HTN in CKD
Hypertension in CKD
• 80% of patients with CKD have HBP • Most start with essential hypertension • As GFR decreases it is more dependent on
Hypertension in CKD
Michael J Casey, MD Wake Nephrology Associates
Evaluation of the Hypertensive Pt
• Age and rapidity of HBP onset • Accurate measurement of BP • Medication review • Family History • H/O CVD or kidney disease • EtOH and tobacco • Sleep history
• Frequency of monitoring can vary • All current outcome data/guidelines/trails
are from office readings
Ambulatory BP Monitoring
Ambulatory BP Monitoring
salt/water retention from decreased GFR • CKD patients also have derangements in the
Renin/Angiotensin/Aldosterone system
Treatment of Hypertension
• Goal depends on disease state
Home BP Monitoring
• Self readings or continuous ambulatory monitoring • Helpful adjunct to office readings • More readings in patients usual environment • Better correlated with cardiovascular outcomes • Improves patient compliance • Helps clarify symptoms • Defines masked and white coat hypertension
Ambulatory BP Monitoring
• More reproducible than office measurements
• Helpful in early diagnosis • Unexplained microalbuminuria or LVH • White Coat Hypertension • Resistant Hypertension • No long term studies yet
• Headache, MS changes, ICH, Papilledema, CHF, Angina, Renal failure with hematuria, Hemorrhage are emergencies require hospitalization
• Otherwise treat asymptomatic severe HBP over days/weeks