【高血压精品英文课件】Hypertension
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【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.
英文疾病介绍——Hypertension(高血压病)PPT课件
Who is at risk?
➢Your chances of having high blood pressure are higher if you:
• Are overweight • Eat foods high in salt • Do not get regular exercise • Smoke • Drink alcohol heavily • Under Stress,anger,frightened or
Diagnosis
systolic blood
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Classification Of Hypertension
➢Hypertension
Essential Secondary Hypertension Hypertensio ①pr原im发ar性y o高r e血s压sennt继ial发性高血 hype（rte高n血sio压n:病h）igh blood压 pressu➢9rPer0im–war9yito5hr %Esnseontiaol bHyvpei5orte–un1ssio0n % underlying(潜在的,根本的) meBdeicnailgcnause. Malignant ②HSyepceorntednasriyoHn ypHeyrpteenrtseionnsi:on
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
Why should we care about hypertension?
One of the most common chronic medical concerns in the US
Affects >30% of the population > age 20 Risk factor for
vasoactive substances Further loss of autoregulatory mechanism Exposes organs to increased pressure
Diagnosis and Recognition
Presentation
Always present with a new onset symptom
Take a good history
History of HTN and previous control Medications with dosage and compliance Illicit drug use, OTC drugs
Diagnosis and Recognition
Normal BP
高血压英文PPT精品课件HYPERTENSIONDIABETESADANGEROUS
IL- 6, TNF- @, and RAS
liver(NASH)
(↑CRP) (Endothelial
Dysfunction)
• ↑Small, dense LDL • ↑triglyceridemia
Atherosclosis
Activation • ↓HDL
Reduced • Hypertension
Renal Na+ Reabsorption
Hypertension
Cardiometabolic Syndrome:
Large
(Insulin resistant) ( ↑Central Fat)
Fat Cells
(Fatty
Visceral Obesity
Enhanced
Lipolysis > FreeFA
Millions of Cases
60 50 40 30 20 10
0
India
China
1995 2025
US
Data from King H et al. Diabetes Care. 1998;21:1414-1431.
CV Mortality Risk Doubles with Each 20/10 mm Hg BP Increment*
<200 mg/dL (5.18 mmol/L)
Vascular Disease Risk Factors
Saydah SH et al. JAMA. 2004;291:335-342.
Metabolic Syndrome: NCEP/ATP III Definition
Presence of at least 3 of 5 risk factors: Abdominal obesity Elevated blood pressure Elevated fasting glucose Elevated triglycerides Low HDL-C
liver(NASH)
(↑CRP) (Endothelial
Dysfunction)
• ↑Small, dense LDL • ↑triglyceridemia
Atherosclosis
Activation • ↓HDL
Reduced • Hypertension
Renal Na+ Reabsorption
Hypertension
Cardiometabolic Syndrome:
Large
(Insulin resistant) ( ↑Central Fat)
Fat Cells
(Fatty
Visceral Obesity
Enhanced
Lipolysis > FreeFA
Millions of Cases
60 50 40 30 20 10
0
India
China
1995 2025
US
Data from King H et al. Diabetes Care. 1998;21:1414-1431.
CV Mortality Risk Doubles with Each 20/10 mm Hg BP Increment*
<200 mg/dL (5.18 mmol/L)
Vascular Disease Risk Factors
Saydah SH et al. JAMA. 2004;291:335-342.
Metabolic Syndrome: NCEP/ATP III Definition
Presence of at least 3 of 5 risk factors: Abdominal obesity Elevated blood pressure Elevated fasting glucose Elevated triglycerides Low HDL-C
hypertension高血压全英语版-共40页
Classification Of Hypertension
ØPrimary or Essential Hypertension 原发性高血压 high blood pressure with no obvious underlying（潜
在的，根本的） medical cause.
90-95% ØSecondary Hypertension 继发性高血压
Cause and Pathogenesis
Cause and Pathogenesis
Cause and Pathogenesis
---Inherited genetic factors
➢ About half of patients have family history of hypertension, they were born to have higher risk to suffer hypertension.
Signs And Symptoms
✓ Most of the time, there are no symptoms.
✓ About one out of every 100 (1%) people with hypertension is diagnosed with severe high blood pressure (accelerated or malignant hypertension) at their first visit to the doctor.
Diagnosis of Hypertension
systolic blood pressure≤120 diastolic blood pressure ≤ 80
Both of them
高血压英语PPTPPT课件
Blood pressure readings of 180/110 mmHg or higher
Headache
Vision changes
Shortness of Breath
Fatigue
Dizziness
Chest pain or discomfort
01
02
03
04
05
06
Symptoms of Hypertension
Mental stress
Sleep quality
Chronic stress
03
The HAZARDS of Hypertension
Increased risk of heart disease
High blood pressure can damage the heart muscle, leading to heart disease
Hypertension English PPT courseware
contents
目录
Introduction to Hypertension The causes of hypertension The HAZARDS of Hypertension Diagnosis and prevention of hypertension
Diagnostic method
ቤተ መጻሕፍቲ ባይዱ
Preventive measure
Healthy die: A balanced die rich in fruits, vegetables, whole grains, and lean protein can help reduce blood pressure Limiting salt and reducing intake of saturated fat and trans fat are also important
Headache
Vision changes
Shortness of Breath
Fatigue
Dizziness
Chest pain or discomfort
01
02
03
04
05
06
Symptoms of Hypertension
Mental stress
Sleep quality
Chronic stress
03
The HAZARDS of Hypertension
Increased risk of heart disease
High blood pressure can damage the heart muscle, leading to heart disease
Hypertension English PPT courseware
contents
目录
Introduction to Hypertension The causes of hypertension The HAZARDS of Hypertension Diagnosis and prevention of hypertension
Diagnostic method
ቤተ መጻሕፍቲ ባይዱ
Preventive measure
Healthy die: A balanced die rich in fruits, vegetables, whole grains, and lean protein can help reduce blood pressure Limiting salt and reducing intake of saturated fat and trans fat are also important
【高血压精品英文课件】高血压急症 Hypertensive emergencies
• CBF = CPP / CVR • CPP = MAP - ICP • MAP = DBP + 1/3 PP • Cerebral autoregulation
– normal between 50 - 150 – 70/40 to 190/130
• Vascular stenosis
Cerebral Autoregulation
– Acute myocardial ischemia – Acute cardiogenic pulmonary edema – Acute aortic dissection – Post-op vascular surgery
• Renal - Acute renal failure • Eclampsia • Catechol excess- Pheochrom, Drugs
Concept of Hypertensive Urgencies
• Potentially dangerous BP elevation without acute, life-threatening end-organ damage
• Examples (controversial!) – Retinal changes without encephalopathy or acute visual symptoms – High BP with nonspecific Sx (headache, dizziness, weakness) – Very high BP without symptoms
– Prevalence of cerebrovascular disease and coronary artery disease (Stenotic lesions)
– normal between 50 - 150 – 70/40 to 190/130
• Vascular stenosis
Cerebral Autoregulation
– Acute myocardial ischemia – Acute cardiogenic pulmonary edema – Acute aortic dissection – Post-op vascular surgery
• Renal - Acute renal failure • Eclampsia • Catechol excess- Pheochrom, Drugs
Concept of Hypertensive Urgencies
• Potentially dangerous BP elevation without acute, life-threatening end-organ damage
• Examples (controversial!) – Retinal changes without encephalopathy or acute visual symptoms – High BP with nonspecific Sx (headache, dizziness, weakness) – Very high BP without symptoms
– Prevalence of cerebrovascular disease and coronary artery disease (Stenotic lesions)
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
hypertension高血压 全英语版 -ppt课件
hypertensio n高血压 全英 语版 -
What is Hypertension?
Hypertension (HTN) or high blood pressure, sometimes called arterial hypertension, is a chronic medical condition in which the blood pressure in the arteries is elevated.
Precaution
---Lifestyle
8.Be physically active.
Precaution
--- Check our blood pressure
>90 >130 Be careful!
Thanks
Signs And Symptoms
Most of the time, there are no symptoms. About one out of every 100 (1%) people with hypertension is diagnosed with severe high blood pressure (accelerated or malignant hypertension) at their first visit to the doctor.
Cause and Pathogenesis
Cause and Pathogenesis
Cause and Pathogenesis
---Inherited genetic factors
About half of patients have family history of hypertension, they were born to have higher risk to suffer hypertension.
What is Hypertension?
Hypertension (HTN) or high blood pressure, sometimes called arterial hypertension, is a chronic medical condition in which the blood pressure in the arteries is elevated.
Precaution
---Lifestyle
8.Be physically active.
Precaution
--- Check our blood pressure
>90 >130 Be careful!
Thanks
Signs And Symptoms
Most of the time, there are no symptoms. About one out of every 100 (1%) people with hypertension is diagnosed with severe high blood pressure (accelerated or malignant hypertension) at their first visit to the doctor.
Cause and Pathogenesis
Cause and Pathogenesis
Cause and Pathogenesis
---Inherited genetic factors
About half of patients have family history of hypertension, they were born to have higher risk to suffer hypertension.
Hypertension教学课件ppt
脑出血
高血压会导致脑血管破裂，引起脑出血， 严重时可能导致瘫痪或死亡。
脑梗死
高血压会加重脑血管狭窄，引起脑梗死， 导致脑部缺血缺氧。
认知功能障碍
高血压会影响脑部血管供血，导致认知功 能障碍，如记忆力减退、思维迟钝等。
防治措施
控制血压，定期进行脑血管检查，如脑电 图、脑CT等，预防脑血管病变。
高血压对肾脏的损害及防治
高血压对心脏的损害及防治
左心室肥厚
高血压会导致左心室肥厚，影响心脏的泵血功能，增加心脏病发作的风险。
心绞痛
高血压会加重冠状动脉粥样硬化，引起心绞痛，严重时可能导致心肌梗死。
心力衰竭
长期高血压会导致心脏负担加重，引起心力衰竭。
防治措施
控制血压，定期检查心电图和超声心动图，及时发现心脏病变。
高血压对脑血管的损害及防治
控制能量的摄入 过度摄入能量会导致肥胖和高血 压，建议控制每天的总能量摄入 。
运动疗法
01
有氧运动
如快走、慢跑、游泳等可以提高 心肺功能，降低血压。
柔韧性训练
如瑜伽、普拉提等可以增加关节 的灵活性和柔韧性，防止受伤。
03
02
抗阻运动
如举重、俯卧撑等可以增强肌肉 力量，提高基础代谢率。
平衡训练
如单脚站立、太极拳等可以改善 平衡能力，防止跌倒。
高血压通常分为原发性高血压 和继发性高血压。
原发性高血压是指原因不明的 高血压，而继发性高血压是指 由于某种疾病或原因导致的高
血压。
高血压分类
原发性高血压根据病因和发病机制不同，可分为原发性高血压、肾性高血压、心 理性高血压等。 肾性高血压是指肾脏疾病引起的继发性高血压。
心理性高血压是指情绪变化或心理压力引起的高血压。
高血压会导致脑血管破裂，引起脑出血， 严重时可能导致瘫痪或死亡。
脑梗死
高血压会加重脑血管狭窄，引起脑梗死， 导致脑部缺血缺氧。
认知功能障碍
高血压会影响脑部血管供血，导致认知功 能障碍，如记忆力减退、思维迟钝等。
防治措施
控制血压，定期进行脑血管检查，如脑电 图、脑CT等，预防脑血管病变。
高血压对肾脏的损害及防治
高血压对心脏的损害及防治
左心室肥厚
高血压会导致左心室肥厚，影响心脏的泵血功能，增加心脏病发作的风险。
心绞痛
高血压会加重冠状动脉粥样硬化，引起心绞痛，严重时可能导致心肌梗死。
心力衰竭
长期高血压会导致心脏负担加重，引起心力衰竭。
防治措施
控制血压，定期检查心电图和超声心动图，及时发现心脏病变。
高血压对脑血管的损害及防治
控制能量的摄入 过度摄入能量会导致肥胖和高血 压，建议控制每天的总能量摄入 。
运动疗法
01
有氧运动
如快走、慢跑、游泳等可以提高 心肺功能，降低血压。
柔韧性训练
如瑜伽、普拉提等可以增加关节 的灵活性和柔韧性，防止受伤。
03
02
抗阻运动
如举重、俯卧撑等可以增强肌肉 力量，提高基础代谢率。
平衡训练
如单脚站立、太极拳等可以改善 平衡能力，防止跌倒。
高血压通常分为原发性高血压 和继发性高血压。
原发性高血压是指原因不明的 高血压，而继发性高血压是指 由于某种疾病或原因导致的高
血压。
高血压分类
原发性高血压根据病因和发病机制不同，可分为原发性高血压、肾性高血压、心 理性高血压等。 肾性高血压是指肾脏疾病引起的继发性高血压。
心理性高血压是指情绪变化或心理压力引起的高血压。
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,
高血压英语课件
Moderate exercise
Moderate exercise is beneficial for controlling blood pressure and avoiding physical discomfort caused by excessive exercise.
Weight control
Extreme heat or cold can temporarily raise blood pressure levels
Mental stress
Chronic stress
Constant exposure to severe situations or emotional trauma can lead to persistent elevation in blood pressure
Drug therapy
要点一
Antihypertensive drugs
These drugs are used to lower blood pressure by relaxing the blood vessels, reducing the heart rate, or removing excess fluid from the body Commonly used antihypertensive drugs include angiotensin converting enzyme inhibitors, beta blockers, and diuretics
Dizziness or falling
High blood pressure can lead to insufficient blood flow to the brain, causing dizziness or falling falls
Moderate exercise is beneficial for controlling blood pressure and avoiding physical discomfort caused by excessive exercise.
Weight control
Extreme heat or cold can temporarily raise blood pressure levels
Mental stress
Chronic stress
Constant exposure to severe situations or emotional trauma can lead to persistent elevation in blood pressure
Drug therapy
要点一
Antihypertensive drugs
These drugs are used to lower blood pressure by relaxing the blood vessels, reducing the heart rate, or removing excess fluid from the body Commonly used antihypertensive drugs include angiotensin converting enzyme inhibitors, beta blockers, and diuretics
Dizziness or falling
High blood pressure can lead to insufficient blood flow to the brain, causing dizziness or falling falls
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
高血压英文PPT精品课件Hypertensioninthe
Clinical Findings
• Of Complications/TOD
– Brain: H/A, N/V, meningism, FND, delirium, decreased LOC, seizures, coma
– Retina: blurred vision, papilledema (IV) +/- cotton wool exudate, flame shape hg, AV nipping and silver wiring (G I-III in chronic Htn)
Definitions: Hypertensive
Crisis (Severe Htn)
• Hypertensive Urgency:
– SBP >180 or DBP>110 w/o TOD
• Hypertensive Emergency (Malignant Htn):
– SBP >180 or DBP>110 (esp >120) or accelerated htn wt TOD – TODs: 1. Brain: Hypertensive encephalopathy/edema, ICH, ischemic
• In the last week, the headaches have become much more severe and frequent, occurring almost daily, and are accompanied by throbbing chest pain, sweating, dizziness and palpitations.
– Including microvascular thrombosis
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Kieran McGlade Nov 2001
Investigation of the New Hypertensive
• History and examination • Exclude secondary Hypertension • Urea and electrolytes • FBP and ESR • ECG • Lipid profile
disease. • Mild – moderate renal dysfunction. • Sudden onset pulmonary oedema.
Kieran McGlade Nov 2001
Ladder Approach
• Bendrofluazide • Bendrofluazide + Atenolol or ACE • Calcium Channel blocker • Alpha blocker
• Phaeochomocytoma • Cusings syndrome • Conn’s syndrome • Acromegaly and hypothyroidism
– Coarctation of the aorta – Iatrogenic
• Hormonal / oral contraceptive • NSAIDs
• Chest x-ray no longer routinely indicated
Kieran McGlade Nov 2001
Clinical clues to renal vascular disease
• Hypertension under 50 Yrs of age. • Generalised vascular (esp peripheral)
• In diabetes – Diastolic< or = 80mmhg 51 % lower risk compared to 90 mmHg
Kieran McGlade Nov 2001
Global heart threat from diabetes:
A global explosion in the number of cases of diabetes is threatening to reverse the reduction in deaths from heart disease in many western countries, including the United Kingdom. To coincide with World Diabetes Day on 14 November, Diabetes UK is calling for action to be taken to reduce the 20,000 deaths per year from coronary heart disease (CHD) among people with diabetes in the UK.
Kieran McGlade Nov 2001
This left ventricle is very thickened (slightly over 2 cm in thickness), but the rest of the heart is not greatly enlarged. This is typical for hypertensive heart disease. The hypertension creates a greater pressure load on the heart to induce the hypertrophy.
• At least 60% of patients will require 2 or 3 antihypertensive agents to achieve tight control.
Kieran McGlade Nov 2001
Stages
• Identification of hypertensive patients • Baseline investigations • Initiating therapy • Reviewing patients • Stepping up therapy • Motivation and compliance
Hypertension
Kieran McGlade Nov 2001
Aetiology of Hypertension
• Primary – 90-95% of cases – also termed “essential” of
“idiopathic”
• Secondary – about 5% of cases – Renal or renovascular disease – Endocrine disease
Kieran McGlade Nov 2001
Hypertension and Diabetes
• Hypertension co-exists with type II in about 40% at age 45 rising to 60% at age 75.
• 70% of type II patients die from cardiovascular disease.
Kieran McGlade Nov 2001
H O T Findings
• Lowest incidence of major CV events occurred at a mean achieved DBP of 83 mmhg. This target (compared to mean achieved of 105 mmHg was associated with a 30% reduction in main CV events.
Kieran McGlade Nov 2001
Taiቤተ መጻሕፍቲ ባይዱored Approach
• Assessment of overall cardiovascular risk • Recognition of co-morbidities • Lipid profile • Renal function • Existing contra- indications
Investigation of the New Hypertensive
• History and examination • Exclude secondary Hypertension • Urea and electrolytes • FBP and ESR • ECG • Lipid profile
disease. • Mild – moderate renal dysfunction. • Sudden onset pulmonary oedema.
Kieran McGlade Nov 2001
Ladder Approach
• Bendrofluazide • Bendrofluazide + Atenolol or ACE • Calcium Channel blocker • Alpha blocker
• Phaeochomocytoma • Cusings syndrome • Conn’s syndrome • Acromegaly and hypothyroidism
– Coarctation of the aorta – Iatrogenic
• Hormonal / oral contraceptive • NSAIDs
• Chest x-ray no longer routinely indicated
Kieran McGlade Nov 2001
Clinical clues to renal vascular disease
• Hypertension under 50 Yrs of age. • Generalised vascular (esp peripheral)
• In diabetes – Diastolic< or = 80mmhg 51 % lower risk compared to 90 mmHg
Kieran McGlade Nov 2001
Global heart threat from diabetes:
A global explosion in the number of cases of diabetes is threatening to reverse the reduction in deaths from heart disease in many western countries, including the United Kingdom. To coincide with World Diabetes Day on 14 November, Diabetes UK is calling for action to be taken to reduce the 20,000 deaths per year from coronary heart disease (CHD) among people with diabetes in the UK.
Kieran McGlade Nov 2001
This left ventricle is very thickened (slightly over 2 cm in thickness), but the rest of the heart is not greatly enlarged. This is typical for hypertensive heart disease. The hypertension creates a greater pressure load on the heart to induce the hypertrophy.
• At least 60% of patients will require 2 or 3 antihypertensive agents to achieve tight control.
Kieran McGlade Nov 2001
Stages
• Identification of hypertensive patients • Baseline investigations • Initiating therapy • Reviewing patients • Stepping up therapy • Motivation and compliance
Hypertension
Kieran McGlade Nov 2001
Aetiology of Hypertension
• Primary – 90-95% of cases – also termed “essential” of
“idiopathic”
• Secondary – about 5% of cases – Renal or renovascular disease – Endocrine disease
Kieran McGlade Nov 2001
Hypertension and Diabetes
• Hypertension co-exists with type II in about 40% at age 45 rising to 60% at age 75.
• 70% of type II patients die from cardiovascular disease.
Kieran McGlade Nov 2001
H O T Findings
• Lowest incidence of major CV events occurred at a mean achieved DBP of 83 mmhg. This target (compared to mean achieved of 105 mmHg was associated with a 30% reduction in main CV events.
Kieran McGlade Nov 2001
Taiቤተ መጻሕፍቲ ባይዱored Approach
• Assessment of overall cardiovascular risk • Recognition of co-morbidities • Lipid profile • Renal function • Existing contra- indications