Dijana Vidović Mentor: A. Žmegač Horvat

 F orce exerted by circulating blood on the arterial walls  One of principal vital signs  Maximum (systolic) pressure – pressure in the artery when the left ventricle is contracting to force the blood into aorta and other arteries  Minimum (diastolic) pressure – pressure in the artery when the ventricles are relaxing and the heart is filling up, receiving blood from veins  Sphygmomanometer

 U ses the height of a column of mercury to reflect the circulating pressure  Blood pressure values – millimeters of mercury (mm/Hg)  Aneroid and electronic devices do not use mercury

 Baroreceptor reflex – changes in arterial pressure – medulla (brain stem) Location : left and right carotid sinuses, aortic arch  Renin – angiotensin system (RAS) Long – term adjustment of arterial pressure Kidney - compensation Endogenous vasoconstrictor – angiotensin I  Aldosterone release (adrenal cortex) Stimulates sodium retention and potassium excretion by the kidney Increases fluid retention and indirectly arterial pressure

 Chronic medical condition in which blood pressure is elevated  Systemic, arterial hypertension  Essential (primary) hypertension  Secondary hypertension

 No medical cause  Risk factors : Sedentary lifestyle Obesity ( body mass index greater than 25) Salt ( sodium) sensitivity Alcohol, smoking Family history

 High blood pressure is a result of another condition  Adrenal cortical abnormalities : Cushing ’ s syndrome ( adrenal glands overproduce the hormone cortisol) More than 85 % of patients with Cushing’s syndrome have hypertension Primary aldosteronism ( overproduction of aldosterone by adrenal glands) Aldosteronism causes sodium and water retention, potassium excretion in the kidneys - arterial hypertension  Diseases of the kidney (polycystic kidney disease – genetic disorder of the kidneys)  Diseases of the renal arteries supplying the kidney – RENOVASCULAR HYPERTENSION  Neuroendocrine tumors (pheochromocytoma)  Medication side effects (NSAID)

 Inability of the kidneys to excrete sodium  An overactive renin – angiotensin system, vasoconstriction and retention of sodium and water – hypertension  An overactive sympathetic nervous system

 No symptoms – many people unaware they have hypertension, accidentally found; complications :  Non–specific symptoms – mild symptoms  Headache  Morning headache  Tinnitus – ringing in ears  Dizziness  Confusion  Fatigue  Shortness of breath  Changes in vision - blindness  Nausea

 Anxiety  Nose bleeds  Heart palpitations  Flushed skin  Pale skin  Chest pain

 History  Physical examination  Measuring blood pressure – diagnosis of hypertension is based on a persistently high blood pressure

 Antihypertensive drugs – act by lowering blood pressure  A im of treatment - <140/ 90  Reduction of blood pressure by 5-6 mm/Hg decreases the risk of stroke by 40%, coronary heart disease by %, heart failure and mortality from vascular disease  Groups of antihypertensive drugs: ACE inhibitors (captopril, ramipril, lisinopril) Angiotensin II receptor antagonist (losartan, valsartan) Calcium channel blockers (amlodipine) Diuretics (hydrochlorothiazide) Additional diuretics such as furosemide or spironolactone Alpha blockers Beta blockers (atenolol, propranolol) Renin inhibitors (aliskiren)

 Weight reduction  Aerobic exercise (e.g. walking)  Reducing sugar intake  Reducing sodium (salt)  Fruits, vegetables  Lowfat or fatfree food  Stop ping smoking  Reducing stress (relaxation therapy – meditation)

 High blood pressure - m ajor public health problem  A ffects approximately one in three adults in the United States – 73 million people  A ffects about 2 million American teens and children ( many underdiagnosed)  Normalize blood pressure and prevent complications!

  Kumar P. i sur. Clinical medicine VI izd. Elsevier- Saunders, Edinburgh 2005  Vrhovac B. i sur. Interna medicina IV izd. Naklada Ljevak, Zagreb 2008