Hypertension By Alexandre Sloukgi

More than ¼ of the world’s population is hypertensive The burden of hypertension is very high. According to last report from WHO, more than ¼ of the world’s population is hypertensive World Health Organization, 2012. (http://www.who.int/gho).

Hypertension: a growing disease +60% Increased population Increased life-expectancy Risk factors Obesity Diabetes … And this burden is expected to increase in the coming years by 60% , with increased population and increased life-expectancy. Add to this the increased risk factors such as obesity and diabetes. Kearney PM, Whelton M, Reynolds K, Muntner P, Whelton PK, He J. Lancet. 2005;365(9455):217-223.

Hypertension: a growing disease Prevalence: 30% +60% Increased population Increased life-expectancy Prevalence: 26% Risk factors Obesity Diabetes … And the prevalence is expected to reach 30% of the total adult population in 2025 Kearney PM, Whelton M, Reynolds K, Muntner P, Whelton PK, He J. Lancet. 2005;365(9455):217-223.

Definition Chronic medical condition in which the blood pressure of the arteries is persistently elevated. Arterial hypertension example: Systolic blood pressure(SBP)= 158mmHg Diastolic blood pressure(DBP)=99mmHg While normal blood pressure: 120/80 mmHg

Signs and symptoms Headaches, lightheadedness, vertigo, tinnitus(buzzing or hissing of the ears), fainting episodes. Hypertensive crisis: severe elevated blood pressure(180/110) is categorized as hypertensive emergency or urgency according to presence or absence of end organ damage.

Pathophysiology Renin-angiotensin system : Ang II acts on musculature of arteries and raises resistance=> blood pressure. Endothelial dysfunction Autonomic nervous system: regulating peripheral vasculature and kidney function.  Excessive activity of sympathetic nervous system increases blood pressure=> hypertension

Risk factors Age Heredity Gender(male) Obesity Smoking High cholesterol Diabetes Physical inactivity

Etiology Primary hypertension : BP rises with aging mostly. Environmental factors that influence : Stress, depression... Events in early life can influence as well : low birth weight, maternal smoking.

Secondary hypertension : results from identifiable cause : Kidney disease (most common) Endocrine conditions such as : hyper/hypothyroidism, hyperaldosteronism, hyperparathyroidism Other causes: illegal drugs, pregnancy, obesity, sleep apnea, narrowing of aorta

Consequences of hypertension End organ damage

Prevention Maintain normal body weight Reduce dietary sodium(<6g of NaCl/day) Engage in physical activities(>30 mins/day) Limit alcohol consumption (2-3 units/day => 20-30 mL of pure alcohol /day ) Consume a diet rich in fruit and vegetables (at least 5 portions a day)

Treatment Dietary program for patients: limiting wine, meat, pastries, low-energy diet Antihypertensive agents : calcium channel blockers, angiotensin converting enzyme (ACE) inhibitors, angiotensin receptor blockers and renin inhibitors, beta blockers, diuretics.

ACE inhibitors: a complete mode of action on RAAS and kallikrein-kinin system Angiotensin Renin Vasodilation Antiremodeling Antioxidant Antithrombotic + Bradykinin Ang I ACE inhibitor Chymases Cathepsin G CAGE Ang II Inactive peptides ACEis increase bradykinin level leading to favorable effects: Vasodilation Antiremodeling Antioxidant antithrombotic AT1 AT2 + + Sartan Dominyak and Unger (eds) in Ang II-AT1- Receptor Antagonists. Steinkopff ;1997.

Reduces arterial stiffness Stiff artery Elastic artery Restores endothelial function Early prevention of atherosclerotic plaques In fact Coversyl has proven Unique arterial protection beyond BP control such as: Restoration of endothelial function, Reducing arterial stiffness Early prevention of atherosclerotic plaque…… Effective 24 h blood pressure control Corrects left ventricular hypertrophy Prevents cardiac remodeling Controls central aortic blood pressure 15

References https://www.drinkaware.co.uk/understand-your-drinking http://www.heart.org/HEARTORG/Conditions/HighBloo dPressure/WhyBloodPressureMatters/Why-Blood- Pressure-Matters_UCM_002051_Article.jsp