1. Source: Your Guide To Lowering Blood Pressure, www.nhlbi.nih.govc Pathophysiology BMS 243 Hypertension Dr. Aya M. Serry 2015/2016

2. Source: Your Guide To Lowering Blood Pressure, www.nhlbi.nih.govc Blood Pressure Blood pressure is the force of blood pushing against the arteries. Blood is carried to all parts of the body in vessels called arteries.

3. Source: Your Guide To Lowering Blood Pressure, www.nhlbi.nih.govc. Each time the heart beats (about 60-70 times a minute at rest), it pumps out blood into the arteries. Blood Pressure The blood pressure is at its highest level when the heart beats, pumping the blood. When the heart is at rest, between beats, the blood pressure falls. The blood pressure is always given as these two numbers with one above or before the other. This is called SYSTOLIC pressure. 120/ Top number 80 This is called DIASTOLIC pressure. Bottom number

4. Source: Your Guide To Lowering Blood Pressure, www.nhlbi.nih.govc Category Systolic (Top Number) Diastolic (Bottom Number) NormalLess than 120Less than 80 Normal Blood Pressure Normal Blood Pressure “Normal” blood pressure is when both numbers are lower than 120/80.

5. Source: Your Guide To Lowering Blood Pressure, www.nhlbi.nih.govc If the blood pressure is in the prehypertensive range: It means that the patient does not have high blood pressure now, but he is likely to develop it in the future. Unless he takes ACTION to prevent it! “Prehypertension” Prehypertension120-13980-89

6. Source: Your Guide To Lowering Blood Pressure, www.nhlbi.nih.govc High Blood Pressure When blood pressure stays elevated over a long period of time it is called high blood pressure or “hypertension”. High blood pressure is dangerous because it makes the heart work too hard and contributes to hardening of the arteries.

7. Source: Your Guide To Lowering Blood Pressure, www.nhlbi.nih.govc High Blood Pressure A blood pressure of 140/90 is considered high blood pressure. “ Hypertension ”

8. Source: Your Guide To Lowering Blood Pressure, www.nhlbi.nih.govc High Blood Pressure Warning Signs: 1. 2. 3. 4. “Silent Killer”

9. Source: Your Guide To Lowering Blood Pressure, www.nhlbi.nih.govc Hypertension etiology  The exact causes of high blood pressure are not known, but several factors and conditions may play a role in its development, including: 1.Smoking 2.Being overweight or obese 3.Lack of physical activity 4.Too much salt in the diet 5.alcohol consumption

10. 6.Stress 7.Older age 8.Genetics (Family history of high blood pressure) 9.Chronic kidney disease 10.Adrenal and thyroid disorders.

11. Source: Your Guide To Lowering Blood Pressure, www.nhlbi.nih.govc Hypertension Complications  Increases your risk for : Heart disease & Stroke  If left uncontrolled, hypertension can also cause: Heart failure Heart Attack Kidney disease Blindness

12. Source: Your Guide To Lowering Blood Pressure, www.nhlbi.nih.govc Complications of Hypertension Heart Attack High blood pressure is a major risk factor for heart attack. The arteries bring oxygen-carrying blood to the heart muscle. If the heart cannot get enough oxygen, chest pain, can occur. If the flow of blood is blocked, a heart attack results. Blindness High blood pressure can eventually cause blood vessels in the eye to bleed. Vision may become blurred or otherwise impaired and can result in blindness. Kidney disease Kidneys act as filters to rid the body of waste. High blood pressure can narrow and thicken the blood vessels of the kidneys. The kidneys filter less fluid and waste builds up in the blood. The kidneys may fail altogether. High blood pressure is the most important risk factor for stroke. Very high pressure can cause a break in a weakened blood vessel, which then bleeds in the brain. This can cause a stroke. If a blood clot blocks one of the narrowed arteries, it can also cause a stroke. Stroke As people get older, arteries throughout the body "harden," especially those in the heart, brain, and kidneys. High blood pressure is associated with these "stiffer" arteries. This, in turn, causes the heart to work harder. Arteries Heart failure The heart is unable to pump enough blood to supply the body's needs.

13. Source: Your Guide To Lowering Blood Pressure, www.nhlbi.nih.govc Pathophysiology of hypertension 1 Renin angiotensin aldosteron System(RAAS) 2 Sympathetic control 3 Endothelial control

14. Source: Your Guide To Lowering Blood Pressure, www.nhlbi.nih.govc Renin-Angiotensin-Aldosterone System  Renin is a proteolytic enzyme produced by cells of kidney.  It is secreted in response to: Decrease in arterial blood pressure. Decrease Na+. Increased sympathetic nervous activity.  Renin acts on a protein ( Angiotensinogen) and cleaves it to produce Angiotensin-I.  Angiotensin-I is rapidly converted to Angiotensin-II by ACE (angiotensin converting enzyme)  Angiotensin-II stimulates Aldosterone secretion from Adrenal Cortex which causes sodium and water retention..

15. Source: Your Guide To Lowering Blood Pressure, www.nhlbi.nih.govc Vasoconstriction Renin-Angiotensin-Aldosterone System Angiotensinogen Angiotensin I Angiotensin II ACE Renin Aldosterone secretion Sodium & fluid retention From kidney From liver

16. Sympathetic control of blood pressure Sympathetic stimulation and catcholamines (Adrenaline and nor adrenaline ) Stimulation of Beta receptors vasodilatation Stimulation of Alpha receptors vasoconstriction Vasoconstriction activated by  -adrenergic receptors would override vasodilatation by  -adrenergic receptors. BP BP

17. Endothelial control Endothelin Thromboxane A2Vasoconstriction BP Prostacyclin Bradykinin Histamine Serotonin Vasodilatation BP

18. Treatment of hypertension

19. Source: Your Guide To Lowering Blood Pressure, www.nhlbi.nih.govc 1.Diuretics: Acts on Kidneys to increase excretion of Na and H 2 O – decrease in blood volume – decreased BP. 2.Angiotensin-converting Enzyme (ACE) inhibitors: Inhibit synthesis of Angiotensin II –decreased BP. 2.α-adrenergic blockers: Bind to alpha adrenergic receptors and blocks the activity, vasodilatation- decreased BP. Treatment of hypertension

20. Source: Your Guide To Lowering Blood Pressure, www.nhlbi.nih.govc Non pharmacological prevention of Hypertension Hypertension You can take action to prevent getting high blood pressure or take steps to control it! See your doctor for regular blood pressure check ups Maintaining a healthy weight Get physically active Eat a healthy diet rich in vegetables and fruits, and low fat dairy foods Choose and prepare foods with less salt If you smoke, think about quitting

21. Source: Your Guide To Lowering Blood Pressure, www.nhlbi.nih.govc 1. GET YOUR BLOOD PRESSURE CHECKED. 2. EAT HEALTHY FOODS. 3. GET PLENTY OF EXERCISE. Our heart health depends on it! Live Healthy Source: Your Guide To Lowering Blood Pressure, www.nhlbi.nih.govc