1. Hypertension
By Alexandre Sloukgi

2. 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, (

3. 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):

4. 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):

5. 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

6. 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.

7. 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

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

9. 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.

10. 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

11. Consequences of hypertension
End organ damage

12. 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 => mL of pure alcohol /day )
Consume a diet rich in fruit and vegetables (at least 5 portions a day)

13. 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.

14. 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.

15. 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

16. References https://www.drinkaware.co.uk/understand-your-drinking
dPressure/WhyBloodPressureMatters/Why-Blood- Pressure-Matters_UCM_002051_Article.jsp