dijana vidović mentor: a. Žmegač horvat. f orce exerted by circulating blood on the arterial...
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Dijana VidovićMentor: A. Žmegač Horvat
Force 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
Uses 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
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
Aim of treatment - <140/ 90 Reduction of blood pressure by 5-6 mm/Hg
decreases the risk of stroke by 40%, coronary heart disease by 15- 20%, 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 Stopping smoking Reducing stress (relaxation therapy – meditation)
High blood pressure - major public health problem Affects approximately one in three adults in the
United States – 73 million people Affects about 2 million American teens and children
(many underdiagnosed) Normalize blood pressure and prevent
complications!
http://en.wikipedia.org/wiki/Blood_pressure Kumar P. i sur. Clinical medicine VI izd. Elsevier-
Saunders, Edinburgh 2005 Vrhovac B. i sur. Interna medicina IV izd. Naklada
Ljevak, Zagreb 2008