Chapter 16 - Blood Pressure

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Hypertension definition:

adult BP persistently elevated 140 systolic and/or 90 diastolic

Risk factors For Hypertension

Increasing age, race (esp. African-Americans), obesity, high-sodium diet, genetics, smoking, sedentary life style

Classification of Hypertension:

Primary (essential or idiopathic) hypertension—95% of cases. Secondary hypertension—can be explained by a specific disease

Primary hypertension physiology

renin-angiotensin-aldosterone system, endothelin-1 in particular is vascoconstrictive. Hyperinsulinemia & insulin resistance

Vascular endothelium

is a hormone-producing endocrine gland in its own right—endothelin-1 in particular is vascoconstrictive.

Hyperinsulinemia & insulin resistance

account for about ½ of all cases of essential hypertension

Factors for Secondary hypertension(caused by a specific disease)

-Renal disorders
-Endocrine disorders
-Vascular disorders

Renal disorders

most common cause; for instance, renal artery stenosis causes reduced renal perfusion & activation of the renin-angiotensin-aldosterone system.

Endocrine disorder examples

-Adrenocortical hormone excess (both mineralocorticoids & glucocorticoids),
-Hypo- or hyper-thyroidism

Vascular disorder Examples

-Coarctation of the aorta
-Neurologic disorders


increases systemic vascular resistance, therefore blood pressure; also narrows renal arteries as in #1 above

Coarctation of the aorta

markedly elevated BP in arms, low BP in legs

Neurologic disorders

-Elevated intracranial pressure
-spinal cord injuries can cause autonomic hyperreflexia

Drugs That cause secondary Hypertension

amphetamines, steroids, oral contraceptives, caffeine, nicotine, cocaine

Isolated systolic hypertension in the elderly

affects about ½ of people > age 65; Defined as systolic BP > 140 with diastolic < 90, More common in women Associated with decreased arterial distensibility

Hypertension during pregnancy

BP normally decreases in 1st & 2nd trimesters, returns to normal in 3rd. Defined as BP > 140/90 after 20 weeks of pregnancy

Predisposing factors to Hypertension during Pregnancy

Young (teenage) & older (late 30's & 40's) mothers, Multiple fetuses, Preexisting diabetes, HTN, renal, or cardiovascular disease


elevated BP, proteinuria, & edema, a serious threat to mother & fetus


further progression to seizures & possibly coma

Accelerated (malignant) hypertension

rapidly progressive, potentially fatal; diastolic BP > 120; present < 1% of hypertensives; 1-year mortality if untreated = 90%! Most likely in males, African-Americans, middle-aged, bilateral renal artery stenosis, targets kidneys.

Cardiac Effects of hypertension

left ventricle (LV) must work harder to overcome resistance to ejection of blood (afterload) This causes LV hypertrophy, increases myocardial O2 consumption, raises risk of ischemia, heart failure.

Vascular effects of hypertension

Atherosclerosis & arteriosclerosis—lesions in brain, retinas, kidneys. HTN is one of the leading preventable causes of renal failure

Signs & symptoms of hypertension

very few!! "silent killer", Signs/symptoms usually only appear when target organ damage occurs. Strokes, cerebrovascular disease, Coronary artery disease in all its forms, Development & rupture of aortic aneurysms, Renal problems

Renal problems of hypertension

Proteinuria, Nocturia, Azotemia

Diagnosis of hypertension

made after a minimum of 2 BP measures on separate occasions.

white coat phenomenon

term used to denote individuals who have blood pressures that are higher than normal in the medical environment,but whose blood pressures are normal when they are going about their daily activities.

Ambulatory blood pressure monitoring

measures blood pressure at regular intervals throughout the day and night. It is believed to be able to reduce the white coat hypertension effect.

Management of hypertension

goal should be AT LEAST 130/80

Lifestyle modifications of hypertension

weight reduction, decrease alcohol consumption, sodium restriction, high K+ & Ca2+ intake, exercise, cholesterol reduction

Hypertension Medications

Typically begin with diuretics or β-blockers, ACE (angiotensin converting enzyme) inhibitors & angiotensin receptor blockers useful in hypertension, congestive heart failure & diabetes.

Low blood pressure Causes What two problems

Shock—inadequate blood pressure to perfuse vital organs. Orthostatic hypotension—excessive drop in blood pressure when upright posture assumed.

What will Hyperinsulinemia & insulin resistance probably be classified as?

Metabolic syndrome

HTN complicates this many pregnancies...

12-22% of pregnancies;

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