Hypertension

Hypertension
High blood pressure, defined as a repeatedly elevated blood pressure
exceeding 140 over 90 mmHg -- a systolic pressure above 140 or a
diastolic pressure above 90

Epidemiology
● About 75 million American adults (29%) have high blood pressure—that’s 1 of every 3 adults.
● High blood pressure costs the nation $46 billion each year. This total includes the cost of health care
services, medications to treat high blood pressure, and missed days of work

Classification of Hypertension Types of Hypertension

Classification of blood pressure
● Hypertension
● Primary Hypertension
● Secondary Hypertension

Primary Hypertension
● Essential hypertension or idiopathic hypertension
● It is the most common type of hypertension, affecting 95% of hypertensive patients
Secondary Hypertension
● Inessential hypertension
● It is much less common than the other type, called essential hypertension, affecting only 5% of
hypertensive patients.
● It has many different causes including endocrine diseases, kidney diseases, and tumors.
● It also can be a side effect of many medications.
Signs and symptoms
● Hypertension is rarely accompanied by symptoms, and its identification is usually through screening, or
when seeking healthcare for an unrelated problem.
● Some with high blood pressure report headaches (particularly at the back of the head and in the
morning), vertigo, tinnitus (buzzing or hissing in the ears), altered vision or fainting episodes.
● These symptoms, however, might be related to associated anxiety rather than the high blood pressure
itself.
Causes of Hypertension
In general the major causes of hypertension are the following:

● Hectic and stress filled life style ● Metabolic disorders

● Unhealthy food habits ● Excessive use of pain killers and other strong
● Obesity medicines
● Excessive consumption of liquors ● Genetic disorders
● Smoking ● Over consumption of oily food and fast food
● Over consumption of tea/coffee ● High salt intake
● Insufficient rest and sleep ● Emotional and Physical stress
● Family history of hypertension

Pathophysiology of Hypertension
These are the fundamental factors which
determine the value of BP.
They are
1. Cardiac output (Describes the volume of blood
being pumped by the heart, in particular by the
left or right ventricle, per unit time)
2. Peripheral vascular resistance.
These are also called as factors controlling BP.
BP= Cardiac Output X PVR

RAAS
1. The renin-angiotensin system (RAS) or the renin-angiotensin-aldosterone system (RAAS) is a hormone
system that regulates blood pressure and water (fluid) balance.
2. When blood volume is low, juxtaglomerular cells in the kidneys activate their prorenin and secrete renin
directly into circulation.
3. Plasma renin then carries out the conversion of angiotensinogen released by the liver to angiotensin I.
4. It is subsequently converted to angiotensin II by the enzyme angiotensin-converting enzyme found in
the lungs.
5. Angiotensin II is a potent vaso-active peptide that causes blood vessels to constrict, resulting in
increased blood pressure.
6. Angiotensin II also stimulates the secretion of the hormone aldosterone from the adrenal cortex
7. Aldosterone causes the tubules of the kidneys to increase the reabsorption of sodium and water into
the blood.
8. This increases the volume of fluid (Cardiac Output) in the body, which also increases blood pressure.
9. If the renin-angiotensin-aldosterone system is abnormally active, blood pressure will be too high.
Agents that blocks the RAAS

High Salt Intake and Hypertension

● A high sodium intake may result
in water retention.
● Some people are Na sensaitive
(about 20%) ; not everyone with
high salt diet develops
hypertension

Mutation in 10 genes which control the blood pressure

Mutations affect blood pressure by altering renal salt handling
Insulin Resistance and Hypertension
● Insulin resistance & hyperinsulinemia
● High insulin concentration stimulates SNS activity and impairs nitric oxide–mediated vasodilation
● Not present in secondary hypertension and don’t improve when hypertension is treated
Stress Induced Hypertension
● Stress and increased SNS activity ● ↑ HR
● Produces increased vasoconstriction ● ↑ Renin release
● Angiotensin II causes direct arteriolar constriction, promotes vascular hypertrophy and induces
aldosterone secretion
 Obesity and Hypertension
● Obesity resulting in increased blood volume
resulting in increased CO.
● As you gain weight, the amount of blood
circulating through your body increases.
This puts added pressure on your artery
walls, increasing your blood pressure.
● Excess weight often is associated with an
increase in heart rate and a reduction in the
capacity of your blood vessels to transport
blood.
Smoking and Hypertension

Nicotine in tobacco raises blood pressure by stimulating sympathetic neurons to increase vasoconstriction and
by stimulating the adrenal medulla to increase secretion of epinephrine and norepinephrine.

Role Autonomic Nervous System in Hypertension

● The autonomic nervous system plays a central role in maintaining cardiovascular homeostasis via
pressure, volume, and chemoreceptor signals.
● It does this by regulating the peripheral vasculature, and kidney function, which in turn affect cardiac
output, vascular resistance, and fluid retention.
● Excess activity of the sympathetic nervous system increases blood pressure and contributes to
hypertension

Simple Mechanism
● It does this by regulating the;
● Peripheral vasculature, and kidney function, which in turn
affect
● Cardiac output, Vascular resistance, and Fluid retention.

NOTE : Conversely, low pressure has opposite effects, reflex causing the pressure rise back to normal.
Short-term Regulation of Falling Blood Pressure

Baroreflex and Blood Pressure Chemorceptors and Blood Pressure

● The mechanisms of increased sympathetic nervous
system activity in hypertension involve alterations in
baroreflex and chemoreflex pathways at both
peripheral and central levels.
● Arterial baroreceptors are reset to a higher pressure in
hypertensive patients, and this peripheral resetting
reverts to normal when arterial pressure is
normalized.
● Furthermore, there is central resetting of the aortic
baroreflex in hypertensive patients, resulting in
suppression of sympathetic inhibition after activationof aortic baroreceptor nerves.
● This baroreflex resetting seems to be mediated, at least partly, by a central action of angiotensin II.

Complications:
1. Endothelial Dysfunction
● The endothelium of blood vessels produces an extensive range of substances that influence blood flow
and, in turn, is affected by changes in the blood and the pressure of blood flow.
● For example, local nitric oxide and endothelin, which are secreted by the endothelium, are the major
regulators of vascular tone and blood pressure.
● In patients with essential hypertension, the balance between the vasodilators and the vasoconstrictors is
upset
● Evidence suggests that oxidant stress alters many functions of the endothelium, including modulation of
vasomotor tone.
● Inactivation of nitric oxide (NO) by superoxide and other reactive oxygen species (ROS) seems to occur
in conditions such as hypertension.
● It has been suggested that angiotensin II enhances formation of the oxidant superoxide at concentrations
that affect blood pressure.
2. Sodium/Potassium ratio hypothesis of essential hypertension
● A 2007 review article states that while excessive sodium consumption has long been recognized as
contributing to the risk of hypertension, "potassium, the main intracellular cation, has usually been viewed
as a minor factor in the pathogenesis of hypertension.
● However, abundant evidence indicates that a potassium deficit has a critical role in hypertension.
● The authors state that modern, western, high sodium, low potassium diets result in corresponding
changes in intracellular concentration of these, the two most important cations in animal cells.
● This imbalance leads to contraction of vascular smooth muscle, restricting blood flow and so driving up
blood pressure.
3. Diabetes Complications (Diabetic Nephropathy)
Diabetes can damage your kidneys' filtering system, which can lead to high blood pressure.
4. Polycystic kidney disease
In this inherited condition, cysts in your kidneys prevent the kidneys from working normally and can
raise blood pressure.
5. Glomerular disease
Your kidneys filter waste and sodium using microscopic-sized filters called glomeruli that can
sometimes become swollen. If the swollen glomeruli can't work normally, you may develop high blood
pressure.
6. Renovascular hypertension
● This type of hypertension is caused by narrowing (stenosis) of one or both arteries leading to your
kidneys.
● It's often caused by the same type of fatty plaques that can damage your coronary arteries
(atherosclerosis) or a separate condition in which the muscle and fibrous tissues of the renal artery wall
thicken and harden into rings (fibromuscular dysplasia).
● Renovascular hypertension can cause irreversible kidney damage.
7. Cushing syndrome
In this condition, corticosteroid medications may cause secondary hypertension, or hypertension may
be caused by a pituitary tumor or other factors that cause the adrenal glands to produce too much of
the hormone cortisol.
8. Aldosteronism
● In this condition, a tumor in the adrenal gland, increased growth of normal cells in the adrenal gland or
other factors cause the adrenal glands to release an excessive amount of the hormone aldosterone.
● This makes your kidneys retain salt and water and lose too much potassium, which raises blood
pressure.
9. Pheochromocytoma
This rare tumor, usually found in an adrenal gland, increases production of the hormones adrenaline
and noradrenaline, which can lead to long-term high blood pressure or short-term spikes in blood
pressure.
10. Hyperparathyroidism
● The parathyroid glands regulate levels of calcium and phosphorus in your body.
● If the glands secrete too much parathyroid hormone, the amount of calcium in your blood rises — which
triggers a rise in blood pressure.
11. Sleep apnea
● In this condition, often marked by
severe snoring, breathing repeatedly
stops and starts during sleep, causing
you to not get enough oxygen.
● Not getting enough oxygen may
damage the lining of the blood vessel
walls, which may make your blood
vessels less effective in regulating your
blood pressure.
● In addition, sleep apnea causes part of
the nervous system to be overactive
and release certain chemicals that
increase blood pressure.