Hypertension. Causes, Effect. Mechanism of Hypertensive activities. Treatment and Management of hypertension. effect of angiotensin. Investigations. kidney and hypertension. How to keep Normal Bloos Pressure. Normal Ranges of Blood Pressure. Stages Of Hypertension. Complications of Hypertension. Clinical Features of Elevated B.p. Endocrine System . Life style Modification in Hypertension. Pharmacological Therapy in Hypertension

2. Hypertension
PATHOLOGY PRESENTATION
BY DR KHUSHMINA KHAN
ASSIGNED BY – SIR MOHAMMAD ASIF

3. What is Hypertension?
▪ Blood pressure is the pressure of your blood on the walls of your
arteries as your heart pumps it around your body.
▪ A blood pressure reading under 120/80mmHg is considered
optimal.
▪ Readings over 120/80mmHg and up to 139/89mmHg are in the
normal to high normal range.
▪ The medical name for high blood pressure over a long period of
time is hypertension.

4. Stages of
Hypertension
PREHYPERTENSION IS 120/80 TO
139/89.
MILD HYPERTENSION IS 140/90 TO
159/99.
MODERATE HYPERTENSION IS
160/100 TO 179/109.
SEVERE HYPERTENSION IS
180/110 OR HIGHER.

6. COMPLICATIONS OF HYPERTENSION
▪ Hypertension is a risk factor for many negative health outcomes,
including
▪ Heart Failure
▪ Coronary Artery Disease
▪ Stroke
▪ Kidney Disease
▪ Peripheral Artery Disease
▪ Hypertensive Retinopathy, A Disease Of The Eye.

7. Complications With the Eyes
▪ Hypertensive disease of the eye is known as Hypersensitive
Retinopathy.
▪ In the retina of the eye, changes in the blood vessels eventually
result in disruption of the integrity of the vessel, and blood or fatty
acids may leak onto the delicate retinal tissue.
▪ This results in permanent vision
change, and it's very preventable.

8. Etiology
▪ Primary HTN: it is the elevation in BP without an identified cause.
▪ Secondary HTN: it is the elevation in BP with an exact cause. This
type is account for 5-10% of total cases.
▪ The causes of Secondary HTN includes
▪ Congenital narrowing of aorta
▪ Renal disease
▪ Neurological disorders like brain tumors and head injury
▪ Sleep apnea

9. Causes
▪ The exact causes of high blood pressure are often not clear. Your
blood pressure may be strongly influenced by:
▪ Family history
▪ Eating patterns, including salty foods
▪ Alcohol Intake
▪ Weight
▪ How much physical activity you do.
▪ Some medicines can also raise blood pressure.

10. CVC Information System
▪ The cardiovascular center receives information about the state of
the body through the following sources:
▪ Baroreceptors are sensory neurons that monitor arterial blood
pressure. Major baroreceptors are located in the carotid sinus (an
enlarged area of the carotid artery just above its separation from
the aorta), the aortic arch, and the right atrium.
▪ Chemoreceptors are sensory neurons that monitor levels of
CO 2 and O 2. These neurons alert the cardiovascular center when
levels of O 2 drop or levels of CO 2 rise. Chemoreceptors are found
in carotid bodies and aortic bodies located near the carotid sinus
and aortic arch.

11. Cont…
▪ Higher brain regions, such as the cerebral cortex, hypothalamus,
and limbic system, signal the cardiovascular center when
conditions (stress, fight‐or‐flight response, hot or cold
temperature) require adjustments to the blood pressure.
▪ The kidneys provide a hormonal mechanism for the regulation of
blood pressure by managing blood volume.

12. PATHOPHYSIOLOGY
▪ The normal blood pressure is maintained by four
mechanisms.
▪ Sympathetic nervous system activities.
▪ Activities of vascular endothelium.
▪ Activities of renal system.
▪ Activities of endocrine system.

13. SYMPATHETIC NERVOUS SYSTEM ACTIVITIES
▪ When the BP is decreasing the activation of SNS will occur. The
increased SNS activity increases the heart rate and cardiac
contraction.
▪ The increased the heart rate and cardiac contraction produce
vasoconstriction in the peripheral arterioles and promotes the
release of renin from kidney.
▪ The net effect of SNS activation is to increase the arterial blood
pressure by increasing cardiac output and systemic vascular
resistance.

14. ACTIVITIES OF VASCULAR ENDOTHELIUM
▪ The vascular endothelium is a single cell layer that lines the blood
vessel.
▪ It will produce vasoactive substances and growth factors like nitric
acid, endothelin etc..
▪ These substances are potent vasoconstrictors and causes
increases blood pressure level.

15. ACTIVITIES OF RENAL SYSTEM
Angiotensin II activates two mechanisms that raise blood pressure.
Angiotensin II stimulates the adrenal cortex to
secrete aldosterone,
raising blood pressure by increasing blood
volume
Renin converts the plasma protein angiotensinogen
angiotensin I, angiotensin II
The kidneys regulates blood volume.
juxtaglomerular cells secrete Renin into the blood.

16. ACTIVITIES OF ENDOCRINE SYSTEM
▪ When the angiotensin-II is stimulated in the adrenal cortex, it will
secrete aldosterone.
▪ The aldosterone will stimulate the kidneys to retain sodium and
water. Thus the BP and cardiac output will get increased.

17. CLINICAL FEATURES
▪ Some times the high blood pressure does not causes any
symptoms, so that it is known as silent killer disease.
▪ In some patients the symptoms will develop like,
▪ Severe head ache
▪ Blurred vision
▪ Dizziness
▪ Nausea

18. CONT…
▪ Vomiting
▪ Fatigue
▪ Confusion
▪ Chest pain
▪ Shortness of breath
▪ Irregular heart beat
▪ papilledema

19. DIAGNOSTIC EVALUATIONS
▪ History collection and physical examination
▪ Medical history of diabetes mellitus
▪ Complete blood count
▪ Chest x-ray
▪ ECG

20. MANAGEMENT
▪ Mainly the management of hypertension is possible by two ways,
which include
▪ Life style modification
▪ Pharmacological therapy

21. LIFE STYLE MODIFICATION
▪ The life style modification measures mainly includes,
▪ Weight reduction
▪ DASH Diet (Dietary approaches to stop hypertension)
▪ Dietary sodium reduction
▪ Reduce alcohol
▪ Exercise
▪ Stress management

22. PHARMACOLOGICAL THERAPY
▪ Various groups of drugs are used for the treatment of
hypertension, collectively these drugs are called as anti-
hypertensive drugs, which includes,
▪ Diuretics: it helps the kidneys to inhibit the sodium reabsorption in
the distal convoluted tubules, ascending limb and loop of henle.
Eg: chlorothiazide, furosemide
▪ Beta blockers: These medications reduces the workload of the
heart and blood vessal and causing the heart to beat slowly and
with less force. Eg: Atenolol, propanolol
▪ Alpha blockers: These medications causes the peripheral
vasodilation of blood vessals. Eg: Prazosin

23. CONT…
▪ Vasodilators: These medications acting directly on the muscles in
the wall of arteries and preventing the muscles from tightening
and arteries from narrowing. Eg: Nitroglycerin,
▪ ACE Inhibitors: This group of medication will reduce the conversion
of A-I to A-II and prevents vasoconstriction. Eg: Captopril, Ramipril