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1、,Essential Hypertension (EHT),Introduction,What is blood pressure? Blood pressure is the pressure of blood upon the walls of the blood vessels. Blood pressure is measured in millimeters of mercury (mmHg). Your blood pressure is recorded as two figures. For example, 150/95 mmHg. This is said as “150
2、over 95”.,Defination of Hypertension: Hypertension is defined as a SBP of 140 mmHg or greater and/or a DBP of 90 mmHg or greater in subjects who are not taking antihypertensive medication.,Introduction,Introduction,A “silent“ killer Can cause: ischaemic and haemorrhagic stroke, myocardial infarction
3、,heart failure, chronic kidney disease, cognitive decline, premature death.,Introduction,Classification: Essential hypertension: no specific medical cause can be found to explain a patients condition. 90% Secondary hypertension: a result of another condition, such as renal, vascular, and endocrine c
4、auses .,Epidemiology,One of the most common disease in the world. In China, more than 200 million people have established or borderline HP. In the US, 65 million people have hypertension.,患病率(%),所占比例(%),1.2005中国高血压指南 2.中国高血压防治指南(2009 年基层版) 3.2010中国高血压指南,Epidemiology,Epidemiology,In the US: 70% of th
5、e hypertensives are aware that they have hypertension 59% are being treated Only 34% have adequately controlled BP,Epidemiology,In the China: 30.6% of the hypertensives are aware that they have hypertension 24.7% are being treated Only 6.1% have adequately controlled BP,发病率(%),所占比例(%),1.2005中国高血压指南
6、2.中国高血压防治指南(2009 年基层版) 3.2010中国高血压指南,Epidemiology,Etiology,Genetic : a predisposing factor, but the exact mechanism is unclear. Environmental factors: Dietary: Salt intake Psychosocial stress Obesity Alcohol intake,Pathogenesis,High activity of the SNS (Sympathetic Nervous System) RAAS (Renin-Angiot
7、ension Aldosterone System) Renal Sodium Handling Vascular Remodelling Endothelial Cell Dysfunction Others,Pathological consequences,No pathologic changes occur early in hypertension. Severe or prolonged hypertension target organs damages (TOD) (primarily the cardiovascular system, brain, and kidney)
8、 Increasing risk of CAD, MI, stroke, and renal failure The mechanism development of generalized arteriolosclerosis acceleration of atherogenesis,The pathological changes of small artery,Pathological change of the Brain,Stroke: Ischemic stroke Hemorrhagic stoke,Arterial Aneurysm,The pathological chan
9、ge of the Heart,Left ventricular hypertrophy (LVH) Heart failure Coronary artery atherosclerosis Myocardial infarction,Pathological change of Renal,Hypertension induced nephrosclerosis, atrophy of renal cortex,Clinical Features,1. Variation of BP The blood pressure varies widely over time. Depending
10、 on many variables: SNS activity, posture, skeletal muscle tone, state of hydration, and circumstance (white coat HP).,Clinical Features,2. Symptoms of hypertension Usually asymptomatic until complications develop in target organs Dizziness, flushed facies, headache, fatigue, epistaxis, and nervousn
11、ess Hypertensive emergencies can cause severe cardiovascular, neurologic, renal, and retinal symptoms,Clinical Features,3. Complications of Hypertension a) brain and eyes: headache, vertigo, impaired vision, transient ischemic attacks, sensory or motor deficit b) heart: palpitation, chest pain, shor
12、tness of breath, swollen ankles c) kidney: thirst, polyuria, nocturia, haematuria d) peripheral arteries: cold extremities, intermittent claudication,4. family and clinical history Indications of secondary hypertension: a) family history of renal disease c) drug/substance intake: oral contraceptives
13、, steroids d) episodes of sweating, headache, anxiety, palpitation e) episodes of muscle weakness (aldosteronism) Risk factors: a) family and personal history of hypertension and cardiovascular disease b) family and personal history of dyslipidaemia, diabetes mellitus d) smoking habits, dietary habi
14、ts f) obesity; amount of physical exercise g) snoring; sleep apnea h) personality,Clinical Features,- Blood pressure measurement,Clinic Blood Pressure Home Blood Pressure Ambulatory monitoring,Physical examination,1. Clinic Blood Pressure,BP must be measured twicefirst with the patient supine or sea
15、ted, then 2 min after the first measure. Patients should sit with their arms supported at heart level. Patients should not smoke or ingest caffeine for 30 minutes prior to blood pressure measurement.,Patients should sit down for at least 5 minutes before blood pressure is measured. The bladder of th
16、e cuff should encircle at least 80% of the arm. A large cuff should be used for patients with thick arms.,1. Clinic Blood Pressure,2. Home BP,Self-measurement of BP is of clinical value. Should be encouraged in order to: 1. provide more information on the BP lowering effect of treatment at trough, and thus on therapeutic coverage throughout the dose-to-dose time interval 2. improve patients adherence to treatment regimens 3. there are doubts on technical reliability / enviro
