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Main symptoms and syndromes in a rterial hypertension N. Bilkevych

Main symptoms and syndromes in a rterial hypertension N. Bilkevych. Arterial hypertension is defined as rising of arterial blood pressure excess of 140 mm Hg systolic one (SBP), and/or excess of 90 mm Hg diastolic blood pressure (DBP). Epidemiology

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Main symptoms and syndromes in a rterial hypertension N. Bilkevych

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  1. Main symptoms and syndromes in arterial hypertensionN. Bilkevych

  2. Arterial hypertension is defined as rising of arterial blood pressure excess of 140 mm Hg systolic one (SBP), and/or excess of 90 mm Hg diastolic blood pressure (DBP). • Epidemiology • Hypertension is one among the most wide-spread among all cardiovascular diseases. • 15 – 25 % of people in the population have hypertension + 15 % have bordeline hypertension. • Primary hypertensionoccupies 80 – 95 % of all arterial hypertensions and 10 % of them are secondary hypertensions.

  3. Mortality because of AH according to its degree

  4. Presentation of AH in the population according to usage of fats in the diet

  5. Essential, primary, or idiopathic hypertension is defined as high BP in which secondary causes forms are not present • Aetiology and pathogenesis: • Overstrain of the central nervous system • nervous-functional disorder in regulation of the vascular tone • vegetative-endocrine disorders and changes in the renal regulation of the vascular tone • vasopressor adrenal reaction by which arterioles of internal organs are narrowed • production of rennin, stimulation of rennin-angiotensin system and systemic vasodilatation • activation of aldosterone secretion.

  6. Pathogenesis of AH

  7. Risk-factors • Non-modified • Age • Genetics and family history • Sex( male or female) • Family and personal history of hyperlipidaemia • Family and personal history of diabetes • Race • Modified • Cigarette smoking, alkohol • Environment (stress, sedentary lifestyle) • Weight (obesity and metabolic syndrome) • Dietary habits (high alcohol intake, high sodium intake, low potassium intake) • Hypodinamia • Personality

  8. Classification • According to blood pressure: - normal: SBP< 130 andDBP< 90 mm of Hg. - Bordeline hypertension: SBP = 140-160 andDBP = 90-95 mm of Hg; • Arterial hypertension:SBP> 160 andDBP> 95mm of Hg.

  9. Level of BP in mild, moderate and severe AH

  10. WHPO classification of arterial hypertension (1993) Stage I – no evident signs of target organ damage Stage II – presence of at least one of the following signs of target organ damage: Heart: LVH (diagnosed radiologically, on ECG or by Echocardiography) Retina: generalized or focal narrowing of retinal arteries Kidney: microalbuminurua, proteinuria, creatinine<2mg/dl (176 µmol/l) Vessels: increased IMT or plaques in carotid, iliac, or femoral arteries Stage III – signs of severe target organ damage: Heart: angina pectoris, myocardial infarction, heart failure Brain: stroke, TIA, vascular dementia Retina: haemorrhages, exudates, papilloedema Kidney: renal insufficiency (creatinine>2mg/ml) Vessels: dissecting aortic aneurysm, symptomatic occlusive peripheral arterial disease

  11. Manifestation of hypertension depends on: Course of the disease Its stage; Presence of complications and crises; Pathogenetic variant(benign and maligant). Clinical manifestation • The main objective sign of the disease is elevated arterial pressure (over 140/90 mm Hg) . Blood pressure is liable in early stage of the disease but later stabilizes.

  12. I stage Complaints: • may be abcent • patients would usually complain of neurotic disorders: general weakness, impaired work capacity, inability to concentrate during work, deranged sleep, trancient headache, e feeling of heaviness in the heart, vertigo, noise in the ears, and sometimes palpitation, hain in heart region. Exertional dyspnoea develops later. Data of objective examination • Signs if lesions of internal organs are abcent • Stable or trancient elevation of BP

  13. II stage Complaints • headache • Dizziness • Pain in heart region • Exertional dyspnoea • Presence of hpertonic crises • Data of obyective examination: rddness of skin, sweating, decreased tolerance to physical load. • Palpation: Ps – firm and tense, fast. Apex beatis expanded and displaced leftward and downward. • Percussion: widened vascular bundle, displacement of the left border of relative cardiac dullness. • Auscultation: The second heart sound is accentuated over the aorta. Systolic murmur over heart apex • There are signs of internal ograns without functional disorders: • Hypertrophty of the left ventricle (according to data of ECG and X-ray, ultrasound examination). • Generalized or focal narrowing of retinal vessels. • Microalbumiuria, proteinuria and/ormild elevation of blood plasma creatinin (up to 177 mkm/l).

  14. III stage • High, stable elevation of BP • Development of complications: • Myocardial infarction • Heart failure • Insult • Trancient ischemic attack • Retinal hemorrhage • Dissecting aortic aneurism

  15. ECG • І st. – specific signs are abcent. • ІІ – ІІІ st . – hypertrophy of the left ventricle, heart electrical axis is deviated leftward, Rv5-6>Rv4, elevation of ST, biphasic Т (+-) Increased amplitude of Rin left leads and S - in right leads.

  16. ECG in hypertrophy of the left ventricle

  17. Ultrasoung examination of hypertensive heart (B- and M-modes)

  18. Left-ventricular hypretrophy on X-ray

  19. Symptoms of organs damage • Heart: palpitations, chest pain, shortness of breath, swollen ankles • Brain and eyes: headaches, vertigo, impaired vision, TIA’s, sensory or motor deficit • Kidney: thirst, polyuria, nocturia, haematuria • Peripheral arteries: cold extremities, intermittent claudication • Brain: murmurs over neck arteries, motor or sensory deficits • Eyes: funduscopic abnormalities • Heart: location and characteristics of apical impulse, abnormal cardiac rhythms, ventricular gallop, pulmonary rales, peripheral oedema • Peripheral arteries: absence, reduction, or asymmetry of pulses, cold extremities, ischaemic skin lesions

  20. Complications

  21. Дослідження очного дна

  22. I degree: Arteriolar thickening, tortuosity and increased reflectiveness ('silver wiring') II degree: plus constriction of veins at arterial crossings ('arteriovenous nipping') III degree: plus evidence of retinal ischaemia (flame-shaped or blot haemorrhages and 'cotton wool' exudates) IV degree: plus papilloedema HYPERTENSIVE RETINOPATHY

  23. Hypertensive retinopaty

  24. Heart • The excess cardiac mortality and morbidity associated with • Hypertension. Severe hypertension can cause left ventricular failure in the absence of coronary artery disease • Atrial fibrillation

  25. Secondary hypertensionCAUSES OF SECONDARY HYPERTENSION • Alcohol • Pregnancy (pre-eclampsia) • Renal disease • • Renal vascular disease • • Parenchymal renal disease, particularly glomerulonephritis • • Polycystic kidney disease • Endocrine disease • Phaeochromocytoma • Cushing's syndrome • Primary hyperaldosteronism (Conn's syndrome) • Hyperparathyroidism • Acromegaly • Primary hypothyroidism • Thyrotoxicosis • Congenital adrenal hyperplasia due to 11 -p-hydroxylase or • 17-hydroxylase deficiency

  26. Differential features of symptomatic hypertension • Age less than 20 years or more than 60; • quick elevation of BP and its stable high level • very high BP (> 220/120 mm of Hg); • - malignant course of hypertension; • - sympathoadrenal crisesеs; • - renal diseases in anamnesis; • - development of hypertension during pregnancy; • - appearance of changes in patient’s urine.

  27. Complications of hypertonic crisis • Cardial: - acute or chronic heart failure; - accelerated development of atherosclerosis of caoronary arteries followed by symptoms of angina pectoris and myocardial infarction; - arrhythmias. • Aortal: - atherosclerosis ; - dissecting aortal aneurism.

  28. Cerebral: - atherosclerosis of cerebral vessels and impaired cerebral circulation (encephalopathy); - dynamic and organic disorders of brain circulation і органічні Ocular: - retinal hemorrhage and its separation; - decreased vision (edema of ophthalmic nerve).

  29. TreatmentModification of life-style • Diet (Decreased salt intake to 4-6 g/day, alkohol, animal fats). • Decreased body weight. • Avoiding of smoking. • Dynamical physical examinations. • Phytotherapy, acopuncture, psychtherapy, authotrening • Influence of modification of life-style of the course of the disease: • Decreased body weight - 5-20 mm of Hg/10 kg of lost weight • Diet – 8-14 mm of Hg • Decreased salt intake (6 g per day) – 2-8 mm of Hg • Physical activity (30 min per day) – 4-9 mm of Hg • Decreased alkohol consumption (to 1 ounce per day) – 2-4 mm of Hg

  30. Scheme of action of hypotensive drugs

  31. Main groups of hypertensive drugs • Diuretics • -blockers • Ca- channels antagonists • Angiotensine-converting enzyme inhibitors • Blockers of angiotensine-II receptors • ά1-adrenoblochers

  32. Long-acting CCB Beta-blocker* Thiazide diuretic ACE-I ARB TARGET <140 mm Hg systolic and < 90 mmHg diastolic Lifestyle modification therapy Dual Combination Triple or Quadruple Therapy * Not indicated as first line therapy over 60

  33. Thank you!

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