The document provides an outline and objectives for a presentation on hypertension (high blood pressure). It begins with definitions of blood pressure and what constitutes normal versus high blood pressure. It then discusses the different types of primary (essential) and secondary hypertension, identifying causes such as kidney disease. The regulation of blood pressure via the baroreceptor reflex is explained. Prevention and treatment options are covered, such as ACE inhibitors, diuretics, and lifestyle changes like exercise and diet. The objectives are to explain hypertension in detail and discuss causes, consequences, regulation, and treatment.

1. College of Health Sciences
Department of Medical Physiology
Advanced Cardiovascular Physiology
Presentation on
Hypertension
By Teketel Eristu 1

2. Presentation Outline
 Introduction
 Blood Pressure
 High Blood Pressure/Hypertension
 Causes of Hypertension/Risk Factors
 Types of Hypertension
 Regulation of HBP/HPN
 Prevention and Treatment of HPN
 Animation of HPN, Video
 References 2

3. ObjectivesAt the end of the Presentation the Learners are expected to:
Discuss about Blood Pressure
Explain High Blood Pressure/ Hypertension in detail
Classify Hypertension and Causes
Explain the Consequences of Hypertension
Discuss the regulation of Hypertension
Explain Treatment of Hypertension
3

4. 1. Introduction
Blood Pressure
- is the pressure exerted by circulating blood upon the walls of blood
Vessels
-decreases as the circulating blood moves away from the heart
- expressed in terms of the systolic pressure over diastolic pressure
(mmHg). Or it makes Lup Dup major sound
4

5. Lub
If you listen to your
heartbeat, it makes a lub dub
sound.
The lub is when blood is
pushed out of the heart into
the body and the dub is the
reloading of the heart with
more blood ready to push it
out to the body
Dub
5

6. Cont..
Blood pressure is an important characteristic of our body.
Without blood pressure, nutrients, oxygen, and proteins could not travel
from the arterial side of the body to the venous side.
6

7. Cont…
Normal Blood Pressure
95/65 mmHg=1 Years
100/65 mmHg=6-9 years
110/65-140/90mmHg= Adults
-its Average Physiologic Value (normal BP) = 120/80 mmHg
7

8. Cont…
If blood pressure is chronically elevated a condition is known as
hypertension
According to medical dictionary, hypertension means "High blood
pressure; transitory or sustained elevation of systemic arterial blood
pressure
A consistent blood pressure of 140/90 mm Hg or higher is considered
high blood pressure.
8

9. Cont…
• Isolated Systolic Hypertension is Systolic BP elevation in the absence
of elevated diastolic Blood Pressure .
• Isolated Diastolic Blood Pressure is Diastolic BP elevation in the
absence of Systolic BP.
• Accelerated Hypertension / Malignant Hypertension occurs when BP
elevates extremely .
9

10. Table.1. Classification of Blood Pressure for Adults =>18 Years old
Category Systolic mmHg Diastolic mmHg
Hypotension <90 <60
Desirable/Normal 90-119 60-79
Prehypertension 120-139 80-89
Stage 1/Mild Hypertension 140-159 90-99
Stage 2 / Moderate
Hypertension
160-179 100-109
Hypertensive Crisis/ stage 3/
Severe/HYN
=> 180 =>110
10

11. 2. Types of Hypertension
is abnormal elevation of pulmonary
artery BP.
11

12. Cont…
• Pulmonary blood pressure is normally a lot lower than systemic blood
pressure.
• Normal pulmonary-artery pressure is about 14 mm Hg at rest.
• If the pressure in the pulmonary artery is greater than 25 mm Hg at
rest and 30 mm Hg during exercise, it is abnormally high and is called
pulmonary hypertension.
• Broadly Classified as Primary or Secondary Hypertension 12

13. Cont…
• Primary pulmonary hypertension
• When not accompanied by underlying heart and
lung disease or other illnesses, it is called primary
pulmonary hypertension.
13

14. Con….
Secondary pulmonary hypertension
If a pre-existing disease triggered the PHT
e.g. Congenital heart defects
Intracardiac left-to-right shunts :
Heart valve conditions : mitral stenosis
14

15. Cont….
• Typically "blood pressure," "high blood pressure" and "hypertension"
refer to the systemic pressure throughout your body.
Hypertension is classified as either primary (essential)
Idiopathic / hypertension or secondary hypertension
15

16. a) Primary or Essential Hypertension
About 90–95% of cases are categorized as "primary
hypertension," which means high blood pressure with no
obvious/direct medical cause.
-is the most prevalent hypertension type
16

17. Cont..
Although no direct cause has been identified, there are many factors
such as sedentary lifestyle, smoking, stress, visceral obesity,, salt
(sodium) sensitivity, alcohol intake, and vitamin D deficiency, aging,
some inherited genetic mutations and having a family history of
hypertension, an elevated level of renin, sympathetic nervous system
over activity…etc. increase the risk of developing primary
hypertension.
17

18. b) Secondary Hypertension
About 5–10% of cases (Secondary hypertension) are caused by other
conditions that affect the kidneys, arteries, heart or endocrine
system.
Thus, results from an identifiable cause.
but: may come to normal values by treatment.
18

19. Cont…
This type is important to recognize since it's treated differently to essential
hypertension. Facrors that cause this type of HYN
1. Adrenocortical hyperfunction
Primary hyperaldosteronism
Cushing Syndrome
Congenital or hereditary adrenogenital syndromes
(17a-hydroxylase and 11b-hydroxylase defects)
2. Pheochromocytoma
3. Severe Polycythemia 19

20. Cont…
4). Renal Diseases
It is common for all types of chronic kidney disease to eventually cause
hypertension (approx. 80% of chronic kidney disease patients
develop hypertension at some point). This is due to fluid retention in
the body, due to poor elimination of fluids and poor control of
sodium
20

21. Cont….
Glomerulonephritis (chronic renal inflammation )
Polycystic renal disease-is cystic genetic disorder of the kidneys
Tumors of JG Cell- Renin-producing tumors
Renovascular stenosis or renal infarction (Reno vascular
hypertension)------RAS
Hyperparathyroidism and Calcium overload leads to renal failure and
hypertension
21

22. Cont…
5) Neurogenic hypertension
Polyneuritis ( lead poisoning…..) inflammation of Peripheral
nerves
Increased intracranial pressure
Arterial occlusion
Tumors
22

23. Cont….
Others
Coarctation of aorta  BP in upper parts of body, i.e. above
obstruction.
Hypercalcemia
Medications, e.g., glucocorticoids, …etc
23

24. Consequences of Hypertension: Organ Damage
CHF=congestive heart failure; CHD=coronary heart disease; LVH=left ventricular hypertrophy.
Chobanian AV et al. JAMA. 2003;289:2560-2572.
Hypertension
LVH, CHD, CHF
Chronic kidney diseaseRetinopathy
Transient ischemic
attack, stroke
Peripheral
arterial
disease
24

25. Regulation of HBP/HPN
Introduction:
Blood Pressure is regulated within a narrow Range
If the blood pressure is too low:
Inadequate perfusion of organs
If the Blood pressure is abnormally high:
Heart diseases, Vascular diseases ,strokes….
25

26. Cont…
The Baroreceptor reflex functions to restore blood pressure back to
normal values whenever the blood pressure deviates from the
normal range. The homeostatic mechanism involves a negative
feedback loop to minimize and oppose any changes in Blood
pressure.
i.e. An increase in BP reflexively causes the BP to decrease and vice
versa.
26

27. What is a Baroreceptor?
Stretch –sensitive
Mechanoreceptors
Located in the Carotid Sinus
and aortic arch
Monitor the pressure of
blood flow to brain and
body
Action potentials are fired
continuously at normal
blood pressure
Fig. 1 Location and innervations of arterial Baroreceptor
High pressure baroreceptors respond to stretch in
the aortic arch and carotid sinus.
27

28. Pathway
Increase in BP stretches the
baroreceptors and increase the
firing rate in the afferent nerves
Glossopharyngeal nerve and
Vagus nerve
This leads to the excitation of the
nucleus tractus solitarius(NTS) in
the Medulla, which inturn inhibits
the vasomotor center via
interneurones.
28

29. Cont…
The inhibition of the vasomotor center
decrease the sympathetic output and
causes vasodilation, bradycardia,
decrease in CO & fall in BP
The excitation of NTS also stimulates the
Vagus nerve which decrease the HR
& CO
29

30. Baroceptors
with increased P
Medulla
Heart and
Blood Vessels
Nucleus tractus solitarius
Cardiac
decelerator
Cardiac
accelerator
Vaso
constrictor
Sinoatrial
node
Contract-
ility
Arterioles Veins
Carotid
sinus
baroceptors
Aortic arch
baroceptors
Vagus nerve
Carotid sinus nerve
glossopharyngeal nerve
Heart Blood vessels
+ +
+ -
Dilation
- - 30

31. Blood Pressure Regulation
Baroreceptors
Afferent nerves
Medulla oblongata center
Sympathetic efferents
SA node, ventricles,
Arteriolar smooth muscle
Venous smooth muscle
Fig 2 Components of the Baroreceptor Reflex
• Main coordinating center is in the
medulla oblongata of the brain;
medullary cardiovascular control
center
31

32. Regulation of Blood Pressure
Figure 3 T he baroreceptor reflex: the response to increased blood pressure
32

33. Fig.4 Blood Pressure control includes
rapid responses from cardiovascular
system and slower responses by the
kidneys
When the body contains too
much EC fluid, the arterial
pressure rises. This increase
in pressure causes the
kidneys to excrete the
excess fluid, until pressure
returns to normal (pressure
diuresis).
33

34. 5.Prevention and Treatment of Hypertension
ACE Inhibitors Drugs inhibit the enzyme converting angiotensin into
angiotensin II. Acts as vasodilators of both resistance and capacitance
vessels. Thus, blood vessels relax and blood flow freely.
Angiotensin II receptor blockers
34

35. Cont….
Diuretics work on the kidney to remove exess water and fluid from body to
lower BP.
Beta blockers-: Competitively inhibit the binding of catecholamines to
beta-adrenergic receptors
Calcium Channel Blockers- Decrease calcium influx into cells of vascular
smooth muscle -causes the blood vessel to relax and widen.
Nervous system inhibitors- slow nerve impulses to the heart.
Vasodilators- cause blood vessel to widen, allowing blood to flow more freely.
Alpha Blocker- blocks an impulse to the heart causing blood to flow more
freely.
35

36. Cont….
Minimize Alcohol
Alcohol raises blood pressure and can harm liver, brain, and heart
• Quite Smoking/ Stop
• Smoking damages blood vessel walls and causes early hardening of
the arteries. Nicotine narrows your blood vessels and forces your
heart to work harder
Be Physically Active/Exercise
Blood pressure rises as weight rises. Obesity is also a risk factor for
heart disease
36

37. 5. References
1. Fauci, Braundwald, Kasper and et al, Harrison’s principles of internal
medicine, 17th edition, 2008, McGraw Hill publisher
2.Pearson International Edition Human Physiology An Integrated
Approach 5th Edition.
DEE UNGLAUB SILVERTON
3 .ww.americanheart.org/presenter.jhtml?identifier “High Blood
Pressure”
4.Different internet sources
5. Lecture Note of Cardiovascular Physiology, Prof. Yekoya A. 2011
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38. THANK YOU
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