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1、SYSTEMICHYPERTENSIONRANDAM.AL-HARIZYProf.ofInternalMedicineSYSTEMICHYPERTENSIONDefinitionsofhypertensionElevatedarterialbloodpressureisamajorcauseofprematurevasculardiseaseleadingtocerebrovascularevents,ischaemicheartdiseaseandperipheralvasculardisease.Hypertension-IntroductionSi
2、lentKiller–painlesscomplicationsItistheleadingriskfactor–MI,HF,CRFStrokeResponsibleforthemajorityofofficevisits,Numberonereasonfordrugprescription.25%ofpopulationComplicationsbringtodiagnosisbutlate…RegulationofBP:BP=CardiacOutputxPeripheralResistanceEndocrineFactorsRenin,Angiote
3、nsin,ANP,ADH,Aldosterone.NeuralFactorsSympathetic&ParasympatheticBloodVolumeSodium,Mineralocorticoids,ANPCardiacFactorsHeartrate&Contractility.ControlofBloodPressure:BPCardiacOutputPeripheralResistanceBloodVolumeNa+,AldosteroneVasoconstrictorsAngiotensinIICatecholaminesVasodilato
4、rsPg&KininsLocalFactorspH,HypoxiaNeuralFactorsAdrenergic–ConsßAdrenergic-DilCardiacFactorsRate&Contract..HumoralFactorsEtiology1-Essential:Inmorethan95%ofcases,anunderlyingcausecannotbefound.Proposedmechanismsinclude:ExcessrenalsodiumretentionOveractivityofsympatheticnervoussyste
5、mReninangiotensinexcessHyperinsulinemiaAlterationsinvascularendotheliumFactorscontributingtothedevelopmentofEssentialhypertensionGeneticFactors:hypertensionismorecommoninsomefamiliesandinsomeethnicgroupslikeAfricanAmericansEnvironmentalfactorsincludeobesity,alcohol,lackofexercise
6、andexcesssaltintake2-SecondaryhypertensionRenal:Theseaccountforover80%ofthecasesofsecondaryhypertension.Thecommoncausesarediabeticnephropathy,chronicglomerulonephritis,adultpolycysticdisease,chronictubulointerstitialnephritis,andrenovasculardisease.Endocrinal:TheseincludeConn'ssy
7、ndrome,adrenalhyperplasia,acromegaly,Phaeochromocytoma,Cushing'ssyndrome.DrugsandtoxinsPregnancy-inducedhypertensionVascular:coarctationofaorta,vasculitisComplicationsCerebrovasculardiseaseandcoronaryarterydiseasearethemostcommoncausesofdeath,althoughhypertensivepatientsarealsopr
8、onetorenalfailureandperipheralvasculardi