Hypertension

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Introduction to the cardiovascular system
Anatomy of the heart
Anatomy of the coronary circulation
Anatomy clinical correlates: Heart
Anatomy of the superior mediastinum
Anatomy of the inferior mediastinum
Anatomy clinical correlates: Mediastinum
Development of the cardiovascular system
Fetal circulation
Cardiac muscle histology
Artery and vein histology
Arteriole, venule and capillary histology
Cardiovascular system anatomy and physiology
Lymphatic system anatomy and physiology
Coronary circulation
Blood pressure, blood flow, and resistance
Pressures in the cardiovascular system
Laminar flow and Reynolds number
Resistance to blood flow
Compliance of blood vessels
Control of blood flow circulation
Microcirculation and Starling forces
Measuring cardiac output (Fick principle)
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Cardiac contractility
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Acyanotic congenital heart defects: Pathology review
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Atherosclerosis and arteriosclerosis: Pathology review
Coronary artery disease: Pathology review
Peripheral artery disease: Pathology review
Valvular heart disease: Pathology review
Cardiomyopathies: Pathology review
Heart failure: Pathology review
Supraventricular arrhythmias: Pathology review
Ventricular arrhythmias: Pathology review
Heart blocks: Pathology review
Aortic dissections and aneurysms: Pathology review
Pericardial disease: Pathology review
Endocarditis: Pathology review
Hypertension: Pathology review
Shock: Pathology review
Vasculitis: Pathology review
Cardiac and vascular tumors: Pathology review
Dyslipidemias: Pathology review
Sympatholytics: Alpha-2 agonists
Adrenergic antagonists: Presynaptic
Adrenergic antagonists: Alpha blockers
Adrenergic antagonists: Beta blockers
ACE inhibitors, ARBs and direct renin inhibitors
Thiazide and thiazide-like diuretics
Calcium channel blockers
cGMP mediated smooth muscle vasodilators
Class I antiarrhythmics: Sodium channel blockers
Class II antiarrhythmics: Beta blockers
Class III antiarrhythmics: Potassium channel blockers
Class IV antiarrhythmics: Calcium channel blockers and others
Lipid-lowering medications: Statins
Lipid-lowering medications: Fibrates
Miscellaneous lipid-lowering medications
Positive inotropic medications
Cardiomyopathies: Clinical
Congenital heart defects: Clinical
Valvular heart disease: Clinical
Infective endocarditis: Clinical
Pericardial disease: Clinical
Chest trauma: Clinical
Hypertension: Clinical
Pulmonary hypertension
Aortic aneurysms and dissections: Clinical
Raynaud phenomenon
Peripheral vascular disease: Clinical
Heart failure: Clinical
Coronary artery disease: Clinical
Deep vein thrombosis and pulmonary embolism: Pathology review
Fascia, vessels and nerves of the upper limb
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Anatomy of the abdominal viscera: Blood supply of the foregut, midgut and hindgut
Fascia, vessels, and nerves of the lower limb
Vessels and nerves of the gluteal region and posterior thigh
Anatomy of the popliteal fossa
Ventilation
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Carbon dioxide transport in blood
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Yellow fever virus
Rickettsia rickettsii (Rocky Mountain spotted fever) and other Rickettsia species
Arteriovenous malformation
Cerebral circulation

Transcript

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Over a billion people around the world have hypertension, or high blood pressure, so that pretty much means it’s pretty common. 

Let’s start by defining it. Typically, it’s represented by two numbers: the top number is the systolic blood pressure, which is the arterial pressure when the heart’s contracting; and the lower number is the diastolic blood pressure, which is the arterial pressure when the heart’s relaxing or refilling. Most of the time, blood pressure is taken in the brachial artery in your upper arm, because if the pressure is high there, it’s probably high throughout all of the arteries.

The guidelines for categorizing blood pressure have recently changed to reflect a growing body of evidence that shows that even moderately high blood pressures can significantly increase your risk for developing heart disease. Now, ‘normal’ systolic blood pressure is defined as less than 120 mmHg, and a normal diastolic pressure is less than 80 mmHg. Elevated systolic blood pressure is considered between 120 and 129 mmHg and less than 80 mmHg on the diastolic side. Stage 1 hypertension is between 130 and 139 mmHg on the systolic side, and between 80 and 89 mmHg on the diastolic side. Stage 2 hypertension is defined as anything that is 140 mmHg or higher on the Systolic side and 90 mmHg or higher on the diastolic side.

Typically, both systolic and diastolic pressures tend to climb or fall together, but that’s not always the case. Sometimes, you can have systolic or diastolic hypertension, when one number is normal and the other is really high. This is referred to as isolated systolic hypertension or isolated diastolic hypertension. 

High blood pressure is a serious problem for the blood vessels because it causes wear and tear on the endothelial cells that line the inside of the blood vessels. Just like a garden hose that’s always under high pressure, in the long term, blood vessels can develop tiny cracks and tears that can lead to serious problems, like myocardial infarctions, aneurysms, and strokes.

Now, about 90% of the time, hypertension happens without a clearly identifiable underlying reason. We call this primary hypertension, or essential hypertension. In other words, over time, pressure in the arteries starts to silently creep up.  And there are a bunch of risk factors that we’ve identified for primary hypertension. And these include: old-age, obesity, salt-heavy diets, and sedentary lifestyles. 

Sources

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  3. "Pathophysiology of Disease: An Introduction to Clinical Medicine 8E" McGraw-Hill Education / Medical (2018)
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  5. "Arterial hypertension in the light of current recommendations" Terapevticheskii arkhiv (2018)
  6. "Gender-specific therapeutic approach in arterial hypertension – Challenges ahead" Pharmacological Research (2019)