Increased arterial blood pressure

Maia Alkhidze, Ass. Prof. PhD,

University of Georgia,
Institute of Neurology and Neuropsychology
 Blood pressure
systolic blood pressure - the pressure in the
blood vessels when the heart muscles squeeze

diastolic blood pressure - the pressure in the

blood vessels when the heart muscles relax
 High blood pressure
• Usually goes unnoticed

• Only if it is extremely high – may be dizziness,

vision problems

• Over time it can damage blood vessels

• Blood pressure readings may vary - a sign of an

active life, but If too high for too long - can
damage blood vessels
 Epidemiology
• in 2008–2011 reveal a decline in the frequency of uncontrolled
hypertension from 22% to 13% in women and from 24% to 18% in
men. However, the prevalence among men aged 18 to 29 rose from
4.1% to 8.5% /German epidemiological data/

• It is a main risk factor for cardiovascular morbidity and mortality -

54% of strokes and 47% of cases of ischemic heart disease are the
direct consequence of high blood pressure (WHO)

• Treatment-resistant arterial hypertension - the blood pressure

cannot be adequately controlled even if the patient does take the
prescribed medication regularly.
 Types
• essential hypertension
None of the currently available clinical methods can
detect a specific cause of the elevated blood pressure.

• secondary hypertension - causes

renal artery stenosis, hyperaldosteronism,
pheochromocytoma (particularly in younger patients
and those whose blood pressure is hard to control)
 Pathophysiology
• due to elevated cardiac output,
• elevated peripheral vascular resistance,
• combination of both
Regulated by hemodynamic, neural, humoral,
and renal processes
The pathophysiology of essential arterial hypertension. Multiple hemodynamic,
neural, humoral, and renal mechanisms lead to increased cardiac output and/or
peripheral vascular resistance. The product of these two hemodynamic variables
determines the blood pressure. ANP, atrial natriuertic peptide; BNP, B-type
natriuretic peptide; RAAS, renin-angiotensin-aldosterone system
 European Society of Cardiology
European Society of Hypertension

• threshold value of = 140/90 mm Hg

• At least three measurements should be made
on each of several days, with 1–2 minutes
between measurements and with a 3–5
minute pause before blood pressure is
measured with the patient sitting. The optimal
conditions for blood pressure measurement
should be maintained
 Rules for good measurement
• Measurements with an arm circumference of 22–32 cm - standard
cuff (12–13 cm wide, 35 cm long);
• for larger upper arms – cuffs of 15–18 cm wide.
• When first measured - on both sides.
• If the difference in the values obtained on the two sides is >20
mmHg systolic or >10 mmHg diastolic, the following potential
causes must be ruled out, and, if the blood pressure is lower on the
left side, the possibility of an aortic isthmus stenosis should be
considered: Aortic arch syndrome due to atherosclerosis, or, rarely,
vasculitis;
• Unilateral subclavian artery stenosis;
• Aortic dissection.
• Further measurements are subsequently always made on the arm
with the higher values.
Rules for good measurement
 Orthostatic hypotension
• a fall in blood pressure by more than 20
mmHg systolic and/or more than 10 mmHg
diastolic after standing for three minutes.
• If orthostatic hypotension is suspected,
particularly in an elderly or diabetic patient,
two further measurements should be made 1
and 3 minutes later, with the patient still
standing
White-coat and masked hypertension
• white-coat hypertension - regularly elevated
blood pressure in the doctor’s office, but normal
values when measured at home (the prevalence
in the general population - 13%)

• masked hypertension - measured blood pressure

values are normal in the doctor’s office, but
elevated at home. more common in young
people, males, smokers, overweight or diabetic
persons, and those suffering from anxiety or
stress.
10–15% of persons with hypertension have secondary
hypertension due to a potentially treatable cause.
 Goal of treatment
• ESH/ESC guidelines 2018- all patients,
including those with renal failure or diabetes,
should have their blood pressure reduced to
less than 140/90 mmHg (as measured in the
doctor’s office) at the beginning of their
treatment.
 Goals for treatment
target systolic blood pressure
•patients aged 18–65-below 130.no less than 120
•diabetic patients – the same
•patients with renal failure - systolic b/p range
(below 140,no less than 130)
•patients over age 65- systolic b/p range below 140,
no less than 130.
target diastolic blood pressure range
for all patients - below 80, no less than 70
 Goals for treatment
• Blood pressure target values in the NICE
guideline
• NICE defines hypertension as an initial
measurement of = 140/90 mmHg with
subsequent measurements of = 135/85
mmHg.
 Treatment

• ll persons should have a body-mass index

between 20 and 25 kg/m2, with a waist
circumference less than 94 cm in men and 80
cm in women
 treatment
• thiazide diuretics for most patients
• in diabetes mellitus type 1, with proteinuria - ACE inhibitor
• In heart failure-ACE inhibitors, diuretics, aldosterone
antagonists
• isolated systolic hypertension of older individuals-diuretics,
long-acting dihydropyridine calcium antagonists
• myocardial infarction-beta blockers, ACE inhibitors
• chronic kidney disease-ACE inhibitors, angiotensin II
receptor blockers (ARBs) in diabetic and nondiabetic renal
disease
• Recurrent stroke-ACE inhibitors and thiazide diuretics
 Treatment
• chronic congestive heart failure-ACE
inhibitors, beta blockers, and aldosterone
inhibitors decrease morbidity and mortality.
• Calcium channel blockers are beneficial in
reducing cardiovascular disease and stroke in
patients with diabetes mellitus.
 Treatment
• ACE inhibitors - avoid in women of
childbearing age or pregnant women because
they are teratogenic.
• Thiazides are useful in the treatment of
osteoporosis, they slow the demineralization
process.
• Beta blockers are useful in migraine headache
prophylaxis but are contraindicated in
Raynaud phenomenon.