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Student%20Lecture%2020%20%28Hypertension%29 - Lecture 20...

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Unformatted text preview: Lecture 20 Hypertension Hypertension Tuesday 3­30­10 Announcements Outline Outline – Proof of completion of online course evaluation. Due 5­7­10. – Proof of attending a Purdue Sporting event (ticket stub and picture) plus ½ page summary of applying concept learned in HK368 to what you observed. Due 5­7­10. – Ultrasound practice subject. Contact: [email protected] Monday and Friday – 8:30am to 12:30pm Tuesday and Thursday – 9:30am Wednesday – 8:30am to 11:30am Quiz – Seminar – April 14th, 3:30pm, Armstrong 1109 Lecture – Hypertension What is blood pressure? What Blood Pressure Blood Physiological Factors Physical Factors Arterial Blood Pressure Berne and Levy Classification of Hypertension Classification Normal Prehypertensive Stage 1 hypertensioin Stage 2 hypertension – – – – Prevalence of Hypertension in the United States United million individuals over the age of 20 years old. of the United States Population. Cause of million physician visits a year. In 2002 hypertension was the listed as the primary cause of death for Americans. Who does it affect (gender/race)? Who Women: All women African American Mexican American Men: All men African American Mexican American 28.5% 27.9% 27.6% 26.8% ww.cdc.gov Prevalence of hypertension between socioeconomic classes between Poverty status Poor Near Poor 28.2% ww.cdc.gov Age group comparison of the prevalence of hypertension Prevalence of Prevalence of hypertension McArdle, Katch and Katch Types of Hypertension – Chronic elevation of blood pressure without prevalence of other disease. – Comprises of hypertension – Elevation in blood pressure results from some other disorder – Comprises of hypertension – Examples Aortic coarctation, renal disease Causes of Essential Hypertension Causes Mechanisms for how these factors influence blood pressure still unclear. – – – – Potential Mechanisms Underlying Hypertension – heart rate – arteriole diameter ↑ ↑ ↓ ↑ ↑ Blood pressure Potential Mechanisms Underlying Potential Hypertension system – Renin (enzyme) typically released from as a response to decreased BP. – Renin converts (protein released from liver) into angiotensin . – Angiotensin converted by angiotensin­converting enzyme into . – Angiotensin II binds to receptors on endothelium and causes . This system may be over stimulated with hypertension! Potential Mechanisms Underlying Hypertension Hypertension Decreased – Decreased release of NO – Increased reactive oxygen species (ROS) which inactivates NO http://ethesis.helsinki.fi/julkaisut/laa/biola/vk/lassila/index.html What diseases does uncontrolled hypertension lead to? hypertension – Increased afterload → left ventricular hypertrophy → congestive heart failure ↓ Nitric oxide → ↑ Atherosclerosis ↑ ↑ ↑ ↑ Pharmacological Treatments of Hypertension Hypertension β ­blockers α­blockers Ca++ channel blockers Diuretics Ace inhibitors Angiotensin II receptor blockers – – – – – – McArdle, Katch and Katch Modification of lifestyle to treat hypertension hypertension loss Decrease Decrease Increase Recommended treatment for hypertension CCD = Clinical Cardiovascular Disease TOD = Target Organ Disease McArdle, Katch and Katch How much of a reduction is blood pressure is needed to decrease mortality? mortality? A decrease of mmHg in systolic blood pressure deaths from stroke by and heart disease by Effects of chronic aerobic exercise training on hypertension training Both cross­sectional and longitudinal data suggests that chronic aerobic exercise training reduces both systolic and diastolic blood pressure. Review of 20 studies by Kokkinos et al. – Average Systolic BP – Average Diastolic BP Example McArdle, Katch and Katch Effects of exercise intensity on hypertension hypertension Studies that have compared the effects of exercise intensities on blood pressure have determined that . – % of max heart rate – METS or 10.5­21.0 ml/kg/min Effects of resistance exercise training on hypertension training Conflicting data. Some data suggests small but significant reductions in BP. However, of data suggests that resistance exercise training is not effective in lowering blood pressure in hypertensive individuals. Exercise + Drug Therapy Exercise Nine weeks of exercise + medication Suggests medication + exercise can have . What are the mechanisms for the effects of exercise on hypertension? effects ↓ → ↓ ↓ ↓ → ↓ ↓ (not case in healthy individuals) Increase ...
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