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HTN Pathophysiology Lecture Fall (4) (1)

Functional vascular constriction raas stimulation

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Functional vascular constriction RAAS stimulation Sympathetic over activity Genetics Endothelial-derived factors Structural hypertrophy RAAS stimulation Sympathetic over activity Genetics Endothelial-derived factors Insulin induced (growth hormone like activity)
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Circadian Rhythm BP is highest in the early morning Lowers throughout the day
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Risk Factors Cigarette smoking Cigarette smoking Obesity Obesity Physical inactivity Physical inactivity Dyslipidemia Dyslipidemia DM Microalbuminuria or a GFR < 60 ml/min Microalbuminuria or a GFR < 60 ml/min Age (> 55 for men, > 65 for women) Age (> 55 for men, > 65 for women) Family history of premature CVD (men < 55, women < 65) Family history of premature CVD (men < 55, women < 65) Race Race Insulin resistance Insulin resistance Diet (EtOH use and sodium intake) Diet (EtOH use and sodium intake)
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Non-Modifiable Risk Factors Family history Age Stiffening of large arteries Baroreceptor sensitivity PVR Renal blood flow Race African-Americans Insulin resistance
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Modifiable Risk Factors Insulin resistance & metabolic abnormalities? Sodium intake Obesity Excessive alcohol consumption Stress
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Overall Goal!!! Overall Goal!!! Hypertension Related TOD 1. Brain (stroke, transient ischemic attack, dementia) 2. Eyes (retinopathy) 3. Heart (left ventricular hypertrophy, angina or myocardial infarction, prior coronary revascularization, heart failure) 4. Kidney (chronic kidney disease) 5. Peripheral vasculature (peripheral arterial disease) To reduce hypertension related morbidity morbidity (TOD) and mortality mortality
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Lifestyle Modifications!!! Lifestyle Modifications!!! Modification SBP (mmHg) Weight reduction 5-20 Adopt DASH eating plan 8-14 Dietary sodium reduction 2-8 Physical activity 4-9 Moderating EtOH consumption 2-4
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Secondary Causes of Hypertension
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Secondary Causes of Hypertension Medications, medications, medications Renal disease Endocrine Thyroid disorders Pheochromocytoma Hyperaldosteronism Cushing’s disease Sleep apnea EtOH abuse Sodium intake
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Medications Illicit substances Attention deficit hyperactivity disorder medications Decongestants Appetite suppressants MAOI’s, TCA’s, bupropion, venlafaxine Herbals NSAIDS Birth control/estrogens Corticosteroids Cyclosporine Triptan’s
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Sympathomimetics Illicit drugs Cocaine, methamphetamine Attention deficit hyperactivity disorder medications Amphetamine salts Appetite suppressants Sibutramine, phentermine Decongestants Pseudoephedrine, phenylephrine Tri-cyclic antidepressants Doxepin, amytriptyline, imipramine, nortriptyline Bupropion Venlafaxine, desvenlafaxine Monoamine oxidase inhibitors Herbals Licorice, ma huang, ephedrine norepinephrine, dopamine, and serotonin
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Other Medications NSAIDS Nephrotoxic agents Ibuprofen, naproxen
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