When NaCl intake exceeds the capacity of the kidney to excrete
sodium, vascular volume may initially expand and cardiac output may increase. Mechanism AUTONOMIC NERVOUS SYSTEM
• Sympathetic stimulate the a1 receptor result in vasoconstriction.
increase Resistence • β1 receptors stimulates the rate and strength of cardiac contraction and consequently increases cardiac output. • Baroreflex mechansim Mechanism RENIN-ANGIOTENSIN-ALDOSTERONE Mechanism VASCULAR MECHANISMS • Remodeling refers to geometric alterations in the vessel wall without a change in vessel volume. • Hypertrophic, or eutrophic vascular remodeling results in decreased lumen size and, hence, increased peripheral resistance • Vessels with a high degree of elasticity can accommodate an increase of volume with relatively little change in pressure PRIMARY HYPERTENSION • 80–95% of hypertensive patients are diagnosed as having primary hypertension. • tends to be familial • likely to be the consequence of an interaction between environmental and genetic factors. OBESITY AND THE METABOLIC SYNDROME Free fatty acids (FFAs) are released in abundance from an expanded adipose tissue mass
In the liver, FFAs result in increased production of glucose
The increase in circulating glucose, and to some extent FFAs, increases
pancreatic insulin secretion, resulting in hyperinsulinemia.
Hyperinsulinemia may result in enhanced sodium reabsorption and
increased sympathetic nervous system (SNS) activity and contribute to hypertension RENAL PARENCHYMAL DISEASES • Renal disease is the most common cause of secondary hypertension. RENOVASCULAR HYPERTENSION • In the initial stages, the mechanism of hypertension generally is related to activation of the renin-angiotensin system PRIMARY ALDOSTERONISM CUSHING’S SYNDROME PHEOCHROMOCYTOMA MISCELLANEOUS CAUSES OF HYPERTENSION MONOGENIC HYPERTENSION APPROACH TO THE PATIENT History Taking • Most patients with hypertension have no specific symptoms referable to their blood pressure elevation • hypertensive headache occur in the morning and is localized to the occipital region • Other nonspecific symptoms that may be related to elevated blood pressure include:dizziness, palpitations, easy fatigability and impotence. APPROACH TO THE PATIENT History Taking APPROACH TO THE PATIENT Physical Examination • Vital sign Heart rate ,Respiratory rate, temperature and Especially Measurement of Blood Pressure • weight and height • Palpate Thyroid Gland • Funduscopic Examination(increased arteriolar light reflex, arteriovenous crossing defects, hemorrhages, exudates, papilledema) • palpation of femoral and pedal pulses • auscultation for bruits over the carotid and femoral arteries • Examination of the heart APPROACH TO THE PATIENT Laboratory Examination