00:01
As you very well know, there is a continuous association
between high blood pressure and cardiovascular disease.
00:07
In an attempt to classify the different
stages of high blood pressure,
the American College of Cardiology and
the American Heart Association Task force
published new guidelines in 2017 that
are different from the JNC 7 report.
00:22
According to the current recommendations
normal blood pressure is defined as systolic blood pressure
lower than 120 milimeter Hg and diastolic
blood pressure lower than 80 milimeter Hg.
00:35
Blood pressure is considered elevated when
the systolic pressure is 120-129 milimeter Hg
and the diastolic pressure
lower than 80 milimeter Hg.
00:46
Any values above 130/80 milimeter
Hg are considered hypertension -
in contrast with the previous guidelines that
defined hypertension as blood pressure greater than 140/90 milimeter Hg.
01:00
The idea behind this new categorization
rests on multiple studies that suggest
that there is increased risk for cardiovascular
and cerebrovascular disease in levels lower than 140/90 milimeter Hg.
01:14
This, of course, doesn’t necessarily mean
that people with elevated blood pressure
or stage 1 hypertension will
receive pharmacotherapy.
01:22
This classification suggests
that these individuals
are at increased risk for adverse
outcomes due to high levels of blood pressure
and would benefit from appropriate lifestyle -
and, if necessary, pharmacologic - interventions.
01:38
So, primary is what we talk about.
What does primary mean to you?
It is a fact that your focus should be on sodium.
Why? Because if sodium comes in and you are retaining it,
then what are you going to do with the volume?
You are going to retain that as well.
01:51
You retain your volume and so therefore you
increased the amount of fluid or preload in the heart
and what is this relationshop called?
Called Frank-Starling relationship.
02:00
What are you going to an increase when you have
increase in volume within the heart?
The force of contraction at the left ventricle during
systole, the active phase of the cardiac cycle.
02:09
Systolic blood pressure is the pressure
in the arteries during systole.
02:13
Could diastole also be affected?
Of course, with the diastolic pressure, you're looking
at the pressure of the arteries during diastole,
the relaxation phase of the cardiac cycle.
02:24
Let us go onto secondary, what does that mean?
We're looking at an underlying issue in which now
the patient has developed secondary hypertension
and we shall go through the
most common causes of secondary.
02:37
We will walk through the pathogenesis so that you
understand what is going on with your patient.
02:42
Onset, prior to age of 30, we'll
talk about this being bimodal
and this will make sense to you as you move on.
02:47
Secondary change in hypertension,
what does that mean?
Well, once again as I said we
are looking for underlying cause.
02:53
For all patients.
02:54
Obesity and alcohol
use should be addressed as a risk factor
for hypertension, along with discussions
about healthy diet, regular exercise
and weight loss to maintain
a body mass index below 25
or a level reasonable for the individual.
03:07
Why not recommend your patient to
lose weight and when they do so,
Why not recommend your patient to
lose weight and when they do so,
you should be able to knock out
a few things at the same times.
03:15
You should maybe take care of that hyperglycemia.
03:17
Maybe, just maybe, you are increasing the
sensitivity of the insulin receptors.
03:22
Welcome to management of diabetes.
03:25
Maybe by controlling the diet, you should
be able to control the lipid and also
by losing weight, you should be able
to control some of this hypertension.
03:33
Atherosclerosis, secondary hypertension.
03:36
What does atherosclerosis
mean? Accumulation of lipid.
03:40
Where might this be taking place?
It might be taking place in the renal vasculature.
03:44
Right?
We will get into this in a second.
03:46
You will see as to how if there is
a blockage to the renal vasculature
that it may result in secondary
hypertension, males, alcohol abuse.
03:55
What about female?
What about renovascular disease?
What particular renovascular disease should come
to mind when you're thinking about a female?
A young female, 30's perhaps.
04:05
You're thinking about something
called fibromuscular dysplasia.
04:09
I'll talk about this in a second, what's
our topic? secondary hypertension.
04:12
Elderly, without history of prior hypertension,
consider atherosclerosis, you must.
04:17
Atherosclerosis is something,
from the day that we're born,
we pretty much are developing
fatty streaks, aren't we?
You are what you eat.
04:25
And this is so incredibly true when
you are talking about hypertension.
04:29
Atherosclerosis, what if it
took place in renal artery?
Now let me give you a little bit
of a preface as to what is to come.
04:36
Meaning what, you decrease the amount
of blood flow to your blood vessels.
04:40
Where?
In the glomerulus.
04:43
Are you there? Picture the afferent
please and picture the efferent.
04:46
I want you to focus upon the afferent arteriole.
04:49
Would you tell me what vasculature or blood
vessel is proximal to the afferent arteriole?
I believe it is renal artery, wow.
04:58
That is a huge blood vessel undergoing
atherosclerosis, a decrease of blood vessel.
05:02
What then happens at juxtaglomerular apparatus?
It becomes very, very active, doesn't it?
It doesn't like the fact that it's
receiveing decreased perfusion.
05:10
What are you going to release?
Renin and company.
05:13
What do you mean renin and company?
Welcome to RAS, Renin-Angiotensin-Aldosterone system.
05:18
So as you we move through here, we will then
take a look at the RAS sytstem in greater detail.
05:22
What's my topic?
Secondary hypertension , different patients
presenting with most common diseases.