being affected is to know.
Now with hypertension, how important is this
for you to know? My goodness gracious. Are
you kidding me? Hypertension is part of what?
Metabolic syndrome X. Is that a problem in
the United States? Of course, it is. 85-90
percent of our patients are obese, aren't
they? Those are type of patients that you
are going to see. What do they have? They've got
hyper, hyper, hyper. Hypertension, hyperglycemia,
hyperlipidemia. Hypertension is a huge concept.
So far we have introduced the normal, we've gone
into the cut off point of 140/90 and there it
would be and we got into urgency and emergency.
You focus upon please anything beyond 140
and 90 you are in stage 1. All the other categories
that we see here. Well, you take a look at
it on your own time. Once you get into emergency
in such, well not only are we going to use thiazides. Think about
thiazides. What did they do? Get rid of some
of that fluid. Is it a diuretic, is it not? Where does it work?
DCT, distal convulated tubule. What is there? Is it the sodium,
potassium, two chlorides, yes or no? Good,
no. It is the sodium chloride channel, is
it not, in the DCT? That is where the thiazides
work. What receptor works in the DCT, in
which perhaps thiazide might influence? Just
to make sure that we're clear. PTH, parathyroid
hormone. Keep those in mind as you move forward.
We are focusing upon the pathology, but understand
the pathology is not just path is it?
You need to make sure that you know what normal is
the physio and to make sure what the disease
is and how do you manage your patient.
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. 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.
What are you going to an increase when you have
increase in volume within the heart? I believe
it is called systole. The active portion of
you blood pressure, is it not? And could you
also have your diastole affected? Of course,
you can. But with diastole, what are you looking?
Are you looking at the heart, are you looking
at the blood vessels? You are looking at the
vasculature, people. So as primary, your
focus there should be on sodium. You know
that and you will be in good shape. Let us
go onto secondary. What does that mean? We
are looking at an underlying issue in which
now the patient has developed secondary hypertension.
We shall go through the most common causes
of secondary. We will walk through the pathogenesis
so that you understand what is going on with
your patient. Onset, prior to age of 30. We
talked about this being bimodal and this
will make sense to you as you move on. Secondary
change in hypertension, what does that mean?
Well once again as I said we are looking for
underlying cause. Male patient, as a general
rule of thumb, as a male patient, in the United
States, obese. That is the problem. Obese patient,
what do we say this was called? Most of the
patients that may present with? Metabolic syndrome.
What is the prefix that you are thinking about
metabolic syndrome, reflex of you, you should be thinking
about hyper, hyper, hyper. Like what I am
experiencing when I talk about medicine? I
get all hyper. As you do, it is hypertension,
hyperlipidemia, hyperglycemia. Is that clear?
What is your point of reference? Hypertension.
So with the male patient, obese, atherosclerosis.
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 thing.
You should may be take care of that hyperglycemia.
Just maybe you are increasing the sensitivity
of the insulin receptors. Welcome to management
of diabetes. 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. Atherosclerosis,
secondary hypertension. What does atherosclerosis
mean? Accumulation of lipid. Where might this
be taking place? It might be taking place
in the renal vasculature. We will get into this
in a second. You will see as to how if there
is a blockage to the renal vasculature that it
may result in secondary hypertension in males,
alcohol abuse. What about female? What do
you know about estrogen, please? Prothrombotic,
antithrombotic. What? Prothrombotic. Really? Ya.
What is one of the risk factors for DVT? Estrogen.
DVT, deep vein thrombosis. Estrogen, prothrombotic.
So what if you ended up developing thrombus
because of oral contraceptive pills that might
have estrogen. May you result in secondary
hypertension? Sure you could. What about renal
vascular disease? What particular renal vascular
disesase should come to mind when you are
thinking about a young female, 30s perhaps.
You are thinking about something called fibromuscular
dysplasia. We will talk about this in a second.
What is our topic? Secondary hypertension.
Elderly, without history of prior hypertension,
consider atherosclerosis you must. Atherosclerosis
is something from the date that we were born, we pretty much
are developing fatty acids, aren't we? You are what you eat. And this
is so incredibly true when you are talking
about hypertension. Atherosclerosis, what
if it took place in renal artery? Now let
me give you a little bit of prefix as to what
is to come, meaning what? You decrease
the amount of blood flow to your blood vessels,
where? In the glomerulus. Are you there? Picture
the afferent please and picture the efferent. I want you
to focus upon the afferent arteriole. Would
you tell me what vasculature or blood vessel
is proximal to the afferent arteriole? I believe
it is renal artery. That is a huge blood vessel
undergoing atherosclerosis. It decrease your
blood vessel. What then happens of juxtaglomerular
apparatus? It becomes very very active, doesn't
it? It doesn't like the fact that it is receiving
decreased perfusion. What are you going to
release? Renin and company. What do you mean
by renin and company? Welcome to RAAS. Renin
angiotensin aldosterone system. So as we move
through here, we will then take a look at
the RAAS system in greater detail. What is
my topic? Secondary hypertenion, different
patients presenting with most common diseases.