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Hypetension I Notes

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Drugs: From Molecules to Man - Lecture 12 (9/03/2018)

Hypertension I
Cardiovascular Disorders cause:

17.3 million deaths in 2008.
30% of all deaths.

7.3 million deaths from CAD; 6.2 million deaths from stroke.
It will cause 23.3 million deaths by 2030.

Cardiovascular diseases account for around 1 in 4 deaths and so are a major public health concern and a major market for the pharmaceutical industry.

Most of these disorders have both genetic and lifestyle factors that influence their development. For instance, it is well-known that a diet high in saturated fat and salt is likely to result in problems with the heart and arteries.

However, the inter-relationships between causative factors and the diseases themselves are extremely complex, and not fully understood.

Blood Pressure

"120 over 80" = Describes the systolic over diastolic blood pressure.

The Systolic pressure is the pressure whilst the heart is contracting (maximum pressure).
The Diastolic pressure is the pressure while the heart is filling (minimum pressure).
The Pulse pressure is the difference between the Systolic and Diastolic pressures.

Hypertension can be caused by an Increased diastolic pressure, an Increased systolic pressure and an Increased pulse pressure.
Hypotension causes a decreased blood pressure.

The 'average' blood pressure is usually quoted as being 120/80.
However, age and sex are major determinants.

There are an estimated 70 million untreated hypertensive patients in the world's top 7 countries.

60% of hypertensive patient's blood pressures are
'adequately controlled.

10% of people have an optimal blood pressure.

So, there is a big market for treating hypertension and one that is ripe for development.

Classification of Hypertension by Aetiology (Causation)  Primary (Essential or Idiopathic) Hypertension - Cause unknown.
 Secondary Hypertension - Identified cause.

Hypertension can also be classified by what causes it, its aetiology.

Most cases of hypertension are termed primary hypertension, where hypertension is the main identifiable disorder but its cause is unknown. This type is also known as essential or idiopathic hypertension.

Secondary hypertension arises as a symptom of another disorder. There are many different disorders that can give rise to this form such as kidney problems, such as polycystic renal disease and renal artery stenosis, and tumors of the adrenal medulla
(phaeochromocytomas), due to the excessive production of circulating adrenaline.

Consequences of Hypertension
A high sustained arterial BP increases mortality from:

 Coronary artery disease (myocardial infarction)
 Stroke - Cerebral haemorrhage, Thrombosis and Thromboembolism.

Hypertension is a very serious problem and if untreated it can cause damage to arteries,
leading to the deposition of fats and the blockage of the arteries.
This increases the risk of thrombosis and thromboembolism, which often cause myocardial infarctions and ischaemic strokes.

Treatment Algorithm for Hypertension
Lifestyle modifications:

Lose weight.
Limit alcohol intake.
Increase aerobic activity.
Reduce sodium intake.
Maintain K+ intake.
Maintain Ca2+ and Mg2+ intake.
Stop smoking.
Reduce dietary fat and cholesterol.

Principles of Treatment for Hypertension

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