The goal of treatment: Lower the blood pressure; Protect the target organ Reduce the morbidity and mortality rates Best therapy and minimal risk
The goal of treatment: • Lower the blood pressure; • Protect the target organ; • Reduce the morbidity and mortality rates; • Best therapy and minimal risk;
Hypertension regulation of blood pressure Normal regulation of blood pressure BP CO PVR Arterial blood C arenac Peripheral arterio pressure output Vascular resistance tone Blood HeartContractility Filling volume rate pressure Venous tone Baroreceptors and sympathetic nervous system Renin-angiotention-aldosterol system(RAAS)
BP CO PVR
Hypertension regulation of blood pressure 2. CAPACITANCE Baroreflexes(mediated by Venules 3. PUMP OUTPUT Heart autonomic nerves) CNS Humoral mechanisms Sympathetic nerves 4. VOLUME (include: RAAS system and 1. RESISTANCE Kidneys local release of hormones from vascular endothelium Renin such as, NO, endothelin 1) Aldosterone -+ Angiotensin Anatomic sites of blood pressure control Anatomic sites of blood pressure control
Anatomic sites of blood pressure control Baroreflexes (mediated by autonomic nerves) Humoral mechanisms (include: RAAS system and local release of hormones from vascular endothelium, such as, NO, endothelin 1)
Hypertension regulation of blood pressure A Postural baroreflex: responsible for rapid, moment to moment adjustments in blood pressure. Sense the stretch of the vessel walls from a reclining to an upright posture; 2. Nucleus of the tractus solitarius reduction of peripheral vacular resistance; Reduction in intravascular volume: Brain stem Sensory fiber 1. Baroreceptor in carotid sinus Inhibitory interneurons Arterial blood pressure 3. Vasomotor Motor fibers 4. Autonomic 5. Sympathetic nerve ending 6.aor阝 receptor Figure 11-2. Baroreceptor reflex arc
Sense the stretch of the vessel walls • from a reclining to an upright posture; • reduction of peripheral vacular resistance; • Reduction in intravascular volume; - A. Postural baroreflex: responsible for rapid , moment to moment adjustments in blood pressure
Hypertension regulation of blood pressure B. Renin-Angiotensin-Adolsteron (RAAS AngiotensinⅡ Adrenal cortex Aldosterone Systemic arteries Vasoconstriction 2. CAPACITANCE Venules 3. PUMP OUTPUT Kio Increase Nat and H2o reabsorption pressure CNS- 4. VOLUME Kidneys Redistribution of renal blood flow 1. RESISTANCE Arterioles This is responsible for Renin long-term blood pressure Aldosterone-+ Angiotensin control Anatomic sites of blood pressure control
B. Renin-Angiotensin-Adolsteron (RAAS) This is responsible for long-term blood pressure control. Redistribution of renal blood flow Angiotensin II