Endocrine Hypertension

Topic

Presenting to:Sir. Bakht Tarin Khan-

Presenting by;Abdul Qahar

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Overview of the Endocrine System

• System of ductless glands that secrete hormones

– Hormones are “messenger molecules”– Circulate in the blood– Act on distant target cells– Target cells respond to the hormones for which they have receptors– The effects are dependent on the programmed response of the target cells– Hormones are just molecular triggers

What the High Blood Pressure and Prehypertension are?Blood pressure is the force of blood against the walls of arteries. Blood pressure rises and falls during the day. When blood pressure stays elevated over time, it is called high blood pressure.

The medical term for high blood pressure is hypertension.If your blood pressure is between 120/80 mmHg and 139/89 mmHg, then you have prehypertension. This means that you don't have high blood pressure now but are likely to develop it in the future.

Hypertension (HTN)

“The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure defines hypertension as a blood pressure exceeding 139/89 mm Hg for adults ages 18 years or older on the mean of 2 or more properly seated BP readings on each of 2 or more office visits.”

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Blood Pressure Classification

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Hypertension

Hypertension is the most common public health problem in developed countries

Called Silent Killer

No cure is available, but prevention and management decrease the incidence of hypertension and disease.

PrevalencePrevalence on hypertension by age

Age % Hypertension18~29 430~39 1140~49 2150~59 4460~69 5470~79 6480 + 65

85 % of hypertension is essential or idiopathic.

15 % have identifiable causes of secondary HTN.

Hypertension affects approximately 1 billion individual worldwide.

Types of Hypertension In ~80–95% of hypertensive patients are diagnosed as

having "essential" hypertension (also referred to as primary or idiopathic hypertension).

In the remaining 5–20% of hypertensive patients, a specific underlying disorder causing the elevation of blood pressure can be identified.

In individuals with "secondary" hypertension, a specific mechanism for the blood pressure elevation is often more apparent. Renal disease is the most common cause of secondary hypertension.

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Hypertension : Symptoms

Most of the patients do not complain of any symptoms

Symptomatic patients may have one or more of the

following symptoms

- Headache

- Confusion

- Severe shortness of breath

- Visual disturbances

- Nausea and vomiting

Causes of Hypertension

1- Primary hypertension (90 – 95%) - Essential hypertension

2- Secondary hypertension (5 – 10%) - Renal diseases - Endocrine disease

- Steroid excess- Growth hormone excess- Vascular causes

- Drugs

Renin-Angiotensin SystemCushing’s SyndromePrimary AldosteronismPheochromocytomaRenal Vascular HypertensionOther

Causes of Secondary HTN

Pheochromocytoma

Secrete catecholamines which can produce severe HTN

Cause:10% arise outside the adrenal10% of those in adrenal are bilateral10% are malignant(to harm other)10% arise in children10% occur in association with other endocrine

neoplasm (tumour)

Aldosterone and Hypertension• Primary aldosteronism as described by Conn in 1955 had

been thought to be an uncommon cause of hypertension with prevalence of < 1% among hypertensive patients

• Gordon et al in early 1990s screened 52 hypertensive pts and found that 12% of the individuals were positive for primary aldosteronism

• In a follow up study by Gordon evaluation of 199 pts referred to a hypertension clinic found a prevalence of primary aldosteronism to be at least 8.5%

• Since the early studies by Gordon multiple investigators have confirmed a prevalence of primary aldosteronism of 5-15% in general selective hypertensive population. Two studies in particular:

• Schwartz and Turner evaluated 118 pts with hypertension and withdrew antihypertensive treatment. Diagnosis of primary aldosteronism was made with 4 day salt load and lack of suppresion of aldosterone secreation

• Primary aldosteronism was diagnosed in 13% of individuals

Aldosterone and Hypertension

CUSHING’S SYNDROME

•Results from hypersecretion of glucocorticoids

•Lipid reserves are mobilized

•Adipose tissue accumulates in cheeks & base of neck

Hyperaldosteronism

Excessive aldosterone causesHTNlow blood Ca2+

low blood renin

Primaryusually from cortical adenoma or hyperplasia

Secondaryusually caused by impaired renal blood flow due to

renal artery stenosis from atherosclerosisinvolves renin-angiotensin

Renin-Angiotensin System

Renin (juxtaglomerular

apparatus)

Angiotensinogen------> Angiotensin I

Angiotensin Converting Enzyme (pulmonary bed)

Angiotensin I ---------> Angiotensin II

Angiotensin II binds to specific receptors

#1. Angiotensin II binds to its receptors and causes:

A. Inhibition of aldosterone secretion

B. Peripheral vasoconstriction

C. Inhibits central sympathetic activity

D. Stimulates ACTH stimulation

E. Inhibits vasopressin release

Renin-Angiotensin System

Angiotensin II functions to maintain normal extracellular volume and blood pressure1. constricts vascular smooth muscle

2. release of Epinephrine and Norepinephrine

3. increases central sympathetic outflow

4. release of vasopressin

5. increases aldosterone secretion

Renin-Angiotensin System

Low renal perfusion sensed by JG apparatus

Low Na load to distal tubule sensed by macula densa

Upright posture increase CNS stimulation

All enhance renin secretion--->increased angiotensin II and aldosterone levels

Renin-Angiotensin System

Feedback at multiple levelsrenin release can be inhibited by high salt diet

and high blood pressureAldosterone secretion sensitive to both

potassium and sodium levels

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Renin Angiotensin Aldosterone System - YouTube.mp4

Hypertension - Management

Life style modification:

Regular physical exercise Stop smoking Stop alcohol Dietary controls : weight control

Restrict salt intake 4-6 gm/day Restrict saturated fats

Drug treatment

Diuretics ß -Blockers Calcium channel blockers ACE inhibitors Angiotensin II receptor blockers α-Adrenergic blockers

The correct Approach to Hypertension

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Step1

• Are all patients screened for hypertension?

• Are all hypertensives correctly identified?

Step 2

• Are the correct drug combinations prescribed?

• What is the compliance for medicines?

Step 3

• Is the goal B.P. achieved and maintained?

• Are there any complications/ side effects?

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THANKS FOR YOUR ATTENTION!!!