Module 1

Presenters:
1.Charles Orora
-corora@pskenya.org
2. Bitonye Jacinta
3. Walter K. Kiptirim
walter.kibet@amref.org

Module 1: Understanding
Hypertension
Objectives

To be able to define hypertension(What?)

To be able to understand and discuss

epidemiology of hypertension(Where/Who?)
To describe the anatomy and physiology of
the heart(How?)
To describe the factors affecting peripheral
vascular resistance and cardiac
output(When/How?)

Definition of hypertension
(What?)
Persistently, elevated systolic and or diastolic

blood pressure greater than or equal to

140/90mmHg or more in adults.
Systolic blood pressure (SBP) is the pressure
exerted when the heart contracts
Diastolic blood pressure (DBP) is the pressure
exerted when the heart relaxes

The Epidemiology of HTN

(Where/Who?)
Global:
HTN causes 7.5million deaths (12.8%) of all deaths
Accounts for 57 million Disability Adjusted Years

(DALYs)
HTN is a major risk factor For cardiovascular
diseases

Regional:
Africa accounts for 46% of HTN Vs America -35%

Kenyan situation:
No statistics; but exists isolated studies show HTN
prevalence is 12.3% in urban slums but may be as
high as 50% in some areas and 21.4% in rural areas

1.2 Anatomy and

physiology of the Heart
The heart is a muscle about the size of a fist

located beneath the sternum

It beats approximately 100,000 times a day
While at rest (72x60minutes x 24 hrs)
The heart has 2 sides separated by a septum
wall
Has four chambers and four valves
The right side pumps blood to the lungs for
oxygenation
The left side receives oxygenated blood from
the lungs and pumps out to the rest of the body

The circulatory system

Arteries
Veins
Heart

BP is equal to (Cardiac output X

peripheral resistance PR) I.e. CO = (CO X

PR)
CO is affected by;
Stroke volume x heart rate
Preload (end diastolic pressure)
Myocardial contractility (starlings law)
After load (peripheral vascular resistance)

1.3 Factors affecting Peripheral

Vascular Resistance
PVR is the resistance determined by the

structure (anatomic) and functional changes

in small arteries and arterioles
Constrictors reduce size of these vessels and
include; Angiotensin II, catecholamine,
endothelin, & leukotrienes .
Dilators enlarge the vessels and includes
prostaglandins, bradykinins, and nitric acid
(NO)

1.3. Factors affecting

Cardiac Output.
Cardiac output (CO) is the amount of blood the

heart pumps through the circulatory system in a

minute
Stroke volume is the amount of blood ejected
out of the left ventricle in one contraction
The Cardiac Output is a product of heart rate
and stroke volume (CO= Stroke Volume X
Heart Rate)
Example : Find CO= given that SV is 70ml
and HR is 70 beats/minute =......?
A normal adult has a cardiac output of 5
litres per minute

Factors affecting cardiac output.

Myocardial contraction ability of the heart

muscles to contract and relax

Stroke volume which depends on;
Preload, amount of blood returning to the heart
Contractility of the myocardium
After load which is a function of the compliance of
the large arteries that determine peripheral
resistance
NB: The nueroendocrine system (Sympathetic

system; Renin Angiotensin , Aldosterone system

influences contractility and peripheral resistance
There are drugs that affect the neuroendocrine

system thus reducing BP in hypertension

Question and answer session