18.1 Hypertension and Angina
3 min read•june 18, 2024
and are two crucial cardiovascular conditions that can significantly impact heart health. Understanding their mechanisms, symptoms, and diagnosis is essential for effective management and prevention of complications.
Blood pressure guidelines help identify hypertension stages, while angina symptoms signal an imbalance between heart oxygen supply and demand. Both conditions share risk factors and require a comprehensive diagnostic approach, including clinical evaluation and specialized tests to guide treatment strategies.
Pathophysiology and Diagnosis of Hypertension and Angina
Mechanisms of hypertension and angina
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- Hypertension
- Increased results from elevated and , leading to higher blood pressure
- Increased due to , (plaque buildup in arteries), and arterial stiffening contributes to hypertension
- Imbalance between vasoconstrictors (, , ) and vasodilators (, ) favors vasoconstriction and raises blood pressure
- Genetic factors influence blood pressure regulation, with some individuals more susceptible to hypertension
- Environmental factors such as high salt intake (sodium), obesity, and chronic stress can contribute to the development of hypertension
- The plays a crucial role in regulating blood pressure and fluid balance
- Angina
- occurs when there is an imbalance between myocardial oxygen supply and demand, leading to chest pain or discomfort (angina)
- Decreased oxygen supply to the heart muscle can result from:
- : narrowing of the coronary arteries due to atherosclerosis
- Coronary artery spasm: sudden constriction of the coronary arteries ()
- Anemia: low red blood cell count reduces oxygen-carrying capacity
- Hypoxemia: low oxygen levels in the blood
- Increased oxygen demand by the heart muscle can occur due to:
- : rapid heart rate
- Hypertension: high blood pressure increases the workload on the heart
- : thickening of the heart muscle wall
- : narrowing of the aortic valve opening, increasing the workload on the left ventricle
Blood pressure guidelines for diagnosis
- Normal blood pressure: systolic < 120 mmHg and diastolic < 80 mmHg
- Elevated blood pressure: systolic 120-129 mmHg and diastolic < 80 mmHg
- Stage 1 hypertension: systolic 130-139 mmHg or diastolic 80-89 mmHg
- Stage 2 hypertension: systolic ≥ 140 mmHg or diastolic ≥ 90 mmHg
- : systolic > 180 mmHg and/or diastolic > 120 mmHg, requiring immediate medical attention
Symptoms of hypertension and angina
- Hypertension
- Often asymptomatic (no symptoms) in early stages
- Possible symptoms include headache, dizziness, shortness of breath, chest pain, blurred vision, and nausea
- Signs of hypertension include elevated blood pressure readings, (arteriovenous nicking, hemorrhages, exudates), and (, displaced apex beat)
- Angina
- Symptoms include chest pain or discomfort (pressure, squeezing, fullness, or pain), often in the center of the chest and may radiate to the neck, jaw, shoulder, back, or arm
- Other symptoms: shortness of breath, fatigue, nausea, and lightheadedness
- Signs of angina include elevated heart rate and blood pressure during an episode, S4 gallop if left ventricular dysfunction is present, and mitral regurgitation murmur if papillary muscle dysfunction occurs
Causes and diagnosis of cardiovascular conditions
- Hypertension
- Primary (essential) hypertension accounts for 90-95% of cases and is multifactorial, involving genetic, environmental, and behavioral factors
- Secondary hypertension (5-10% of cases) can be caused by renal disease, endocrine disorders (, , ), , and
- Diagnostic approach involves:
- Confirming elevated blood pressure readings over multiple visits
- Assessing for end-organ damage (, renal function tests, )
- Evaluating for secondary causes (, )
- Angina
- Causes include obstructive (a common form of ), coronary artery spasm (Prinzmetal's angina), , aortic valve stenosis, and hypertrophic cardiomyopathy
- Diagnostic approach includes:
- (ECG) during an episode to detect ischemic changes
- to assess for ischemia during physical exertion
- to visualize the coronary arteries and detect stenosis or blockages
- Echocardiogram to evaluate heart structure and function
- (MRI) for detailed assessment of heart structure and function
Cardiovascular Risk Factors and Prevention
- Major modifiable risk factors include hypertension, smoking, diabetes, dyslipidemia, obesity, and physical inactivity
- Non-modifiable risk factors include age, gender, and family history
- Prevention strategies focus on lifestyle modifications and management of underlying conditions to reduce and improve cardiovascular health
Key Terms to Review (64)
Aldosterone-Renin Ratio: The aldosterone-renin ratio (ARR) is a diagnostic test used to evaluate the balance between the hormone aldosterone and the enzyme renin. This ratio helps identify the underlying cause of hypertension and can aid in the diagnosis and management of primary aldosteronism, a common cause of secondary hypertension.
American Heart Association: The American Heart Association (AHA) is a non-profit organization dedicated to fighting cardiovascular diseases and promoting heart health through research, education, and advocacy. It plays a crucial role in setting guidelines for the management of cardiovascular conditions.
Angina: Angina is chest pain or discomfort caused by reduced blood flow to the heart muscle. It is often a symptom of coronary artery disease.
Angiotensin I: Angiotensin I is an inactive precursor peptide that is converted into angiotensin II by the enzyme angiotensin-converting enzyme (ACE). It plays a crucial role in the Renin-Angiotensin-Aldosterone System (RAAS), which regulates blood pressure and fluid balance.
Angiotensin II: Angiotensin II is a potent vasoconstrictor involved in regulating blood pressure and fluid balance. It plays a crucial role in the renin-angiotensin-aldosterone system (RAAS).
Angiotensin II: Angiotensin II is a potent vasoconstrictor hormone that plays a central role in the regulation of blood pressure and fluid balance within the body. It is a key component of the renin-angiotensin-aldosterone system (RAAS), which is a complex physiological pathway involved in maintaining homeostasis.
Aortic Valve Stenosis: Aortic valve stenosis is a heart valve disorder characterized by the narrowing or obstruction of the aortic valve, the main artery that carries oxygenated blood from the heart to the rest of the body. This condition impairs the valve's ability to open fully, making it harder for the heart to pump blood effectively.
Atherosclerosis: Atherosclerosis is a chronic inflammatory condition characterized by the buildup of plaque within the arterial walls, leading to the narrowing and hardening of blood vessels. This condition is closely linked to various cardiovascular and cerebrovascular disorders, including intracranial emergencies, hypertension, and angina.
Cardiac Magnetic Resonance Imaging: Cardiac magnetic resonance imaging (cMRI) is a non-invasive imaging technique that uses strong magnetic fields and radio waves to create detailed images of the heart and surrounding structures. It allows healthcare providers to assess the structure, function, and perfusion of the heart, providing valuable information for the diagnosis and management of various cardiovascular conditions, including hypertension and angina.
Cardiac output: Cardiac output is the volume of blood the heart pumps per minute. It is a critical parameter in assessing cardiovascular health and function.
Cardiac Output: Cardiac output is the volume of blood pumped by the heart per minute. It is a critical measure of the heart's pumping ability and a key determinant of tissue perfusion and oxygen delivery throughout the body. This term is essential in understanding the fundamental mechanics of the cardiovascular system and its role in various cardiovascular conditions and their management.
Cardiovascular Risk Factors: Cardiovascular risk factors are characteristics or conditions that increase an individual's likelihood of developing cardiovascular diseases, such as heart disease, stroke, and hypertension. These factors can be modifiable or non-modifiable, and understanding them is crucial for assessing and managing an individual's overall cardiovascular health, particularly in the context of hypertension, angina, and the use of sodium-glucose cotransporter 2 inhibitors (SGLT2Is).
Catecholamines: Catecholamines are a group of neurotransmitters and hormones that play a crucial role in regulating various physiological processes, including cardiovascular function, stress response, and energy metabolism. These chemical messengers are primarily produced in the adrenal glands and the sympathetic nervous system, and they exert their effects by binding to specific receptors on target cells.
Children and adolescents: Children and adolescents are individuals typically categorized from birth to 18 years old. In pharmacology, this group requires special considerations due to ongoing development and differing drug metabolism compared to adults.
Coarctation of the Aorta: Coarctation of the aorta is a congenital heart defect characterized by a narrowing or constriction of the aorta, the main artery that carries oxygenated blood from the heart to the rest of the body. This narrowing can lead to increased blood pressure above the constriction and decreased blood flow to the lower body.
Coronary Angiography: Coronary angiography is a medical imaging procedure that uses X-rays to visualize the inside of the coronary arteries, the blood vessels that supply the heart muscle with oxygen-rich blood. It is a crucial diagnostic tool used to assess the presence and severity of coronary artery disease, which can lead to conditions like hypertension and angina.
Coronary Artery Disease: Coronary artery disease is a condition in which the major blood vessels that supply the heart become damaged or diseased, often due to a buildup of fatty deposits called plaque. This can restrict blood flow to the heart muscle, leading to various cardiovascular complications and potentially life-threatening events.
Coronary Artery Stenosis: Coronary artery stenosis refers to the narrowing or blockage of the coronary arteries, the blood vessels responsible for supplying oxygen-rich blood to the heart muscle. This condition can lead to reduced blood flow and oxygen delivery to the heart, which is a key factor in the development of hypertension and angina.
Cushing's Syndrome: Cushing's syndrome is a hormonal disorder caused by excessive levels of the hormone cortisol in the body. It can lead to a variety of symptoms, including weight gain, high blood pressure, and diabetes, and is often associated with the long-term use of corticosteroid medications or the presence of an adrenal or pituitary gland tumor.
Diastolic blood pressure: Diastolic blood pressure is the pressure in the arteries when the heart rests between beats. It is the lower number in a blood pressure reading.
Diastolic Blood Pressure: Diastolic blood pressure refers to the pressure in the arteries when the heart is at rest, between beats. It is the lower of the two numbers in a blood pressure reading and indicates the minimum pressure the blood exerts on the arterial walls during the relaxation phase of the cardiac cycle.
Echocardiogram: An echocardiogram is a diagnostic test that uses sound waves to create real-time images of the heart. It allows healthcare providers to assess the structure and function of the heart, including the valves, chambers, and surrounding blood vessels.
Electrocardiogram: An electrocardiogram (ECG or EKG) is a diagnostic test that records the electrical activity of the heart. It is a crucial tool used to assess heart health and detect various cardiac conditions, including dysrhythmias, hypertension, and heart failure.
Endothelin-1: Endothelin-1 is a potent vasoconstrictor peptide produced primarily by endothelial cells. It plays a crucial role in the regulation of vascular tone, blood pressure, and the pathogenesis of various cardiovascular diseases, including hypertension and angina.
Exercise Stress Test: An exercise stress test, also known as a cardiac stress test or treadmill test, is a diagnostic procedure that evaluates the heart's response to physical exertion. It is used to assess the presence and severity of cardiovascular conditions, particularly those related to hypertension and angina.
Fundoscopy: Fundoscopy, also known as ophthalmoscopy, is a diagnostic procedure that involves the examination of the fundus, or the back of the eye, using a specialized instrument called an ophthalmoscope. This procedure allows healthcare providers to assess the health and condition of the optic nerve, retina, and blood vessels within the eye, providing valuable information for the diagnosis and management of various medical conditions, particularly those related to hypertension and angina.
Gender and racial bias: Gender and racial bias in pharmacology refers to the systemic differences in drug treatment outcomes and healthcare access based on gender and race. These biases can affect the efficacy, safety, and prescription patterns of antihypertensive and antianginal drugs.
Grades of hypertension: Grades of hypertension classify the severity of high blood pressure based on systolic and diastolic measurements. These grades help guide treatment decisions and risk assessment.
Heart rate: Heart rate is the number of times the heart beats per minute (bpm). It is a crucial indicator of cardiovascular health and is influenced by various factors including medication.
Hypertension: Hypertension, also known as high blood pressure, is a chronic medical condition in which the blood pressure in the arteries is elevated, increasing the risk of heart disease, stroke, and other health complications. It is a key term that is closely connected to various topics in pharmacology, including the management of cardiovascular conditions and the use of specific drug classes to control blood pressure.
Hypertensive Crisis: A hypertensive crisis is a severe elevation in blood pressure that can lead to life-threatening complications if left untreated. This term is particularly relevant in the context of antidepressants, central nervous system (CNS) stimulants and nonstimulants, as well as hypertension and angina, as these medications and conditions can contribute to or exacerbate a hypertensive crisis.
Hypertrophic Cardiomyopathy: Hypertrophic cardiomyopathy is a genetic disorder characterized by the thickening (hypertrophy) of the heart muscle, particularly the left ventricle. This abnormal growth can impair the heart's ability to pump blood effectively, leading to various cardiovascular complications. The term is particularly relevant in the context of calcium channel blockers and the management of hypertension and angina.
Hypotension: Hypotension is a condition characterized by abnormally low blood pressure, generally below 90/60 mmHg. It can lead to symptoms such as dizziness, fainting, and in severe cases, shock.
Ischemic Heart Disease: Ischemic heart disease, also known as coronary artery disease, is a condition where the major blood vessels that supply the heart with oxygen and nutrients become damaged or diseased, typically due to the buildup of fatty deposits called plaque. This reduced blood flow to the heart can lead to chest pain, heart attack, and other serious cardiovascular complications.
Left Ventricular Hypertrophy: Left ventricular hypertrophy (LVH) is a condition characterized by the thickening and enlargement of the left ventricle, the main pumping chamber of the heart. This adaptation occurs in response to increased pressure or resistance in the cardiovascular system, often as a result of chronic hypertension or other underlying heart conditions.
Microvascular angina: Microvascular angina is a type of angina caused by abnormalities in the small blood vessels of the heart, leading to reduced blood flow and chest pain. It is also known as cardiac syndrome X and can occur even when larger coronary arteries appear normal.
Microvascular Dysfunction: Microvascular dysfunction refers to the impaired ability of the smallest blood vessels, known as the microcirculation, to effectively regulate blood flow and oxygen delivery to tissues. This condition is often associated with various cardiovascular and metabolic disorders, including hypertension and angina.
Myocardial Ischemia: Myocardial ischemia is a condition where the heart muscle (myocardium) does not receive enough oxygenated blood, leading to a mismatch between the heart's oxygen demand and supply. This can result in chest pain, known as angina, and potentially cause permanent damage to the heart if left untreated.
Myocardial Oxygen Demand: Myocardial oxygen demand refers to the amount of oxygen required by the heart muscle (myocardium) to meet its metabolic needs and maintain proper function. It is a critical factor in understanding the pathophysiology and management of various cardiovascular conditions, including hypertension, angina, and the effects of certain drug therapies.
Nitric Oxide: Nitric oxide (NO) is a colorless gas that acts as a signaling molecule in the body, playing a crucial role in various physiological processes, including the regulation of blood pressure, cardiac function, and neurotransmission. This versatile molecule has implications in several topics related to cardiovascular and respiratory health.
Obstructive Sleep Apnea: Obstructive sleep apnea is a sleep disorder characterized by repeated episodes of complete or partial airway obstruction during sleep, leading to disrupted breathing and reduced oxygen levels in the body. This condition is closely linked to the topics of hypertension and angina.
Peripheral vascular resistance: Peripheral vascular resistance (PVR) is the resistance that must be overcome to push blood through the peripheral circulatory system. It is a major determinant of arterial blood pressure and is influenced by vessel diameter, blood viscosity, and vessel length.
Peripheral Vascular Resistance: Peripheral vascular resistance refers to the resistance to blood flow in the peripheral blood vessels, primarily the arterioles and capillaries. This resistance is a crucial factor in determining blood pressure and plays a significant role in the regulation of blood flow throughout the body, particularly in the context of hypertension, angina, and shock management.
Pheochromocytoma: Pheochromocytoma is a rare, usually benign tumor that develops in the chromaffin cells of the adrenal glands. These tumors secrete excessive amounts of catecholamines, such as epinephrine and norepinephrine, leading to significant disruptions in blood pressure regulation and other autonomic functions.
Primary Aldosteronism: Primary aldosteronism is a condition characterized by the excessive production of the hormone aldosterone by the adrenal glands, leading to high blood pressure, fluid and electrolyte imbalances, and potential organ damage. It is a common cause of secondary hypertension and can also contribute to the development of angina pectoris.
Prinzmetal's Angina: Prinzmetal's angina, also known as variant angina, is a type of chest pain caused by temporary spasms in the coronary arteries that supply blood to the heart. Unlike typical angina, which is triggered by physical exertion or emotional stress, Prinzmetal's angina can occur at rest and is often associated with changes in the electrocardiogram (ECG).
Prostaglandins: Prostaglandins are a group of lipid compounds derived from arachidonic acid that act as local hormones, mediating a wide range of physiological and pathological processes in the body. They are involved in inflammation, pain, fever, and various other regulatory functions.
Renal Artery Stenosis: Renal artery stenosis is a narrowing or blockage of the arteries that supply blood to the kidneys. This condition can lead to reduced blood flow and decreased kidney function, potentially contributing to the development of hypertension and angina.
Renin-Angiotensin-Aldosterone System: The renin-angiotensin-aldosterone system (RAAS) is a complex physiological mechanism that regulates blood pressure, fluid balance, and electrolyte homeostasis in the body. It is a crucial system involved in the management of hypertension, heart failure, and other cardiovascular and renal conditions.
Renin-angiotensin-aldosterone system (RAAS): The Renin-angiotensin-aldosterone system (RAAS) is a hormone system that regulates blood pressure and fluid balance. It involves the kidneys, liver, lungs, and adrenal glands.
Retinal Changes: Retinal changes refer to the alterations that occur in the retina, the light-sensitive layer at the back of the eye, due to various medical conditions or physiological processes. These changes can have significant implications for vision and overall eye health, particularly in the context of hypertension and angina.
S4 Gallop: An S4 gallop is an abnormal heart sound that occurs during diastole, the relaxation phase of the cardiac cycle. It is associated with impaired ventricular filling and is a sign of certain cardiovascular conditions, particularly those involving hypertension and angina.
Stable angina: Stable angina, also known as effort angina, is chest pain or discomfort that typically occurs with activity or stress and is relieved by rest or nitroglycerin. It is caused by reduced blood flow to the heart muscle due to coronary artery disease.
Stroke volume: Stroke volume is the amount of blood ejected by the left ventricle of the heart during each contraction. It is a critical measure in understanding cardiac function and overall cardiovascular health.
Stroke Volume: Stroke volume is the amount of blood pumped from the ventricles of the heart with each contraction. It is a critical component of cardiac output, which is the measure of the heart's ability to pump blood throughout the body.
Symptoms of hypertension: Symptoms of hypertension are clinical signs indicating high blood pressure. Common symptoms include headaches, dizziness, and blurred vision.
Systolic blood pressure: Systolic blood pressure is the pressure in your arteries during the contraction of your heart muscle. It is the higher number in a blood pressure reading.
Systolic Blood Pressure: Systolic blood pressure is the measurement of the pressure in the arteries during the contraction of the heart, when the heart pumps blood out to the body. It represents the maximum pressure the heart exerts to circulate blood throughout the body.
Tachycardia: Tachycardia refers to a rapid heart rate, typically defined as a resting heart rate exceeding 100 beats per minute. This abnormally fast heart rhythm can have various underlying causes and is an important consideration in several medical conditions and drug therapies.
Unstable angina: Unstable angina is a condition characterized by sudden chest pain due to reduced blood flow to the heart. It is a medical emergency and can be a precursor to a heart attack.
Variant (Prinzmetal) angina: Variant (Prinzmetal) angina is a type of chest pain caused by vasospasm of the coronary arteries, leading to transient myocardial ischemia. Unlike typical angina, it often occurs at rest and is not necessarily induced by physical exertion.
Vasoconstriction: Vasoconstriction is the narrowing or constriction of blood vessels, specifically the arteries and arterioles, which leads to a decrease in blood flow and blood pressure. This physiological process is an important mechanism in the regulation of blood flow and blood pressure throughout the body.
Vasopressin: Vasopressin is a hormone produced by the hypothalamus and stored in the posterior pituitary gland. It primarily acts to regulate water balance in the body and constrict blood vessels.
Women’s health: Women's health focuses on the diagnosis, treatment, and prevention of conditions that are unique to women or affect women differently. In pharmacology, it involves understanding how drugs like antihypertensives and antianginals interact with female physiology.