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1、Hypertension-Introduction Silent Killer painless complications dizziness,headache,and visual difficulties,It is the leading risk factor MI,DM,Stroke Responsible for the majority of office visits,Number one reason for drug prescription.25%of population,35%aware.140,Diastolic 90 mm of Hg*Normal*130 21
2、0/120Regulation of BP:BP=Cardiac Output x Peripheral Resistance Endocrine Factors Renin,Angiotensin,ANP,ADH,Aldosterone.Neural Factors Sympathetic&Parasympathetic Blood Volume Sodium,Mineralocorticoids,ANP Cardiac Factors Heart rate&Contractility.Control of Blood Pressure:BPCardiac OutputPeripheralR
3、esistanceBlood VolumeNa+,AldosteroneVasoconstrictorsAngiotensin IICatecholaminesVasodilatorsPg&KininsLocal FactorspH,HypoxiaNeural FactorsaAdrenergic Cons Adrenergic-DilCardiac FactorsRate&Contract.Humoral FactorsEtiologic Classification:Primary or Essential Hypertension(95%)Secondary Hypertension(5
4、-10%)Renal GN,RAS,Renin tumors Endocrine Cushing,OCP,Thyrotoxicosis Myxdema,Pheochromocytoma,Acromegaly.Vascular Coarctation of Aorta,PAN,Aortic insufficiency.Neurogenic Psychogenic,Intracranial pressure,olyneuritis etc.Pathogenesis of Hypertension:?Pathogenesis in Essential hypertension-Multifactor
5、ial Increased blood volume-Sodum retention ADH,Aldosterone.Increased sympathetic tone-Adrenal tumours,sympathetic stimulation.Increased vasoactive hormones-Cushings,Pheochromocytoma,Pathogenesis of Renovascular HTN:GFRRenin by JGAAngiotensin IIVasoconstriction P.ResistanceSodium RetentionBlood Volum
6、eAldosteroneHypertensionConsequences of Hypertension:Blood Vessels Atherosclerosis and its complications aneurism,Dissection,Rupture,necrosis.Arteriolosclerosis,Heart Hypertensive cardiomyopathy,IHD,MI.Kidney Benign/Malignant nephrosclerosis.Infarction Eyes:Hypertensive retinopathy Brain:Haemorrhage
7、,infarction,splinter&Lacunar hemorrhagesHyperplastic Arteriolosclerosis:Benign Nephrosclerosis:Left Ventricular Hypertrophy:Cerebral Infarction(Stroke):Subarachnoid Haemorrhage:Cerebral Blood vesselsSpecial features:Thin walled*End arteries*Cong.AneurismsLacunar Infarcts:Chronic hypertension Arterio
8、losclerosis of deep penetrating arterioles of brain stem.Single or multiple cavitary infarcts lacunes.Lenticular nucleus,thalamus Slit Haemorrhages.Renal Artery stenosis-AtrophyLeathery GranularityBenign NephrosclerosisNormal Retina-FundoscopyHypertensive Retinopathy:Grade I Thickening of arterioles
9、.Grade II Focal Arteriolar spasms.Vein constriction.Grade III Hemorrhages(Flame shape),dot-blot and Cotton wool and hard waxy exudates.Grade IV-PapilloedemaMalignant Hypertension:May complicate any type of HTN.Necrotizing arteriolitis.Intravascular thrombosis.Rapidly progressive end organ damage.Ren
10、al failure Hypertensive encephalopathy.Left ventricular failure.Necrotizing arteriolitis:Conclusions:Persistent increased blood pressure(140/90)95%Essential,5%secondary-Renovascular Benign and Malignant types(120Diastolic)Vessel damage&Arteriolosclerosis Complicates-Atherosclerosis,Diabetes,IHD Isch
11、emia or Infarction in end organs.Kidney,Brain,Heart&Eyes.Nephrosclerosis,renal damage,IHD,MI,Stroke&Retinopathy.Self Assessment Questions:Define essential,hypertension?Briefly describe pathogenesis of renal damage in hypertension.Classify hypertension,briefly describe pathogenesis in each?Summarize
12、common complications of hptn?What is nephrosclerosis?Briefly describe its pathogenesis?What is meant by malignant hypertension?Briefly describe clinical and pathological features?What are lacunar infarcts?arteriolosclerosis?How does hptn causes stroke?Damage heart?“Do what you love,love what you do,and deliver more than you promise”Harvey Mackay
