1- Hypertension Flashcards
(34 cards)
What are the two factors that influence arterial pressure?
Cardiac output and total peripheral resistance
Cardiac output is influenced by blood volume and cardiac factors like heart rate and contractility. Total peripheral resistance is influenced by humoral, neural, and local factors.
What is hypertensive retinopathy characterized by?
Narrowing and decrease in the diameter of retinal vessels
It is graded from grade I to IV.
What are the complications of hypertension related to large blood vessels?
Atherosclerosis and its complications
This includes risks of heart disease and stroke.
What is the most common underlying cause of primary brain parenchymal hemorrhage?
Hypertension
It accounts for 50% of clinically significant hemorrhage cases.
What characterizes hyperplastic arteriolosclerosis?
Concentric laminated thickening of walls of arterioles with progressive narrowing of the lumens
It is seen in malignant nephrosclerosis.
What is the definition of hypertension?
A sustained diastolic pressure greater than 90 mm Hg or a sustained systolic pressure in excess of 140 mm Hg
There is no rigidly defined threshold for complications.
What are the two types of hypertension?
Essential Hypertension and Secondary Hypertension
Secondary hypertension can be due to renal disease or other less common causes.
What are some causes of secondary hypertension?
- Coarctation of the aorta
- Increased intravascular volume
- Endocrine disorders (e.g., Cushing’s syndrome)
- Renal diseases
Other causes include medications and sleep apnea.
What are the organ changes associated with benign nephrosclerosis?
Normal or mildly reduced kidney size, fine granularity of cortical surfaces, and loss of mass due to cortical narrowing
Microscopy shows fibroelastic hyperplasia of arteriolar walls.
What is the relationship between blood pressure and cardiac output?
BP = Cardiac Output x Peripheral Resistance
This equation shows how both factors influence blood pressure.
What are some endocrine factors that regulate blood pressure?
- Renin
- Angiotensin
- ANP
- ADH
- Aldosterone
These hormones play significant roles in blood pressure regulation.
What is malignant hypertension characterized by?
Rapidly progressive end organ damage
It may lead to renal failure and hypertensive encephalopathy.
What is the typical left ventricular wall thickness in concentric left ventricular hypertrophy?
Greater than 1.5 cm
Cardiomegaly is also noted with specific weight thresholds.
What is the effect of hypertension on blood vessels?
Accelerates atherogenesis and causes structural changes in the walls of blood vessels
Hyaline arteriolosclerosis is one of the changes observed.
What is a common risk factor for hypertension?
Diabetes Mellitus (DM)
It is one of the leading risk factors for hypertension complications.
What are Charcot-Bouchard’s microaneurysms associated with?
Chronic hypertension
They are usually sites of rupture leading to hemorrhagic events.
Fill in the blank: Essential hypertension is considered _______.
multifactorial
It involves genetic, environmental, and lifestyle factors.
True or False: Secondary hypertension accounts for 90-95% of all hypertension cases.
False
About 90-95% of hypertension is idiopathic (essential hypertension).
stages of hypertension
mild- sys- 140-159, dys- 90-99
moderate- sys- 160-179, dys- 100-109
severe- sys- 180-209, dys- 110-119
very severe- sys- >210, dys- 120
Heart changes is hypertension
Concentric left ventricular hypertrophy; left ventricular wall thickness greater than 1.5cm
Cardiomegaly with weight of over 350g in males and 300g in females.
Microscopically, increase in
transverse myocyte diameter
Blood vessel changes in Hypertension
Hypertension accelerates atherogenesis and causes changes in the structure of the walls of blood vessels.
Hyaline Arteriolosclerosis; Can be seen in diabetes
Chronic hemodynamic stress in hypertension or metabolic stress in diabetes accentuates endothelial injury
Characterised by homogenous, pink, hyaline thickening of the walls of the arterioles with loss of underlying structural details and with narrowing of the lumen, this can further reduce blood flow to the organs
Hyperplastic arteriolosclerosis is seen in malignant nephrosclerosis.
Characterised by concentric laminated thickening of walls of arterioles with progressive narrowing of the lumens, there may be resultant necrotising arteriolitis with fibrinoid necrosis of vessel wall
Necrotizing Arteriolitis - deposits of fibrinoid and acute necrosis of the vessel wall.
Kidney changes in Hypertension
Benign Nephrosclerosis; the kidneys are either normal sized or mildly reduced, the cortical surfaces show fine granularity. Cut sections show loss of mass due to cortical narrowing.
Microscopy shows fibroelastic hyperplasia of arteriolar wall with hyaline arteriolosclerosis
Malignant Nephrosclerosis; the changes are dependent on the duration and severity of the hypertensive disease. Cortical surfaces show small pinpoint hemorrhages (flea bitten appearance).
Microscopy: fibrinoid necrosis of arterioles,hyperplastic arteriolitis
Due to duplication of the basement membrane and increase in smooth muscles
Eye changes in Hypertension
Hypertensive retinopathy characterized by narrowing and decrease in the diameter of retinal vessels.
They are graded from grade I to IV
Brain changes in hypertension
Hypertension is the most common underlying cause of primary brain parenchymal hemorrhage.
It accounts for 50% of cases of clinically significant haemorrhage.
Chronic hypertension is associated with Charcot-Bouchard’s microaneurysms which are usually the site of rupture.
Also saccular aneurysms of larger intracranial vessels occuring most commonly within the basal ganglia.
Hypertensive intracerebral haemorrhages are usually ganglionic hemorrhages in the region of the basal ganglia and thalamus.
Hypertension is also a risk factor for berry aneurysms which can rupture and give rise to subarachnoid hemorrhage.
The arteriolar sclerosis of hypertension can result in lacunar infarcts within the deep white matter of the basal ganglia and thalamus, internal capsule and brain stem
