17.8 Pathology: Hypertension Flashcards
(22 cards)
What is the definition of systemic hypertension?
Sustained:
Above 90/140 mmHg
What is systemic hypertension classifed as?
Primary/essential (90-95%): idiopathic
Secondary (5-10%): identifiable cause
(Mostly benign-slow rise, some malignant-rapid rise)
What happens with arteriosclerosis (the layers of the vessel)?
Media: fragmentation of elastin
Media/intima: increased collagen
What happens with hyaline arteriolosclerosis?
Plasma pro deposited on wall, SM atrophy, increased collagen,
Glassy luminal narrowing
What are the factors influencing primary hypertension?
Multifactorial (incl. polygenic genetic influences)
In primary hypertension, what can high/low plasma renin activity correlate with?
Vasoconstriction and volume dependent HT
What happens with decreased aortic compliance? (ending with systolic hypertension)
Arteriosclerosis–>loss of elasticity–> systolic elevation–>widening PP—> isolated systolic HT
(or from increased SV)
How does essential hypertension cause CV problems?
Concentric LV hypertrophy
What can happen in large arteries, medium arteries and arterioles in essential HT?
Large: Atherosclerosis, aortic dissection
Medium: Berry aneurysm
Arterioles: hyaline arteriosclerosis/arteriolar hyalinosis
What causes an AAA to occur?
Weakening in the media
Where does blood track in an aortic dissection?
In the media
What are some complications of aortic dissections?
Haemopericardium
Extension of dissection (coronary ischaemia, stroke)
Blood tracking down and reentering the media (chronic)
What is likely to have caused a recent infarct in the heart?
Atherosclerosis with thrombosis
What happens to the kidney in HT?
Sclerosis of glomeruli
Hyaline arteriolosclerosis (chronic ischaemia)
What do you see histologically with benign nephrosclerosis?
Depressions in capsule
Interstitial scarring, chronic inflammation, atrophic glomeruli/tubules
What are renal infarcts usually due to?
Embolism (e.g. athero-embolism)
What is the most common cause of stroke?
Cerebral infarction
What is the main risk factor for intracerebral haemorrhages?
HT, caused by hyaline arteriolosclerosis
What is AV nipping?
Pressure/leaking/narrowing of veins in the retina (caused by hyaline arteriolosclerosis)
What is malignant hypertension?
Abrupt, severe increase in BP (rare)
What are the effects of malignant hypertension in the kidney?
Hyperplastic arteriolosclerosis (onion skin)
Fibroid necrosis and thrombosis
(kidney)
What are some effects of malignant hypertension?
Retinopathy
Microangiopathic haemolytic anaemia
Encephalopathy (failure to autoregulate cerebral blood flow)
