Hypertension

Question 1

Define Hypertension

Answer 1

Persistent elevation of resting blood pressure above 140/90

Question 2

theories of pathogenesis of essential/primary hypertension

Answer 2

• decrease Na+ excreton/ increase Na+ intake —> increase blood volume —> increase cardiac output (systolic BP)
• Hypersensitivity to Catecholamines –> VC –> increase peripheral resistance (diastolic)
• Genetic: Variation in receptors for Angiotensin II
• Environmental (stress, obesity, increase salt intake)

Question 3

Causes of Secondary Hypertension

Answer 3

REV:
Renal:
* Renal Artery stenosis
* Polycystic kidney
* Chronic Pyelonephritis
* Acute/chronic glomerulonephritis

Endocrinal:
* Hyperthyroidism
* Exogenous corticosteroids
* Cushing’s disease
* Hyperaldosteronism
* Pheochromocytoma

Vascular:
Coarctaton of Aorta

Question 4

explain mechanism of Renal hypertension

Answer 4

1. Juxatglomerular cells secrete Renin
2. Renin converts Angiotensingen into angiotensin
3. ACE converts Angiotensin to Angiotensin II
4. Angiotensin II increase BP by:
   * VC —> increase peripheral resistance (increase diastolic)
   * facilitate Aldosterone secretion —> increase Na+ reabsorption —> increase water reabsorption —> Increase blood volume & Cardiac Output (Systolic)

Question 5

Enumerate diseases linked to Benign Hypertension

Answer 5

Vascular diseases:
* Hyaline Arteriosclerosis
* Fibroplastic Hyperplasia (elastosis)

Cardiac diseases:
* Concentric hypertrophy of left ventricle
* Ischemic Heart disease
* Angina pectoris
* Heart failure

Kidney:
* Benign Nephrosclerosis

others:
* Cerebral hemorrhage

Question 6

Arteries affected by hyaline Arteriosclerosis

Answer 6

small Arteries/ Arterioles

(in benign hypertension)

Question 7

Hyaline Arterosclerosis is due to:

Answer 7

endothelial damage caused by hemodynamic stress (originating from benign hypertension) & Leakage of plasma components into Intima layer

Question 8

Microscopic morphology of Hyaline Arteriosclerosis

Answer 8

• Homogneous pink thickening
• of Intima & Media
• with Narrowed lumen

Question 9

Fibroblastic hyperplasia affects what type of arteries

Answer 9

Large arteries

(in benign hypertension)

Question 10

Microscopic morphology of Fibroblastic hyperplasia

Answer 10

• Duplication (doubling in size) of internal elastic lamina
• Thickened media

Question 11

Explain why benign hypertension may cause Ischemic heart disease or angina pectoris

Answer 11

• due to concentric hypertrophy of left ventricle —> increase in O2 demands
• Acceleration of Coronary Atherosclerosis

Question 12

Morphology of Benign Nephrosclerosis (primary contracted kidney)

Answer 12

• Symmetrical Atrophy of both kidneys
• surface has Diffuse fine granularity (leather grain)
• Hyaline arteriosclerosis of Afferent arterioles
• Fibroblastic hyperplasia of Large arteries of Kidney

Question 13

Effect of benign Nephrosclerosis on renal function

Answer 13

reduced GFR (with mild proteinuria)

due to hyaline arteriosclerosis of Afferent arterioles

Question 14

Diseases caused by Malignant hypertension

Answer 14

• Fibrinoid Necrosis
• Hyperplastic arteriosclerosis
• Malignant nephrosclerosis
• Acute renal failure
• Cerebral hemorrhage

Question 15

fibrinoid necrosis affects what type of Arteries

Answer 15

Small Arteries/Arterioles

(in malignant hypertension)

Question 16

Morphology of Fibrinoid necrosis

Answer 16

Eosinophilic granular materials in vascular wall

Question 17

Morphology of Hyperplastic Arteriosclerosis

Answer 17

hyperplasia of smooth muscle cells & connective tissue

Onion-skin appearance

Question 18

Morphology of Malignant Nephrosclerosis

Answer 18

• Normal size/ shrunken kidney
• Flea bitten kidney: Outer surface of kidney shows pin-pointed hemorrhages
• renal Arterioles: Fibrinoid necrosis
• Large renal Arteries: Hyperplastic Arterosclerosis
• Necrosis of glomeruli

Question 19

effect of Malignant or benign hypertension on the eye

Answer 19

• retinal hemorrhages
• exudates
• papilledoema