Hypertension

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Hypertension
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Diseases of arterias
C. Hypertensive Vascular Disease TYPES .
essential hypertension. About 90-95 of
hypertension is idiopathic and apparenly
primary, secondary 5-10 is to renal disease or
other causes About 5 of hypertensive persons
show a rapidly rising blood pressure,
which, if untreated, leads to death within 1 or 2
years malignant hypertension.
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Diseases of arterias
C. Hypertensive Vascular Disease One of the most
important risk factors coronary heart disease
and cerebrovascular accidents. cardiac
hypertrophy with heart failure, aortic
dissectin, renal failure.
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Diseases of arterias
C. Hypertensive Vascular Disease Morphology
hyaline arteriolosclerosis (in elderly patients,
more severe in patients with hypertesion and
diabetes, a homogenous, pink, hyaline thickening
of the walls of arterioles with narrowing of the
lumen) and hyperplastic arteriolosclerosis (in
patients with more severe elavation of blood
pressure, there is typical onion-skin, concentric
thickening of the walls of arterioles with
progressive narrowing of the lumens).
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Hypertension - Introduction

• Silent Killer painless late symptoms
• dizziness, headache and visual difficulties
• 15- 20 of population
• lt35 aware
• Complications bring to diagnosis but late

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Classifying Blood Pressure Readings

• Category Systolic
  Diastolic
• Normal lt120
  lt 80
• Prehypertension 120-139 80-89
• Stage 1 Hyper 140-159 90-99
• Stage 2 Hyper lt 160 gt
  100
• Malignant Hyper gt 210 gt 120
  

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Types of Hypertension

• Primary or Essential Hypertension (90-95)
• Secondary Hypertension (5-10)
• SUBTYPES
• Benign
• Malignant

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Factors Influencing Essential Hypertension

• Genetic
• Environmental

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Factors Influencing Essential Hypertension

• Genetic Genes
• Aldosteron metabolism 17 alpha hydroxylase
• Plymorphism- Renin agiotensen loci, recepter
• Liddle syndrome- mut protiens( Na channels)
• Mendalian rare
• Susceptibility genes unknown
• Genes- Na load, sooth muscles constriction,
  growth, pressor subs level

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Risk Factors

• Major
• diet and hyperlipidemia, hypertension, cigarette
  smoking, diabetes
• Minor
• obesity, lack of exercise, age, male, family
  history, stress, BCP, High CHO intake,
  hyperhomocysteinemia

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ENVIRONMENTAL FACTORS
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Table 11-3. Types and Causes of Hypertension

• Essential Hypertension
• Secondary Hypertension
• Renal
• Endocrine
• Cardio Vascular
• Neurologic

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Pathogenesis- Essential Hypertension

• ? Pathogenesis - Multifactorial
• Exact not known
• Various Hypotheses

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Control of Blood Pressure
Humoral Factors
Vasoconstrictors Angiotensin II Catecholamines
Vasodilators Pg Kinins
Blood Volume Na, Aldosterone
Cardiac Factors Rate Contract..
Local Factors pH, Hypoxia

• Neural Factors
• Adrenergic Cons
• ß Adrenergic - Dil

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MECHANISM OF ESSENTIAL HYPERTENSION
Homeostasis
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SECONDARY HYPERTENSION -CAUSES
Endocrine Renal diseases
Coarctation of aorta
Drugs Alcohol Pregnancy (pre eclampsia)

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ENDOCRINE CAUSES
High BP
Hyperaldosteronism
Cushing Syndrome
Pheochromocytoma
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ATHEROMA
COARCTATION OF AORTA
VASCULAR CAUSES
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RENAL DISEASES
Renal Artery stenosis
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Pathogenesis of Renovascular HTN
?GFR
Renin by JGA
Angiotensin II
Aldosterone
Vasoconstriction ? P. Resistance
Sodium Retention ?Blood Volume
Hypertension
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Target Organ Damage

• Blood Vessels
• Heart
• Kidney
• Eyes
• Brain

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Hyperplastic Arteriolosclerosis
Narrow Lumen
Onion Skin Thickening Of arterioles.
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Hyaline Arteriolosclerosis
Hyaline deposition
Narrow Lumen
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BLOOD VESSELS
A T H E R O MA
AORTIC DISSECTION
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Heart Attack- Myocardial Infarction
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Left Ventricular Hypertrophy
Left Ventricular Hypertrophy
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Subarachnoid Haemorrhage
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Cerebral Infarction - Stroke
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Renal Artery stenosis -
Atrophy
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Benign Nephrosclerosis
Leathery Granularity due to minute scarring
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Hypertensive Retinopathy
Hemorrhages (Flame shape)
Papilloedema
Narrowing of arterioles
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HYPERTENSION INVESTIGATION OF ALL PATIENTS

• Urinalysis for blood protein and glucose
• Blood urea electrolytes and creatinine
  Hypokalaemic alkalosis may indicate primary
  hyperaldosteronism but is usually due to diuretic
  therapy
• Blood glucose
• Serum total and high-density lipoprotein (HDL)
  cholesterol
• 12-lead ECG (left ventricular hypertrophy,
  coronary artery disease)

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ANEURYSM

• DEFINITION
• It is localized, permanent, abnormal dilatation
  of blood vessels that occurs mostly in the aorta
  or the heart

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ANEURYSM

• DEFINITION
• TYPES
• ETIOLOGYcongenital/ aquired
• MACROSCOPIC saccular/ fusiform
• TRUE OR FALSE

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ANEURYSM (Contd)

• CAUSES congenital
• BERRY ANEURYSM

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T Y P E S S I T E S OF A N E U R Y S M S
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ANEURYSM (Contd)

• CAUSES Aquired
• INFECTIONS (MYCOTIC)
• SYPHILIS TERTIARY- endarteritis of vasavasorum
• media injury, aortic valve annulusl
• TRAUMA
• ATHEROSCLEROSIS
• CYSTIC MEDIAL DEGENERATION
• IMMUNOLOGIC
• SUPPURATIVE PROCESS
• SEPTIC EMBOLI

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ANEURYSM

• DEFINITION
• TYPE
• MACROSCOPIC
• Saccular
• Portion of the wall,
• thrombus,
• 5- 20 cm
• Fusiform cicumferential
• 20 cm

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ANEURYSM

• T
• TRUE intact vessel wall(thinned)
• At rosclerosis
• Syphilis
• Congenital
• Ventricular aneurysm
• FALSE Ventricular rupture
• Hematoma extra vascular
• Arterial dissection

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Aneurysms

• Abdominal aorta frequently affected
• Natural history is to rupture
• Ischemic intima and media?
• Male caucasians
• Early detection

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ANEURYSM (Contd)

• PATHOGENESIS
• (1)QUALITY OF CT
• (2) IMBALANCE OF DEGRADATION AND SYN
• OF COLLAGEN
• (3) SMOTH MUSCLE AND ECM LOSS(OTHER
• THAN COLLAGEN)

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ANEURYSM (Contd)

• PATHOGENESIS
• (1) QUALITY OF CT
• Marfans syndrome fibrillin- TGF-b
• Loeys Dietz synd TGF-b
• Ehlars Danlos syn collagen III
• Vit C def

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ANEURYSM (Contd)

• PATHOGENESIS
• (2) IMBALANCE OF DEGRADATION AND SYN
• OF COLLAGEN
• Inflammatory infiltrate -MMP-macrophages
• atheromatous plaque and vasculitis
• TIMMP
  dec
• Genetic predisposition- polymorph ism in
• MMP/
  TIMMP

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ANEURYSM (Contd)

• PATHOGENESIS
• (3) SMOTH MUSCLE AND ECM LOSS(OTHER
• THAN COLLAGEN) Inappropriate syn
• ischemia- degeneration of media,
• increased syn of glycosaminoglycan
• Atherosclerosis
• Hypertention
• ath

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ABDOMINAL AORTIC ANEURYSM

• gt 50 YEARS, MALE
• BELOW RENAL ARTERIES AND ABOVE BIFURCATION OF
  AORTA
• ATHEROSCLEROSIS plahin thin media, mural
  thrombi
• MYCOTIC- Salmonella destroys media,
• HYPERTENSION
• FAMILIAL
• CONNECTIVE TISSUE COMPONENT DEFECT
• METALLOPROTEINASES (MMPs)

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COURSE OF DISEASE

• RUPTURE HAEMORRHAGE
• OCCLUSION OF BRANCH VESSELS renal, ilial,
  meseteric
• EMBOLISATION
• COMPRESSION OF NEARBY STRUCTURES
• PULSATING MASS

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COURSE OF DISEASE

• RUPTURE HAEMORRHAGE
• Nil-less 4 cm
• 1 - 4-5 cm
• 11- 5-6 cm
• 25- more 6 cm
• Expands .2-.3 cm/ yr

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TREATMENT OF DISEASE

• RUPTURE HAEMORRHAGE
• 5cn or more-
• aggreorssive anti hypertensive
• surgery
• stents
• Mortality Timely surgery-5
• Emergency surgery 50

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THORACIC AORTIC ANEURYSM

• CAUSES
• MARFANS SYN
• LOEYS DIETZ SYN
• HYPERTENTION
• TERTIARY SYPHILIS
• COMPLICATIONS
• RESPIRATORY DISTRESS
• SWALLOWING DIFF
• RUPTURE-CORONARIES

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THORACIC AORTIC ANEURYSM

• SITE
• TEAR TRANSVERS OR OBLIQUE10 CM AORTIC VALVES
• 1-5 CM LONG
• MIDDLE AND OUTER 1/3

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SYPHILITIC ANEURYSM

• TERTIARY STAGE
• THORACIC AORTA
• OBLITERATIVE END ARTERITIS OF VASA VASORUM
• MEDIAL DESTRUCTION DUE TO ISCHAEMIA
• TREE BARKING
• CAR BOVINUM
• COMPRESSION EFFECTS

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DeBakey Classification
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Dissection