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Question 1

What are the pathological effects of hypertension on blood vessels

Answer 1

1. Accelerates atherosclerosis
2. Arteriolosclerosis (affects small arteries/arterioles)
3. Aneurysm formation

Question 2

what is arteriolosclerosis

Answer 2

hyaline/proliferative thickening of small arteries/arterioles

Question 3

What is hyaline arteriolosclerosis

Answer 3

Results from benign hypertension

Due to leakage of plasma proteins that is present in the walls of the arteriole, filling the subintimal layer → narrowing of vessel lumen

Question 4

What is hyperplastic arteriolosclerosis

Answer 4

A result of malignant hypertension

“Onion skin” concentric laminated thickening of smooth muscle & elastin fibres → fibrinoid necrosis of vessel wall → accelerated hypertensive events

Question 5

How does hypertension lead to aneurysm formation

Answer 5

Usually superimposed on atherosclerosis, which weakens the vessel walls

• High pressure of blood flow leads to dilation of the arterial lumen
• Increases risk of dissecting aneurysm → severe abdominal pain + bleeding into abdominal cavity

Question 6

What is accelerated/malignant hypertension

Answer 6

Refers to rapidly rising BP

• Systolic pressure >200mmHg
• Diastolic pressure >120mmHg

If left untreated, it will result in accelerated death

Question 7

What are the consequences of accelerated/malignant hypertension

Answer 7

Acute renal failure

Retinal haemorrhage + papilloedema (swollen optic disc)

Question 8

What is the definition of atherosclerosis

Answer 8

Degenerative & inflammatory disease affecting large and medium sized arteries causing thickening and loss of elasticity of the arterial walls

Question 9

What are the different atherosclerotic lesions

Answer 9

1. Early: fatty streak
2. Established: atheromatous plaque
3. Complicated: unstable plaques

Question 10

What are the clinical consequences of atherosclerosis

Answer 10

1. Vessel thickening → narrowed lumen → poor tissue perfusion → ischaemia (occurs when lumen is at least 70% occluded)
2. Loss of elasticity → predisposition to aneurysm formation, rupture and haemorrhage
3. Endothelial changes → predisposition to thrombus formation
   - - Subendothelial layer is pro-thrombotic - it attracts pro-clotting cells via cytokines to form clots