80. Pathogenesis of hypertension. Hypertensive vascular disease

Question 1

Hypertension definition

Answer 1

chronic medical condition in which the blood pressure in the arteries is elevated, requiring the heart to work harder than normal to circulate blood through vasculature

Question 2

Malignant hypertension

Answer 2

progresses rapidly

values: > 200/120 mmHg

can arise from benign hypertension or de-novo

prognosis: death in 1 year
complication: acute renal failure, retinal hemorrhage
morphology: hyperplastic arteriolosclerosis

Question 3

Essential (benign) hypertension

Answer 3

progresses slowly with age

values: >140/90 mmHg

asymptomatic usually

risk factors: multifactorial, genetic back ground: liddle syndrome (increased epithelial Na channels), stress, obesity, inactivity

increase risk for: stroke, atherosclerotic coronary heart disease, cardiac hypertrophy, aortic dissection

morphology: hyaline arteriolosclerosis

Question 4

Pathogenesis

Answer 4

regulation of blood pressure depends on regulation of cardiac output (affected by blood volume) and TPR (regulated by arterioles via neurological and hormonal inputs)

primary (idiopathic) hypertension (95% of cases)
- decreased sodium excretion from kidney –>
decreased CO
- increased vascular resistance –> increased TPR
- genetic factors: angiotensin 2 receptor variant,
polymorphism of RAS
- environmental: obesity, high salt consumption,
smoking, physical inactivity, stress

secondary hypertension: secondary to underlying cause
- renal artery stenosis: low blood flow to glomerulus –>
ras activated –> angiotensin 2:
1. vasoconstriction increasing TPR
2. aldosterone secrete –> Na resorption –>
increased volume and CO
- parenchymal kidney damage
- myocardial kidney resistance to ANP (that normally reduces blood pressure)
- endocrine disorder
1. cushing syndrome: excess cortisol enhances
vasoconstrictive effects of epinephrine
2. Conn syndrome (primary aldosteronism):
overproduction of aldosterone due to adrenal
adenoma

Question 5

Hypertensive vascular diseases

Answer 5

1. left ventricular hypertrophy: left ventricle trying to adapt to pressure overload -> concentric hypertrophy –> dilative
2. cerebrovascular stroke
3. renal damage (ex: nephrosclerosis)