HT Patho

Question 1

What is Systemic hypertension

Answer 1

chronic condition of elevated blood pressure in the
arteries which requiring more cardiac work than normal
to push the blood through the blood vessels.

Question 2

Normal blood pressure at rest

Answer 2

Normal blood pressure at rest is:
100-139 mmHg systolic .اقل من 140
70-89 mmHg diastolic.اقل من 90
High blood pressure is considered if being persistent at =>140/90

Question 3

Classification
I) According to Measurements

Answer 3

Optimal:less than 120/80
Stage 1 : اول مايدخل ال 140/90
Stage2: اول مايدخل ال160/100
Stage3: ول مايدخل ال180/110
Isolated systolic. نورمال diastolic
Grade1: ول مايدخل ال140
Grade2: ول مايدخل ال160

Question 4

II- According to Etiology

Answer 4

1.Primary (Essential) hypertension (90%):
No obvious underlying cause.
2.Secondary hypertension (10%):
Caused by diseases in the kidneys, cardiovascular
(heart & arteries) or endocrine D

Question 5

1ry HT

Answer 5

Unknown underlying cause
Risk factors:
1-aging
2-genetic
3-environmental:
.early life
.adult life style

Question 6

2ry HP (10%)

Answer 6

This type is 2ry to pre-existing diseases such as:
1- Renal diseases (the commonest)
2- Endocrine diseases
3- Cardiovascular diseases
4- Cerebral diseases
5- Drugs: Corticosteroids ,Contraceptive pills.

Question 7

Pathogenesis

Answer 7

Increased peripheral resistance occurs in hypertension due to the following mechanisms:
1- Intra-renal renin secretion
2- Sympathetic overtone
3- Endothelial dysfunction & vascular inflammation ->vascular
damage

Question 8

Pathophysiology

Answer 8

Bp=COP*TPR
Pathogenic mechanisms involve:
- Increased CO
- Increased TPR
- Both
most cases of hypertension:
Co normal but ↑ TPR
Seen in primary hypertension ,renal disease.
Sometimes ↑ co and normal TPR= isolated systolic HT
in older patients due to arterial stiffening.

Question 9

Clinical Features of Systemic Hypertension

Answer 9

• Most people with hypertension don’t feel any symptoms.
• People with very high blood pressure “stage 3”
  symptoms including:
• severe headaches - dizziness - Confusion - buzzing in the ears
• chest pain - difficulty breathing - abnormal heart rhythm
• Nausea - vomiting
• Anxiety - blurred vision
• nosebleeds

Question 10

(according to the onset & course of the disease)

Answer 10

Benign (90%)

Malignant (10%)

Question 11

Complications of HT

Answer 11

I. CNS
2.Eyes: Glaucoma
3. CVS: MI; Unstable & Stable angina , Heart failure.
4. Kidneys: Chronic renal failure.

Question 12

Pulmonary Hypertension

Answer 12

a mean pulmonary arterial pressure greater than 20 mm
Hg at rest
or greater than 30 mm Hg during exercise

Question 13

Pathology of Pulmonary Hypertension

Answer 13

Histopathological Manifestations:

1.PAH:
A. Medial hypertrophy & cellular intimal thickening
B. Fibrin thrombi in glomoid plexiform lesion
2. PH due to Left Heart Disease:
A. Medial hypertrophy
with intimal and adventitial proliferation of a small pulmonary “artery”.and “vein”

C. Recanalyzed fibrotic thrombus in arterioles

Question 14

Complications of pulmonary hypertension

Answer 14

• Right-sided heart failure (cor pulmonale): The most significant
complication, leading to fluid retention, edema, and ascites.