Lec 16: Pathology of Hypertension

Question 1

How is hypertension defined?

Answer 1

raised pressure in any vascular bed

systolic >= 140 mm Hg, diastolic >= 90 mm Hg

Question 2

What are the conditions that cause normal variation in BP?

Answer 2

time of day (lowest in sleep), position (rises on standing up), exercise, exposure to cold and emotion

Question 3

What is essential hypertension?

Answer 3

form of hypertension with no identifiable cause, linked to genetics, lack of exercise, poor diet, and obesity

Question 4

What is secondary hypertension?

Answer 4

secondary to an underlying condition such as renal disease, alcohol misuse, endocrine disorder

Question 5

What are the determinants of Blood Pressure?

Answer 5

BP = CO x TPR
CO - volume of blood pumped by the heart per minute
TPR - pressure caused mainly by arterioles

Question 6

What are the determinants of stroke volume?

Answer 6

cardiac contractility, venous return (preload), afterload

Question 7

What conditions cause juxtaglomerular cells to release renin?

Answer 7

1. decreased arterial blood pressure
2. decreased sodium in ultrafiltrate
3. sympathetic stimulation

Question 8

What catalyzes the conversion of angiotensinogen to angiotensin I?

Answer 8

renin

Question 9

What are the characteristics of benign hypertension?

Answer 9

asymptomatic, BP rises slowly, affects heart and arteries of all sizes

Question 10

What are the characteristics of malignant hypertension?

Answer 10

diastolic BP > 130 mmHg,

retinal changes of bilateral flame-shaped hemorrhages and/or papilledema

Question 11

What are the manifestations of hypertension in the CVS?

Answer 11

1. hyperplastic arteriolosclerosis - markedly thickened arteriolar wall, narrowed lumen, stiffening of arteries (usually benign)
2. thickening of media (benign)
3. necrotizing arteriolitis (malignant)
4. left ventricular hypertrophy (both)

Question 12

What are the kidney manifestations of hypertension?

Answer 12

1. benign nephrosclerosis (benign)
2. swelling with focal hemorrhages (malignant)
3. fibrinoid necrosis and thrombosis in the renal arterials (malignant)
4. intimal proliferation in small arteries (malignant)
5. renal artery stenosis (malignant)

Question 13

What are the brain manifestations of hypertension?

Answer 13

1. cerebral infarction (malignant)
2. lacunar infarcts (malignant)
3. subarachnoid hemorrhage (malignant)

Question 14

What are some of the special features of cerebral blood vessels that make them vulnerable to hypertensive injury?

Answer 14

1. thin-walled
2. end arteries
3. congenital aneurysms

Question 15

What is the grading scale for hypertensive retinopathy?

Answer 15

Grade I - thickening of arterioles
Grade II - Focal arteriolar spasms, vein constriction
Grade III - flame hemorrhages, yellow exudates
Grade IV - papilloedema

Question 16

What is pheochromocytoma?

Answer 16

tumor of adrenal gland tissue that results in the secretion of too much catecholamines

Question 17

What is Conn’s syndrome?

Answer 17

primary hyperaldosteronism from an adrenal adenoma