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Kidneys > Pathology 3 - Hypertension > Flashcards

Pathology 3 - Hypertension Flashcards

1
Q

What proportion of Australians Australians aged 18 and over are estimated to have high blood pressure or are on medication for that condition?

A

30%

More common as you get older

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2
Q

What is currently considered to be hypertension?

A

Systemic blood pressure above 90 mmHg diastolic and/or 140 mmHg systolic is generally regarded as too high

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3
Q

What is the most common type of hypertension?

A

Primary or ess

ential: no specific identifiable cause (90-95%

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4
Q

What is secondary hypertension?

A

Secondary (5-10%): identifiable cause

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5
Q

What are benign and malignant hypertension?

A

Benign = rises gradually
Malignant = BP gets to very high levels and rises rapidly
(both have significant complications)

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6
Q

What damage does high BP cause to the large arteries?

A

Arteriosclerosis (loss of elasticity and hardening)
–Media: fragmentation of elastin, increased collagen
–Intima: increased collagen

The aorta is a bit dilated with age

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7
Q

What damage does high BP cause to the small and medium arteries?

A

–Media: fragmentation of elastin, increased collagen, sometimes calcification

–Intima: increased collagen -> thickening

Can get narrowing of the lumen and damage
- Hyaline arteriolosclerosis

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8
Q

What happens in hyaline arteriolosclerosis?

A

– Deposition of plasma proteins in wall
– Increased collagen
– Smooth muscle atrophy
– Arteriole wall becomes thickened by homogenous eosinophilic glassy material (‘hyaline’) and the lumen narrowed

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9
Q

What are the causes of primary or essential hypertension?

A

Multifactorial: genetic and lifestyle influences

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10
Q

What are some lifestyle factors which influence hypertension?

A
  • Amount of salt in diet
  • Alcohol intake
  • Levels of physical activity
  • Abdominal obesity and metabolic syndrome
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11
Q

What is the role of age, gender and race in hypertension?

A
  • Prevalence lower in premenopausal females than in age-matched males and in postmenopausal women
  • Higher in blacks
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12
Q

What is the suggested role of inflammation in hypertension?

A
  • Elevated circulating inflammatory molecules

* Cause or effect?

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13
Q

What is the relationship between renin levels and essential hypertension?

A

High and low plasma renin activity forms: possibly correlate with vasoconstrictor and volume dependent forms of HT

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14
Q

Pathogenesis of Systolic hypertension with wide pulse pressure?

A

Decreased compliance of aorta (arteriosclerosis). Age related changes –> loss of elasticity -> elevation of the systolic pressure and widening of the pulse pressure. If excessive -> isolated systolic hypertension

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15
Q

What are some causes of secondary hypertension?

A 
Renal
Endocrine
Vascular 
Medications
Other
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16
Q

What are the renal causes of hypertension?

A

Mechanisms include decreased capacity to excrete sodium, excessive renin secretion in relation to volume, excessive sympathetic activity

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17
Q

Does aortic atherosclerosis cause hypertension?

A

No

18
Q

When does atherosclerosis cause hypertension?

A

Renal atherosclerosis

19
Q

Why is hypertension important?

A

On its own it is asymptomatic but is causes a variety of other organs

20
Q

What is most likely to cause an aneurysm?

A

Weakening of the media

21
Q

Where does an aortic dissection take place?

A

Media

22
Q

Where does aortic dissection take place?

A

The ascending aorta

23
Q

What are some complications of aortic dissection?

A

Haemopericardium
Extension of dissection
Rupture

24
Q

What is a chronic aortic dissection?

A

Where blood re-enters the aorta

25
Q

What can concentric hypertrophy cause?

A

Impairing diastolic filling

Increasing the myocardial oxygen demand

Reducing the coronary perfusion pressure gradient (ischemia)

26
Q

Why is hypertension a risk factor for renal injury?

A

• Transmission of elevated pressures to glomeruli
-> sclerosis

• Hyaline arteriolosclserosis -> chronic ischaemia

27
Q

What does proteinuria measure?

A

Proteinuria is a marker of the severity of chronic kidney disease and is a predictor of its progression

28
Q

What is benign nephrosclerosis?

A

a

29
Q

What happens to athero-sclerotic plaque?

A

It can embolise

30
Q

What is the usual cuase of renal infarction?

A

Athero-embolism

31
Q

What is the most common cause of stroke?

A

Cerebral infarct

32
Q

What is a risk factor for cerebral infarct?

A

Hyaline arteriolosclerosis

33
Q

What are lacunar infarct?

A

Infarct (a couple of mm across caused by small vessels)

34
Q

What are berrry aneurysm?

A

Cause subarachnoid haemorrhage

35
Q

How does hyaline arterioloscerlosis affect the retina?

A

AV nipping, exudates, ischaemia, haemorrhages and other changes

36
Q

What are the consequences of long standing hypertension on the retina?

A

Can cause visual disturbances

37
Q

How doe we assess a patient for hypertension?

A

Complete history and physical examination to
– Confirm diagnosis: guidelines for measuring BP and confirming diagnosis
– Seek other cardiovascular risk factors and assess absolute cardiovascular risk (risk of a cardiovascular event occurring within the next 5 years)
– Seek secondary causes of HT
– Identify end-organ damage
– Seek comorbidities
– Determine the potential for intervention, including lifestyle modification

38
Q

What are lab tests for evaluation of hypertension?

A

–Diagnosis of potential secondary causes
–Evaluation of risk factors
–Detect end organ damage

39
Q

How is hypertension managed?

A 
details determined by absolute risk and presence of end organ damage 
–Treat any secondary cause 
–Lifestyle intervention: for all 
–Pharmacologic therapy 
–Follow-up
40
Q

What is Malignant hypertension or hypertensive emergency?

A
  • Syndrome associated with abrupt, severe increase in BP
  • May develop de novo in those with normal BP or in those with pre-existing essential HT
  • Uncommon
  • Full blown syndrome is a medical emergency
  • Complications related to changes in small arteries and arterioles
41
Q

What does Malignant hypertension cause?

A

Hyperplastic arteriolosclerosis
(hyperplasia of the media cells)

Fibrinoid necrosis and thrombosis

42
Q

What are the progressive effects of malignant hypertension?

A
  • Retinopathy (arteriolar spasm, hemorrhages, exudates, papilledema)
  • Deteriorating renal function
  • Microangiopathic hemolytic anemia
  • Encephalopathy: failure of autoregulation of cerebral blood flow, hyperperfusion and cerebral oedema

Kidneys (15 decks)

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