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Renal Revision > Systemic Hypertension > Flashcards

Systemic Hypertension Flashcards

1
Q

What are the major classifications of hypertension?

A

Primary/essential or secondary

Benign or malignant

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2
Q

What is the most common form of hypertension?

A

Primary (no specific identifiable cause)

Benign more common

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3
Q

What is the difference between benign and malignant hypertension?

A

Benign: rises over years, never gets very high
Malignant: very high, may develop rapidly

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4
Q

What changes occur to arteries with ge?

A

Arteriosclerosis

Hyaline arteriosclerosis

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5
Q

What is arteriosclerosis?

A

Fragmentation of elastin, increased collagen and sometimes calcification in media of arteries (including aorta)
Increased collagen in intima

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6
Q

What changes occur in hyaline arteriosclerosis?

A 
Deposition of plasma proteins in wall
Increased collagen
Smooth muscle atrophy
Arteriole wall thickened by homogenous eosinophilic material (hyaline)
Narrowed lumen
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7
Q

What kind of factors may contribute to risk of primary hypertension?

A 
Polygenic genetic influences
Lifestyle
Age
Gender
Race
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8
Q

List 4 important classifications of causes of secondary hypertension

A

Renal
Endocrine
Vascular
Medications

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9
Q

What renal conditions can cause secondary hypertension?

A

Diabetic glomerulosclerosis
Polycystic renal disease
CRF

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10
Q

How does renal disease cause secondary hypertension?

A

Decreased capacity to excrete Na+
Excessive renin secretion in relation to volume
Excessive sympathetic activity

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11
Q

What endocrine conditions can cause secondary hypertension?

A

Phaeochromocytoma
Pituitary adenoma producing ACTH
Adrenocortical adenoma producing cortisol or aldosterone

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12
Q

What vascular conditions can cause secondary hypertension?

A

Renal artery stenosis

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13
Q

What medications can cause secondary hypertension?

A

GCS

High dose oestrogens

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14
Q

What other conditions can cause secondary hypertension?

A

Hypercalcaemia

OSA

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15
Q

When does atherosclerosis cause hypertension?

A

Only if in renal artery (rare; chronic ischaemia of kidney leads to excess RAAS secretion)

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16
Q

What kind of changes occur in essential hypertension?

A 
Concentric LV hypertrophy
Atherosclerosis in large and medium sized arteries
Aortic dissection
Berry aneurysm
Hyaline arteriosclerosis
17
Q

Where does hyaline arteriosclerosis occur?

A

In arterioles

18
Q

What causes aortic aneurysm?

A

Weakening of the media, usually due to underlying atherosclerosis impinging on blood supply to the media

19
Q

Where does blood collect in aortic dissection?

A

Media (tear occurs between intima and media)

20
Q

What are 3 possible complications of aortic dissection?

A

Haemopericardium
Extension of dissection
Rupture

21
Q

What causes most regional MIs?

A

Atherosclerosis with thrombosis in coronary artery

22
Q

How can concentric hypertrophy of the LV cause HF?

A

Impairs diastolic filling
Increases myocardial O2 demand
Reduces coronary perfusion pressure gradient

23
Q

What macroscopic changes are seen in the kidney in benign nephrosclerosis?

A

Thinned cortex

Granular appearance

24
Q

What histological changes are seen in the kidney in benign nephrosclerosis?

A

Chronic inflammation
Increased interstitial CT (fibrosis, scarring)
Atrophic glomeruli and tubules
Hyaline arteriosclerosis

25
Q

What macroscopic changes occur in renal artery stenosis?

A

Atrophy (usually asymmetric)

26
Q

What causes lacunar infarcts?

A

Hyaline arteriosclerosis

27
Q

What retinal changes are caused by hypertension?

A 
AV nipping
Exudates
Ischaemia
Haemorrhages
N.B. Due to effect of hyaline arteriosclerosis
28
Q

What kind of haemorrhage does a berry aneurysm cause?

A

Subarachnoid

29
Q

What are the histological effects of malignant hypertension?

A

Hyperplastic arteriolosclerosis

Fibrinoid necrosis and thrombosis

30
Q

What are the pathological effects of malignant hypertension?

A

Retinopathy
Deteriorating renal function
Haemolytic anaemia
Encephalopathy (failure of autoregulation of cerebral blood flow)

Renal Revision (14 decks)

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