Systemic Hypertension Flashcards
Systemic Hypertension
Define
Persistent elevation of systolic and diastolic pressures in the systemic arteries.
Clinic: 140/90 rises slightly with age
Signs: Asymptomatic/ headache, dizziness, nosebleed/ target organ failure.
Aetiology
Primary
Idiopathic HPT usually familial & >40yrs
Hypothesis: high sodium in genetically predisposed individuals.
Genetic: RAA system, sympathetic nervous system & sodium homeostasis
Environmental: smoking, high sodium, high serum lipids, obesity, stress
Aetiology
Secondary
Causes
Renal Placental Hormonal Aortic Coartation Neurogenic
Secondary Hypertension
Renal pathophysiology
Lesions cause renal hypoperfusion -> activating release of Renin
Secondary Hypertension
Placental pathophysiology
Placental hypoperfusion
Immune related
Secondary Hypertension
Hormonal
Conn’s Syndrome
(hyperplasia/ adenoma of glomerulosa layer of the adrenal cortex producing aldosterone) -> increase serum sodium/ decreased protons
Cushing’s syndrome
(Bilateral adrenocortical hyperplasia) -> release cortisol secondary to excess ACTH
Congenital adrenal hyperplasia (Adrenogenital syndrome)
Acromegaly due to GH
Hyperthyroidism (Grave’s disease)
Secondary Hypertension
Aortic coarctation
Pre-stenotic Raised systolic BP -> non-pulsatile flow to the kidney ->Renal HPT
Secondary Hypertension
Neurogenic
Raised intracranial pressure -> reduced cranial blood flow-> psychogenic causes or polyneuritis
Complications
Heart
LV Hypertrophy-> LV dilation-> LV failure
Complications
Arteries
Benign HPT-> hyaline arteriolosclerosis in systemic arterioles-> intimal fibrosis, medial hypertrophy & hyalinization
Malignant HPT-> lesions in arterial intima & fibrinoid necrosis of the wall
Complications
Kidneys
Hypertensive nephrosclerosis -> chronic renal failure
Complications
Brain
Cerebral artery spasm-> Hypertensive encephalopathy