1
Q
Definition of hypertension
A
sustained BP of 140/90mmHG or above
2
Q
Causes of hypertension (2)
A
- Primary/Essential HTN (90-95%)
- idiopathic, multifactorial, complex
- influenced by envt (stress, smoking, obesity, inactivity, salt) - Secondary HTN (5-10%)
- Renal
- Endocrine
- Neurologic
- Aortic
- Labile
3
Q
Effects of hypertension (4)
A
- Blood vessels - arteriolosclerosis, accelerated atherosclerosis, aortic aneurysms
- Heart - hypertensive heart disease
- Kidneys - nephrosclerosis
- CNS - cerebral hemorrhage, cerebral thrombosis, hypertensive encephalopathy
4
Q
Definition of arteriolosclerosis
A
- hypertensive vascular disease
- degenerative changes (hyaline/proliferative thickening) in the walls of small arteries & arterioles
5
Q
Types of arteriolosclerosis (2)
A
- Hyaline arteriolosclerosis
2. Hyperplastic arteriolosclerosis
6
Q
Features of hyaline arteriolosclerosis
A
- present in benign HTN
- homogenous pink hyaline thickening + luminal narrowing
- due to plasma protein leakage across injured endothelial cells & increased smooth muscle cell matrix synthesis
7
Q
Features of hyperplastic arteriolosclerosis
A
- present in malignant HTN
- ‘onion-skin’ lesions (concentric laminated thickening + luminal narrowing)
- fibrinoid necrosis
8
Q
Pathogenesis of hypertensive heart disease (L sided - systemic & R sided - cor pulmonale)
A
- HTN - LV pressure overload - LV hypertrophy (increased wall thickness & stiffness) - impairs diastolic filling - LA dilation - LV failure
- LV failure leads to pulm venous HTN, chronic heart failure, sudden death
- Acute cor pulmonale: PE - RV dilation
- Chronic cor pulmonale: pulm HTN - RV pressure overload - RV hypertrophy & dilation - RV failure
9
Q
Features of malignant hypertension
A
- in 5% of hypertensive patients
- rapidly rising BP
- systolic >200mmHg, diastolic >120mmHg
- Clinical manifestations: renal failure, retinal hemorrhage, papilledema
