Hypertension

Terms in this set (27)

LV hypertrophy
increased heart weight & wall thickness, cardiomyocyte hypertrophy (increased cell diameters, large hyperchromic and rectangular "boxcar" nucleus
-advanced stage: interstitial fibrosis, slowly --> heart failure
normal BP
<120 and <80
pre HTN
120-139 and 80-89
HTN stage I
140-159 and 90-99
HTN stage II
> or = 160 and > or = 100
essential HTN
90% of HTN
-no single cause
secondary HTN
~10% of HTN
-renal dz: acute glomerulonephritis, polycystic kidney dz, chronic renal dz/failure
-endo dz: cushing's, primary aldosteronism, pheochromocytoma, influence of exogenous hormones (glucocorticoids, estrogens)
-vascular dz: renal a stenosis, polyarteritis nodosa, coarctation of aorta
etiology of essential HTN
increased symp tone, abnormal Na metabolism, excessive Na intake, stiffness of aorta and other large vessels in young and senior adults, endothelial cell dysfx, inflammation of arteriolar wall
vascular pathology of HTN
-HYALINE ARTERIOLOSCLEROSIS
-eye: mild hypertensive retinopathy (arteriolar narrowing & arterio-venous nicking
-visceral path: target organ damage
-heart: hypertensive heart dz (LV hypertrophy & heart failure)
-kidneys: hypertensive renal dz (hypertensive/benign nephrosclerosis)
-brain: stroke (cerebral infarct & hemorrhage)
mechanism of vascular injury in benign HTN
BP elevation, hemodynamic stress, endothelial injury, increased permeability, transudation and accumulation of plasma proteins in arteriolar wall, hyaline arteriolosclerosis
hyaline arteriolosclerosis
a hallmark of benign HTN, can also be seen in healthy normotensive adults and pts w/ DM
-arteriolar wall thickening, accumulation of pink and homogenous (hyaline) material w/ lumen narrowing and loss of underlying wall structure
hypertensive nephrosclerosis
same as benign nephrosclerosis?
-morph: hyaline arteriosclerosis, glomerular sclerosis, hyalinization, atrophy
-advanced: small, shrunken kidneys
-clinical: proteinuria --> chronic renal failure
hypertensive emergency
-only 1 or 2 out of a million/year
-criteria to Dx: sudden rise in BP > 180/120, acute target organ damage
-fundoscopy: mod-severe hypertensive retinopathy
moderate retinopathy
retinal hemorrhage, exudates, cotton wool spots
severe retinopathy
papilledema
causes of HTN emergency
exacerbation of benign HTN, usually withdrawal of short acting anti-HTN Rx (ie Clonidine, Propanolol, other B-blocker)
-other causes: sympathomimetics (cocaine, amphetamine), pheochromocytoma, pre-eclampsia
acute brain damage in HTN emergency
stroke: lacunar infarct, intracerebral & subarachnoid hemorrhage, HTN encephalopathy
acute heart, BV damage in HTN emergency
acute coronary syndrome, acute L heart failure, aortic dissection
kidneys
malignant nephrosclerosis, syn: acute hypertensive nephrosclerosis
fibrinoid necrosis
aka "necrotizing arteriolitis"
-presents as fibrin containing conglomerate of necrotic tissue and plasma proteins
-indicates malignant HTN
hyperplastic arteriolosclerosis
kidney, PAS +
malignant (acute hypertensive) nephrosclerosis
arteriolar & glomerular fibrinoid necrosis, hyperplastic arteriolosclerosis, microinfarctions, and microhemorrhages ("flea bitten kidney"), w/o Tx --> ARF
hypertensive encephalopathy
high BP --> dilation of cerebral arterioles --> increased permeability --> cerebral edema --> increased intracranial P
-no focal brain lesions, ie not the same as brain infarct or hemorrhage
-can progress to coma/death
hypertensive urgency
severe BP elevation (>180/120) w/o acute target organ damage
-syn: severe asymptomatic HTN
-fund: moderate hypertensive retinopathy (NO papilledema)
-NOT a hypertensive emergency, requires diff management
hypertensive urgency
accelerated HTN, less severe then hypertensive emergency
most common type of HTN:
essential/primary chronic/benign HTN --> essential HTN
-ie no single cause and is benign or chronic
major manifestation of HTN?
high BP
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