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Hypertension

Hypertension. Ali Al Khader, M.D. Faculty of Medicine Al-Balqa’ Applied University Email: ali.alkhader@bau.edu.jo. Introduction. >140/90 Besides increasing the risk of stroke and atherosclerotic coronary heart disease, hypertension can lead to:

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Hypertension

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  1. Hypertension Ali Al Khader, M.D. Faculty of Medicine Al-Balqa’ Applied University Email: ali.alkhader@bau.edu.jo

  2. Introduction • >140/90 • Besides increasing the risk of stroke and atherosclerotic coronary heart disease, hypertension can lead to: • cardiac hypertrophy and heart failure (hypertensive heart disease) • aortic dissection • multi-infarct dementia • renal failure

  3. Introduction, cont’d • Higher in African Americans • Increased risk with age • Without treatment: 50% die (IHD or CHF), 1/3 will have stroke

  4. Malignant HTN • 5% • Die within 1-2 years • >200/120 • Renal failure • Retinal hemorrhages • Most commonly superimposed on benign HTN

  5. Causes Elsevier. Kumar et al. Robbins basic pathology 9th

  6. Causes, cont’d

  7. Mechanisms • Reduced renal sodium excretion • Increased vascular resistance may stem from vasoconstriction or structural changes in vessel walls • Genetic factors …linked to specific angiotensinogen polymorphisms and angiotensin II receptor variants • Environmental factors, such as stress, obesity, smoking, physical inactivity, and high levels of salt consumption

  8. Small vessel changes Layers of SM and reduplicated BM also in old age and DM Elsevier. Kumar et al. Robbins basic pathology 9th…modified

  9. Cardiac complications of systemic HTN • Adaptation (hypertrophy) dilation CHF…and even shock/death • Criteria for diagnosing hypertensive heart disease: • left ventricular hypertrophy in the absence of other cardiovascular pathology (e.g., valvular stenosis) (2) a history or pathologic evidence of hypertension

  10. Functional and structural changes • Normal weight: 320-360 g • May reach 500 g • The hypertrophy is concentric • Initially no dilation • Impaired diastolic filling • Atrial dilation • Microscopically: hypertrophic myocytes and enlarged hyperchromatic nuclei (boxcar nuclei)

  11. Pulmonary Hypertensive HeartDisease—CorPulmonale • Right ventricular hypertrophy and dilation …caused by: pulmonary hypertension attributable to primary disorders of the lung parenchyma or pulmonary vasculature • Can be acute like that due to PE or chronic with chronic lung diseases • The chronic pulmonary HTN is associated with atherosclerosis of pulmonary vasculature

  12. Disorders predisposing to corpulmonale Elsevier. Kumar et al. Robbins basic pathology 9th

  13. Thank You

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