HypertensionHypertension

DR: Gehan MohamedDR: Gehan Mohamed

ArteriolosclerosisArteriolosclerosis(Hypertension)(Hypertension)

When we diagnose hypertension?When we diagnose hypertension?– When there is Persistent elevation of the blood pressure When there is Persistent elevation of the blood pressure

above 140/90 mmHg.above 140/90 mmHg.

– N.BN.B it is called malignant hypertension if Systolic blood it is called malignant hypertension if Systolic blood pressure >220 and diastolic >120mmHg with acute pressure >220 and diastolic >120mmHg with acute impairment of an organ system (e.g., central nervous system impairment of an organ system (e.g., central nervous system [CNS], cardiovascular, renal). [CNS], cardiovascular, renal).

What are symptoms of hypertension ?

1- About 33% of people are asymptomatic. For this reason, it is advisable to undergo periodic blood pressure screenings.

2- symptomatic specially in Extremely high blood pressure may lead to : -

- headaches , - Fatigue ,Dizziness ,confusion

- ,Nausea ,- Problems with vision - Chest pains ,-Breathing problems ,- Irregular

heartbeat - Blood in the urine

investigationsinvestigations Hypertension can be measured by a device

called a sphygmomanometer - the device with the arm cuff.

tests such as:

- electrocardiograms (ECG)

- echocardiograms will be used in order to measure electrical activity of the heart and to assess the physical structure of the heart.

pathophysiologypathophysiology With every heart beat, the heart pumps blood

through the arteries to the rest of the body. Blood pressure is the force of blood that is

pushing up against the walls of the blood vessels.

If the resistance exerted by the blood vessels is too high, the heart has to work harder to pump, and this could lead to organ damage.

What are the factors which What are the factors which determine hypertensiondetermine hypertension

Blood Presure = Cardiac Output x Prepheral Blood Presure = Cardiac Output x Prepheral ResistanceResistance

So Blood pressure is determined by :So Blood pressure is determined by :

- the amount of blood that your heart pumps - the amount of blood that your heart pumps

- the amount of resistance to blood flow in your - the amount of resistance to blood flow in your arteries. arteries.

The more blood your heart pumps and the The more blood your heart pumps and the

narrower your arteries, the higher your blood narrower your arteries, the higher your blood pressure. pressure.

Mechanism of hypertensionMechanism of hypertension

ReninReninAngiotensinAngiotensinAldosteroneAldosterone If the perfusion of the juxtaglomerular apparatus in If the perfusion of the juxtaglomerular apparatus in

the kidneys decreases, then the juxtaglomerular the kidneys decreases, then the juxtaglomerular cells release the enzyme renin. cells release the enzyme renin.

Renin cleaves an inactive peptide called Renin cleaves an inactive peptide called angiotensinogen, converting it into angiotensin I. angiotensinogen, converting it into angiotensin I.

Angiotensin I is then converted to angiotensin II by Angiotensin I is then converted to angiotensin II by angiotensin-converting enzyme (ACE). angiotensin-converting enzyme (ACE).

Angiotensin II is the major bioactive product of the Angiotensin II is the major bioactive product of the renin-angiotensin system. renin-angiotensin system.

Angiotensin II causes :Angiotensin II causes :A- vasoconstriction of the blood vesselsA- vasoconstriction of the blood vesselsB- increase aldosterone secretion causing fluid B- increase aldosterone secretion causing fluid

retentionretention

risk factors for hypertensionrisk factors for hypertension 1- 1- Age & sex Age & sex :: The risk of hypertension The risk of hypertension

increases as you age due to atherosclerosis, increases as you age due to atherosclerosis, also more common in men. Women are more also more common in men. Women are more

likely to develop high blood pressure after likely to develop high blood pressure after menopause.menopause.

2- 2- RaceRace.. Hypertension more among blacks. Hypertension more among blacks. 3- Certain 3- Certain chronic conditions chronic conditions as high as high

cholesterol, diabetes, kidney diseasecholesterol, diabetes, kidney disease 4- Sometimes 4- Sometimes pregnancypregnancy contributes to high contributes to high

blood pressure. blood pressure.

risk factors for hypertensionrisk factors for hypertension

5-Family history5-Family history.. High blood pressure tends High blood pressure tends to run in families.to run in families.

6- 6- Being overweight or obeseBeing overweight or obese.. The more The more you weigh, the more blood you need to you weigh, the more blood you need to supply oxygen and nutrients to your tissues. supply oxygen and nutrients to your tissues. As the volume of blood circulated through As the volume of blood circulated through your blood vessels increases, so does the your blood vessels increases, so does the pressure on your artery walls.pressure on your artery walls.

risk factors for hypertensionrisk factors for hypertension

7- 7- physically inactive physically inactive tend to have higher tend to have higher heart rates. The higher your heart rate, the heart rates. The higher your heart rate, the harder your heart must work with each harder your heart must work with each contraction — and the stronger the force on contraction — and the stronger the force on your arteries. your arteries.

Lack of physical activity also increases the Lack of physical activity also increases the risk of being overweight.risk of being overweight.

risk factors for hypertensionrisk factors for hypertension

8-Using tobacco8-Using tobacco.. the chemicals in tobacco the chemicals in tobacco can damage the lining of your artery walls. can damage the lining of your artery walls. This can cause your arteries to narrow, This can cause your arteries to narrow, increasing your blood pressure. increasing your blood pressure.

9-Too much salt (sodium9-Too much salt (sodium) in your diet ) in your diet can can cause your body to retain fluid, which cause your body to retain fluid, which increases blood pressure.increases blood pressure.

risk factors for hypertensionrisk factors for hypertension

10-Too little potassium 10-Too little potassium in your diet.in your diet. If you If you don't get enough potassium in your diet or don't get enough potassium in your diet or retain enough potassium, you may retain enough potassium, you may accumulate too much sodium in your blood.accumulate too much sodium in your blood.

risk factors for hypertensionrisk factors for hypertension

11-Drinking too much alcohol11-Drinking too much alcohol.. Over time, can Over time, can damage your heart. can also temporarily raise damage your heart. can also temporarily raise your blood pressure, as it may cause your body your blood pressure, as it may cause your body to release hormones that increase your blood to release hormones that increase your blood flow and heart rate.flow and heart rate.

12- Stress12- Stress.. High levels of stress can lead to a High levels of stress can lead to a temporary increase in blood pressure. temporary increase in blood pressure.

Types of hypertensionTypes of hypertension

Hypertension is divided according to presence of known Hypertension is divided according to presence of known etiology or no into two categories:etiology or no into two categories:

1- 1- Primary (essential) Primary (essential) hypertension hypertension (95%) : (95%) : OF UNKNOWN OF UNKNOWN cause ,tends to develop gradually over many years. cause ,tends to develop gradually over many years.

2- Secondary hypertension (5%2- Secondary hypertension (5%) : secondary to another ) : secondary to another diseases diseases

this type of hypertension tends to appear suddenly and cause this type of hypertension tends to appear suddenly and cause higher blood pressure than does primary hypertension.higher blood pressure than does primary hypertension.

–Both primary or secondary hypertension can be Both primary or secondary hypertension can be BenignBenign

Or Malignant according to the degree in rise of BP so Or Malignant according to the degree in rise of BP so

If BP exceed 220/120 it is called malignant hypertension.If BP exceed 220/120 it is called malignant hypertension.

Causes of SecondaryCauses of Secondaryhypertensionhypertension

Renal diseases Renal diseases causes release of renincauses release of renin– Acute and chronic glomerulonephritisAcute and chronic glomerulonephritis– Chronic pyelonephritisChronic pyelonephritis– HydronephrosisHydronephrosis– Polycystic kidneyPolycystic kidney– Renal artery stenosisRenal artery stenosis

Endocrine diseasesEndocrine diseases– Pheochromocytoma(tumor arise from adrenal medulla Pheochromocytoma(tumor arise from adrenal medulla

which secret excess epinephrine which is which secret excess epinephrine which is vasoconstrictor)vasoconstrictor)

– Cushing syndromes (in it increase secretion of Cushing syndromes (in it increase secretion of glucocorticoids)glucocorticoids)

Cardiovascular diseasesCardiovascular diseases– Co-arctation of aorta : i.e congenital narrowing of aorta Co-arctation of aorta : i.e congenital narrowing of aorta

which resist entrance of blood inside it .which resist entrance of blood inside it .

high blood pressure in childrenhigh blood pressure in children

For some children, high blood pressure is For some children, high blood pressure is caused by problems with :caused by problems with :

-the kidneys or heart (secondary -the kidneys or heart (secondary hypertension).hypertension).

- poor lifestyle habits such as an unhealthy - poor lifestyle habits such as an unhealthy diet and lack of exercise contribute to high diet and lack of exercise contribute to high blood pressure. blood pressure.

Differences between benign and Differences between benign and malignant hypertensionmalignant hypertension

Benign essential Benign essential hypertensionhypertension

Malignant essential Malignant essential hypertensionhypertension

1-1-Vascular Vascular lesionslesions

HyalinosisHyalinosisElastosis Elastosis

HyalnosisHyalnosisFibrinoid Necrosis of Fibrinoid Necrosis of blood vessel media blood vessel media

2-Renal 2-Renal lesionslesions

Primary contracted Primary contracted small kidneysmall kidney

Sub-capsular and Sub-capsular and interstitial interstitial hemorrhage hemorrhage

3-3-Cardiac Cardiac lesionslesions

Hypertrophy of the Hypertrophy of the left ventricleleft ventricle

Slight hypertrophy of Slight hypertrophy of the left ventriclethe left ventricle

4-Retinal lesions4-Retinal lesionsRetinal exudateRetinal exudateRetinal Retinal hemorrhagehemorrhage

Retinal exudateRetinal exudateRetinal Retinal hemorrhagehemorrhage

5-Cerebral 5-Cerebral lesionslesions

MicroaneurysmMicroaneurysmCerebral Cerebral hemorrhagehemorrhage

Massive Massive cerebral cerebral hemorrhagehemorrhage

6-Cause of 6-Cause of deathdeath

Left sided HF Left sided HF (60%)(60%)Cerbrel hge Cerbrel hge (30%)(30%)Renal failure Renal failure (10%)(10%)

Renal failureRenal failure (95%)(95%)Cerebral hgeCerebral hgeLeft sided HFLeft sided HF

HHIISSTTOOPPAATTHHOOLLOOGGYY of ESSENTIAL HYPERTENSION: showing of ESSENTIAL HYPERTENSION: showing thickening of arterial wall due to hyaline change of collagen fibers thickening of arterial wall due to hyaline change of collagen fibers

Complications of hypertensionComplications of hypertension

1-The higher your blood pressure and the 1-The higher your blood pressure and the longer it goes uncontrolled, the greater the longer it goes uncontrolled, the greater the damage to the damage to the wall wall of the of the blood vesselsblood vessels. .

2- Weakened and narrowed blood vessels 2- Weakened and narrowed blood vessels in your in your kidneyskidneys.. This can prevent these This can prevent these organs from functioning normally.organs from functioning normally.

3-Thickened, narrowed or torn blood 3-Thickened, narrowed or torn blood vessels in the vessels in the eyeseyes.. This can result in vision This can result in vision loss.loss.

Complications of hypertension (cont.)Complications of hypertension (cont.)

4- 4- HeartHeart attackattack or stroke. or stroke. High blood High blood pressure can cause atherosclerosis, which can pressure can cause atherosclerosis, which can lead to a heart attack, stroke.lead to a heart attack, stroke.

5- 5- Heart failureHeart failure.. To pump blood against the To pump blood against the higher pressure in your vessels, your heart higher pressure in your vessels, your heart muscle thickens. Eventually, the thickened muscle thickens. Eventually, the thickened muscle may have a hard time pumping enough muscle may have a hard time pumping enough blood to meet your body's needs, which can blood to meet your body's needs, which can lead to heart failure.lead to heart failure.

Complications of hypertension Complications of hypertension (cont.)(cont.)

6- 6- AneurysmAneurysm:: Increased blood pressure Increased blood pressure can cause your blood vessels to weaken can cause your blood vessels to weaken and bulge, forming an aneurysm. If an and bulge, forming an aneurysm. If an aneurysm ruptures, it can be life-aneurysm ruptures, it can be life-threatening.threatening.