1. Anatomy
    2. 1. Mediastinum
    2. The Heart Development
    3. Pericardium
    4. Features of the Heart
    5. Arterial Supply of Heart
    6. Venous Drainage of the Heart
    7. Conducting System of Heart
    8. Nervous System of Heart
    9. Foetal Circulation and Changes at Birth
    10. Microscopic Structure of Heart
    11. Arteries
    12. Arch of Aorta
    13. Descending Thoracic Artery
    14. Abdominal Aorta
    15. Subclavian Artery
    16. Axiallary Artery
    17. Internal Thoracic Artery
    18. Brachial Artery
    19. Radial Artery
    20. Ulnar Artery
    21. Palmar Arches
    22. External Iliac Artery
    23. Internal Iliac Artery
    24. Femoral Artery
    25. Popliteal Artery
    26. Posterior Tibial Artery
    27. Anterior Tibial Artery
    28. Dorsalis Pedia Artery
    29. Common Carotid Artery
    30. External Carotid Artery
    31. Internal Carotid Artery
    32. Veins
    33. Internal Jugular Vein
    34. External Jugular Vein
    35. Superior Venacava
    36. Inferior Venacava
    37. Brachiocephali vein
    38. Subclavian vein
    39. Axillary vein
    40. Cephalic vein
    41. Basilic vein
    42. Azygous vein
    43. Hemiazyous vein
    44. Accessory Hemiazyoug Vein
    45. Internal Hemiazygous Vein
    46. Internal Iliac Vein
    47. Femoral Vein
    48. Popliteal Vein
    49. Long Saphenous Vein
    50. Small or Short Saphenous Vein
    51. Hepato-portal System
    52. Lymphatic System
    53. Spleen
    54. Thymus
    55. Thoracic duct
  2. Pharmacology
    3. 56. Congestive Heart Failure
    57. Therapy of Arrhythmiasis
    58. Angina pectoris
    59. Therapy of Hypertension
    60. Therapy of Shock
    61. Haemostatic Agents
    62. Therapy of Thromboembolic Disorder
    63. Thrombolytic or Fibrinolytics
    64. Antifibrinolytics
    65. Antiplatelet Drugs
    66. Therapy of Iron Deficiency Anemia
    67. Therapy of Megaloblastic Anaemia
    68. Hypolipidemic Drugs and Plasma Expanders
  3. Physiology
    4. 69. Properties of Myocardial Cells
    70. Heart - A Mechanical Pump
    71. Cardiac Cycle
    72. Electrocardiogram (ECG)
    73. Cardiac Output (CO)
    74. Haemodynamics of Circulation
    75. Heart Sounds
    76. Arterial Pulse
    77. Blood pressure
    78. Regional circulation
    79. Cardiovascular chanes during exercise
    80. Edema Dropsy of fluid retention
    81. Shock
    82. Hematology
  4. Pathology
    5. 83. Anaemia
    84. Hypertension
    85. Hypertensive Heart Disease
    86. Ischemic Heart Disease
    87. Angina pectoris
    88. Myocardial infarction
    89. Rheumatic Fever and Rheumatic Heart Disease (RHD)
    90. Acute Pericarditis
    91. Myocarditis
    92. Infective Endocarditis (IE)
    93. Congenital Heart Disease
    94. Cardiomyopathies
    95. Arteriosclerosis
    96. Atherosclerosis
    97. Inflammatory Disease of Blood Vessels
    98. Aneurysms and Dissection
    99. Congestive Heart Failure
    100. Iron Deficiency Anaemia
    101. Megaloblastic anaemia
    102. Pancytopenia
    103. Leucocytosis and Leucopenia
    104. Aplastic anaemia
    105. Haemolytic anaemia
    106. Hereditary Spherocytosis
    107. Haemoglobinipathies
    108. Thalassemia syndrome
    109. Sickle Cell Disease
    110. Leukaemia
    111. Leukemoid reaction
    112. Lymphadenitits
    113. Hodgkin lymphoma
    114. Non-hodgkin lymphoma
    115. Myeloproliferative disorders
    116. Myelofibrosis
    117. Multiple myeloma
    118. Bleeding disorders
    119. Coagulation disorders
    120. any
    121. Blood grouping
  5. Microbiology
    6. 122. Introduction of Blood borne infections
    123. Infective Endocarditis
    124. Brucella
    125. Rickettsiae
    126. Leishmania donovani
    127. Plasmodium
    128. Wuchereria bancrofti
  6. Biochemistry
    7. 129. Metabolism in Blood Cells
    130. Iron metabolism
    131. Haemoglobin
    132. Lipoprotein metabolism
    133. Biochemical aspect of MI
Pathology
84. Hypertension

1.

What is hypertension? Describe pathogenesis of essential hypertension.

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[2070]

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2.

Describe the pathogenesis of hypertension caused by renal diseases. List the complications of hypertension.

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[2061]

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3.

Define hypertension. List the causes of hypertension. Enumerate the complications.

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4.

Explain briefly vascular pathology in hypertension.

[2075]

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DEFINITION OF HYPERTENSION
  • •
    Hypertension is defined as elevated blood pressure leading to end organ damage.
    • Or,
  • •
    A sustained diastolic pressure greater than 89 mm Hg or sustained systolic pressure above 139 mm Hg is called Hypertension.
CLASSIFICATION ACCORDING TO WHO
Grade
Systolic (mm Hg)
Diastolic (mm Hg)
Optimal
<120
<80
Normal
<130
<85
High normal
130-139
85-89
Hypertension mild (Grade I)
140-159
90-99
Hypertension moderate (Grade II)
160-179
100-109
Hypertension severe (Grade III)
>180
>110
TYPES OF HYPERTENSION
Primary hypertension/ Essential hypertension/ Idiopathic hypertension (90-95%)
Causes
  1. Gene defects
    1. Single gene defect in
      • •
        Aldosterone metabolism
      • •
        Sodium reabsorption from distal convoluted tubule
    2. Polymorphism of several genes that affect blood pressure
  2. Environmental factors
    1. Stress
    2. Salt intake
    3. Obesity
    4. Smoking
    5. Physical inactivity
  3. Chronic or repeated vasoconstrictive influences
  4. Reduced renal sodium excretion
Pathogenesis
graph TD 1["Genetic factors"] 2["Several single <br>gene disorders"] 3["Alter net sodium <br>reabsorption <br>in the kidney"] 4["Polymorphisms in <br>several genes"] 5["Eg: Sequence variations in <br>both the angiotensinogen <br>and the angiotensin <br>receptor genes"] 6["Reduced renal <br>sodium excretion"] 7["Increase in <br>fluid volume"] 8["Increased cardiac <br>output"] 9["Increased peripheral <br>vasoconstriction"] 10["Vasoconstrictive <br>influence"] 11["Factors inducing <br>vasoconstriction"] 12["Stimuli causing <br>structural changes <br>in the vessel wall"] 13["Increase <br>peripheral <br>resistance"] 14["Environmental factors"] 15["Like Stress, <br>Obesity, Smoking, <br>Physical inactivity, <br>and heavy salt <br>consumption"] 16["Hypertension"] 1 --> 2 2 --> 3 1 --> 4 4 --> 5 5 --> 16 3 --> 16 6 --> 7 7 --> 8 8 --> 9 9 --> 16 10 --> 11 11 --> 13 10 --> 12 12 --> 13 13 --> 16 14 --> 15 15 --> 16

Pathogenesis of Essential Hypertension

Secondary hypertension (5%)
Causes
Renal
  1. Acute glomerulonephritis
  2. Chronic renal disease
  3. Polycystic kidney disease
  4. Renal artery stenosis
  5. Renal vasculitis
  6. Renin-producing tumors
Endocrine
  1. Adrenocortical hyperfunction
    1. Cushing syndrome
    2. Primary aldosteronism
    3. Congenital adrenal hyperplasia
    4. Licorice ingestion
  2. Exogenous hormones
    1. Glucocorticoids
    2. Estrogens (Including pregnancy-induced and Oral contraceptives)
    3. Sympathomimetics and tyramine-containing foods
    4. Monoamine oxidase inhibitors
  3. Pheochromocytoma
  4. Acromegaly
  5. Hypothyroidism (Myxedema)
  6. Hyperthyroidism (Thyrotoxicosis)
  7. Pregnancy-induced
Cardiovascular
  1. Increased cardiac output
  2. Increased intravascular volume
  3. Coarctation of aorta
  4. Rigidity of the aorta
  5. Polyarteritis nodosa
Neurologic
  1. Psychogenic
  2. Increased intracranial pressure
  3. Sleep apnea
  4. Acute stress, including surgery
Pathogenesis
Pathogenesis is different for different cases, some of which are given below.
graph TD A1[Renal artery stenosis] --> A2[Decrease glomerular flow] A2 --> C3 B1[Co-arctation of aorta] --> B2[Ischemia to kidney] B2 --> C3 C1[Cushing syndrome] --> C2[↑ ACTH] C2 --> C3[↑ Renin synthesis] C3 --> D[↑ RAAS] D --> E[Secondary hypertension]
Malignant hypertension (5% of hypertensive persons)
Definition
The severe form of hypertension characterized by systolic pressure more than 200 mm Hg and diastolic pressure more than 120 mm Hg is called Malignant hypertension.
Characteristic
  1. Renal failure
  2. Retinal hemorrhages and exudates
  3. With or without papilledema
  4. Ususally superimposed on preexisting 'benign' hypertension
  5. If untreated, leads to death within 1 to 2 years
MORPHOLOGY
Hyaline arteriolosclerosis
    Image 1
    Fig. Hyaline arteriolosclerosis. The arteriolar wall is thickened with increased protein deposition (hyalinized), and the lumen is markedly narrowed.
  1. Arterioles show homogenous, pink hyaline thickening with associated luminal narrowing.
  2. In response to chronic hemodynamic stresses of hypertension, these changes causes
    1. Plasma protein leakage across injured endothelial cells
    2. Increased smooth muscle cell matrix synthesis
Hyperplastic arteriolosclerosis
    Image 1
    Fig. Hyperplastic arteriolosclerosis (onion-skinning) causing luminal obliteration (periodic acid–Schiff [PAS] stain).
  1. This lesion occurs in severe hypertension.
  2. Vessels exhibit concentric, laminated ('onion-skin') thickening of the walls with luminal narrowing.
  3. The lamination consists of smooth muscle cells with thickened, reduplicated basement membrane.
  4. In malignant hypertension, they are accompanied by fibrinoid deposits and vessel wall necrosis (necrotizing arteriolitis), particulary in the kidney.
COMPLICATIONS
Blood vessels
  1. Atherosclerosis
  2. Aortic dissection
Heart
  1. Cardiac hypertrophy
  2. Heart failure
  3. Myocardial infarction
  4. Angina
  5. Arrhythmia
CNS
  1. Cerebral ischemia
  2. Cerebral hemorrhage
  3. Transient ischemic attack (TIA)
  4. Stroke
  5. Multi-infarct dementia
Eye
  1. Retinal hemorrhage
  2. Papilloedema
Renal
  1. Nephrosclerosis
  2. Chronic renal failure

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