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A detailed overview of arterial hypertension, covering various stages, risk factors, and associated complications. it includes numerous questions and answers testing knowledge of hypertension's pathophysiology, clinical manifestations, and treatment implications. The resource is valuable for medical students and professionals.
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systolic bp: 120- and diastolic bp: < Elevated Blood Pressure
systolic bp: 130- or diastolic bp: 80- Stage 1 Hypertension
systolic bp: > or diastolic bp: > Stage 2 Hypertension
systolic bp: > and/or diastolic bp: > Hypertensive Crisis
What race is hypertension more common, more severe, occurs earlier, and is associated with freater target-organ damage? African Americans
Do men or women have a higher risk of hypertension? Men
Hypertension can be diagnosed after an elevated blood pressure has been documented _____ or more times two
When and where do hypertensive headaches occur? In the morning, in the occipital region
in what condition is there a weak pulse in one arm or a difference of >10 mmHg in systolic blood pressure between arms? Takayasu Arteritis
normally the systolic BP in the legs is ____________% higher than the brachial artery 10-20%
absent pulses in the legs or lower BP readings in the legs as compared with the arms are seen in what two conditions?
the glassy, homogenous appearance of the blood vessels seen by light microscopy Hyaline
what condition:
arterioles will show homogeneous, pink, hyaline thickening with associated luminal narrowing Hyaline Arteriolosclerosis
in Chronic hypertension, __________________________ causes diffuse impairment of renal blood supply whihc leads to glomerular scarring followed by tubular atrophy and loss of entire nephrons Hyaline Arteriolosclerosis
although Hyaline Arteriolosclerosis is generalized in distribution, it is more severe in the
Kidneys
-BP above 180/ -associated with severe and generalized arteriolar spasm -characterized by severe, generalized changes in arterioles of kidney, brain retina, and other organs Malignant Hypertension
Necrotizing Arteriolitis and Hyperplastic Arteriolosclerosis are associated with which type of hypertension? Malignant Hypertension
-rapidly following necrotizing arteriolitis -smooth msucle proliferation, thickened, reduplicated basement membrances, and increased amounts of intercellular collagen and glycosaminoglycans -results in a striking concentric increase in the number of layers of smooth muscle cells Hyperplastic Arteriolosclerosis
where is Hyperplastic Arteriolosclerosis mostly distributed? Interlobular arteries of the Kidneys
-a consequence of the increased demands on the heart causing pressure overload and ventricular hypertrophy -may lead to diastolic dysfunction, congestive heart failure, atherosclerotic coronary artery disease (ischemic heart disease), and cardiac arrhythmias Hypertensive Heart Disease
Hypertensive Heart Disease is most often seen in the __________ heart as the results of systemic hypertension Left
-characterized by right ventricular hypertrophy, dilation, and potentially right-sided failure -typically causes chronic cor pulmonale Right-Sided Hypertensive Heart Disease
-disorders of the lung such as chronic obstructive disease, idiopathic pulmonary fibrosis, and primary pulmonary arterial hypertension Cor Pulmonale
-develops due to occlusion of a single deep penetrating artery -involves the putamen, globus pallidus, thalamus, internal capsule, deep white matter, caudate nucleus, and pons Lacunar Infarct
-caused by the rupture of a small intraparenchymal vessel -ganglionic or lobar Intracerebral Hemorrhage
intracerebral hemorrhage that is caused by a ruptured deep penetrating artery damaged by effects of a long-standing hypertension Ganglionic Hemorrhage
-associated with chronic hypertension
affects small vessels (e.g. in basal ganglia, thalamus) -due to atrophy of the media layer Charcot-Bouchard Microaneurysms
most common vessels affected by Charcot-Bouchard Microaneurysms Lenticulostriate Branches of the MCA
Charcot-Bouchard Microaneurysm
-a spectrum of changes in the fundus of the eye in pts with elevated blood pressure -changes develop in the retina, choroid, and optic nerve -slowly progressive Hypertensive Retinopathy
-in early stages, funduscopy indentifies generalized retinal arteriolar constriction and narrowing -decrease in the ratio o fhte width of the retinal arterioles to the retinal venules -later stages consits of AV nicking or nipping Hypertensive Retinopathy
-narrowing of a venule as an arteriole crosses over it -vein appears to stop abruptly on either side of the AV crossing and inflates on either side of artery cross section point
-Minimal proteinuria (<1 g/day)
-involves hyaline arteriolosclerosis of the glomerular capillaries
-development of secondary tubular atrophy and interstitial fibrosis
-progression of glomerular obsolescence: renal cortex becomes thinner, kidneys become shrunken and scarred
-kidney surfaces have a fine, granularity that resembles grain leather
-tiny scars corresponding to hypertrophic surviving nephrons which are functionally overloaded, compensating for the loss of function in atrophic renal tissue
Benign Hypertensive Nephrosclerosis
-small, petechial-type hemorrhages on cortical surface that can give the kidneys a characteristic flea-bitten appearance
-deterioration of renal arteries at a much faster rate
-fibrinoid necrosis of the afferent arterioles
-glomerular segmental fibrinoid necrosis
-hyperplastic arteriolitis of interlobular arteries and arcuate arteries
Malignant Hypertensive Nephrosclerosis
severe atherosclerosis of the arteries providing flow to the lower extremities Peripheral Artery Disease (PAD)
-classic symptom of PAD -oainful, aching cramping in the calves that occurs during walking and is relieved by rest -a manifestation of exercise-induced reversible ischemia (ex: angina pectoris) Claudication
the most common mechanisms underlying essential hypertension -Inherited defect in renal handling of sodium -Systemic vasoconstriction
-tends to be familial -excess body sodium leads to fluid overload which leads to increased cardiac output and peripheral vasoconstriction -either by directly altering smooth muscle calcium fluxes or by altering smooth muscle response to vasoactive substances Essential Hypertension
-growth hormone -glucocorticoids Endocrine Hypertension
-defined as severe elevation of BP >180/ -rapid, inappropriate, intense, and symptomatic elevation in blood pressure -may have no symptoms -more likey to report headaches and dizziness than the general population -confers a high risk of rapid deterioration of target-organs (potential life threat) Hypertensive Crisis
-characterized by rapid deterioration of one or more target-organs Hypertensive Emergency
-a hypertensive emergency -characterized by hemolytic anemia caused by mechanical destruction of erythrocytes following necrotitizing arteriolitis with fibriniod necrosis of the vessel wall leading to occlusion of arterioles and capillaries bc of fibrin deposition and platelet aggregation -presence of RBC fragments bc of erythryocyte destruction Microangiopathic Hemolytic Anemia (MAHA)
-BP greater than 180/120 in the absence of progressive target organ dysfunction -pts are often therapy-nonadherent or inadequately treated -may present with headache or anxiety but often are asymptomatic
-no clinical or laboratory manifestions -no immediate threat Hypertensive Urgencies
-Initial step: severe vasoconstriction leading to abrupt rise in vascular resistance -decrease in blood flow, mechanical stress, and endothelial injury -second step: activation of renin-angiotensin system -viscious cycle of continuous injury and subsequently ischemia -Prothrombotic state Hypertensive Crisis
-a general brain dysfunction due to significantly high BP -regarded as failure of cerebral autoregulation from a sudden elevation of BP that results in arteriolar damage, the loss of BBB barrier integrity, generalized vasodilation, increased cerebral perfusion, endothelial injury, and cerebral vasogenic edema Hypertensive Encephalopathy
typical clinical manifestations: -headache -confusion -visual disturbances -generalized tonic clonic seizures -imaging: bilateral areas of white matter edema in the posterior cerebral hemispheres with sparing of the cortical gray matter Hypertensive Encephalopathy
