Hypertension

Sustained elevated blood pressure in a quiet state is called- hypertension

Definition

Diagnostic criteria proposed by WHO

classify systolic pressure diastolic pressure

Normal BP <140mmHg <90mmHg

Grade 1 hypertension

Grade 2 hypertension

Grade 3 hypertension

140-159mmHg

160-179mmHg

>180mmHg >110mmHg

100-109mmHg

90-99mmHg

Types Essential hypertension

Secondary hypertension

Cause Not Yet Clear

Cause Clear

Secondary hypertension is secondary from renal, endocrine and nervous system diseases, much as temporarily, after a good treatment of the primary disease, hypertension will fade away.

Pathogenesis

Blood pressure is proportional to cardiac output and peripheral vascular resistance.

Any fators that can cause the above two aspects

rising may be concerned with high blood pressure

Pathogenesis

Major factors

Genetic factors

Dietary factors

Environmental factors

Other factors

Genetic factors

Familial aggregation: parents: 2-3 times, morbidity of children

single-parent: 1.5 times

Serum hormone-like substance

Inhibition of Na / k-ATP enzyme

activity

Concentration of

intracellular Na, Ca ion rise

Contraction of small artery

Angiotensin gene encoding variability

Influenced by multiple genetic and acquired factors

Dietary factors

Excessive sodium intake

sodium intake <5g/d

Potassium promote sodium excretion

Eat a lot of vegetables

Calcium can reduce the pressor effect of

sodium

High calcium diet

The three imbalance cause hypertension

Epidemiological and clinical observations have shown

there is a close relationship between salt intake and

hypertension 。Extracellular fluid volume Cardiac output

Vascular smooth muscle cell Na + Intracellular Ca + +

Vasoconstriction

(peripheral vascular resistance rise)

BP

salt intake

Environmental factors

Long term mental stress, pressure

Vasomotor regulation be out of control

The vasoconstrictor

effect is dominant

Peripheral resistance

BP

Other factors

Overweight or obesity

Smoking

Age

Lack of physical activity

Extracellular fluid

Types and pathological change

benign hypertension （ chronic hypertension ）

malignant hypertension （ accelerated hypertension ）

Process mainly involves small arteries and arterioles ， evokes spasm 、 hardening and affects some important organs.

Benign hypertension may be divided into three stages:

benign hypertension

Dysfunctions period

Arterial system changes period

Visceral lesions period

• small arteries

• arterioles

• elastic arteries

heart

cerebrum

kidney

retina

Dysfunctions period

•The whole body small arteries and arterioles spasm, no organic disease

•BP increased occasionally

•Clinical symptom appear occasionally, BP will return to normal after a rest

Arterial system changes period

•Hyaline arteriolosclerosis: Hyaline arteriolosclerosis: Hyaline arteriolosclerosis Hyaline arteriolosclerosis is a major morphologic characteristic.is a major morphologic characteristic.

•Arteriolar sclerosisArteriolar sclerosis

•Elastic arteries appear AS.

Hyaline arteriolosclerosisHyaline arteriolosclerosis ： The arteriolar wall is hyalinized, and the lumen is markedly narrowed

Arteriolar sclerosis

Clinical features:

May be associated with AS lesions

Further raise of blood pressure, and continued at high levels. Lose Fluctuation.

Visceral lesions period

Heart ： Left ventricle Compensatory hypertrophy

Concentric hypertrophy

Eccentric hypertrophy

Normal heart

Concentric hypertrophy wall thickening, heart cavity to narrow

Eccentric hypertrophy wall thickening, heart cavity enlarge

Microscopically features ： cardiocytes are thicker 、 elongate, nucleus is bigger and hyperchromatic.

Clinical feature

myocardial ischemia ， finally progress to heart failure

kidney ： Primary granular contracted kidney

Microscopically features ：•Renal arteriolar sclerosis, hyalinization

•Sclerosis and hyalinization of some glomeruluses. Visible compensatory hypertrophy of the other glomeruluses

•Atrophy and disappearance of some renal tubules. Visible compensatory dilatation of the other renal tubules

•Hyperplasia of interstitial connective tissue, infiltration of lymphocytes

dilatation of some renal tubules

compensatory hypertrophy of some glomeruluses

Bilateral renal symmetry reduction. Texture hardening, renal surface uneven, with fine granules

Cerebral lesion

1 ） Cerebral edema: headache, dizziness, vertigo and so on

2 ） Hypertensive encephalopathy: the syndrome of central nervous dysfunctions caused by acute cerebral edema and intracranial hypertension. Blood pressure increased significantly, severe headache, vomiting, convulsions and coma.

3 ） Cerebral softening: cerebral ischemic infarction

4 ） Cerebral hemorrhage: known as stroke. The most serious complication of hypertension

Cerebral softening: cerebral ischemia occurs anemic infarct, liquefaction, forming a loose texture mesh lesions. Necrosis of brain tissue repaired by the proliferation of glial cells, because the lesions were smaller, generally do not cause serious consequences.

loose mesh lesions

Hypertensive retinopathy

The central artery arteriolosclerosis, ophthalmoscope see vascular tortuosity, reflecting enhancement, arteriovenous crossing compression, papilledema, retinal hemorrhages and exudates.

Central retinal artery can occur hardening. ophthalmoscope shown vascular tortuosity, pale, with bleeding

In youth, diastolic pressure is often greater than 130mmhg, can be secondary from chronic hypertension, but often from primary.

features: 1 ） Hyperplastic arteriolosclerosis: intima and smooth muscle cell hyperplasia, collagen fibers increased significantly, the vessel wall, a concentric lamellar thickening, called onion-skinonion-skin change. 2 ） Necrotizing arteriolitis: fibrinoid necrosis of the intima and medial.

Patients death in a year due to uremia, cerebral hemorrhage and heart failure.

malignant hypertension （ accelerated hypertension ）

Hyperplastic arteriolosclerosis (onionskinning) causing luminal obliteration, with secondary ischemic changes

fibrinoid necrosis

Benign Malignant

Morbidity high （ 90% ） low （ 10% ）

Age The middle-aged or older The young and middle-aged

BP ＞ 150/95mmHg Persistent diastolic pressure

130 ~ 140mmHg

Symptom mild severity

changes Hyaline arteriolosclerosis Hyaline arteriolosclerosis Hyperplastic arteriolosclerosis

Necrotizing arteriolitis

Course of disease ＞ 10years 1 ～ 2 year

cause of death Cerebral hemorrhage, Renal failure,uremia （ 95% ），

heart failure Cerebral vascular accident

The distinction between benign and malignant hypertension