hypertension robbins: 525 to 530, 1007-1009 cecil: 167-173
DESCRIPTION
Hypertension Sustained: Diastolic > 90 (some >80) Systolic > 140 See table 13-8 in Cecil Essentials Normal100TRANSCRIPT
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Hypertension
Robbins: 525 to 530, 1007-1009Cecil: 167-173
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Hypertensive Vascular Disease
• HTN risk factor for:• Coronary heart disease• Stroke• LVH with heart failure• Aortic dissection• Renal failure
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Hypertension• Sustained:
• Diastolic > 90 (some >80)• Systolic > 140
• See table 13-8 in Cecil Essentials
Normal <120 And <80
Prehypertension 120-139
Or 80-89
Stage 1 140-159
Or 80-90
Stage 2 >160 Or >100
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Causes of Hypertension
• 90-95% idiopathic• 5-10% 2° to renal disease or
renovascular hypertension• All other causes rare
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Accelerated (Malignant) hypertension
• Severe hypertension (diastolic >120mmHg)
• Renal failure• Retinal hemorrhages with papilledema• Seizures • Strokes• DIC
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Normal Blood Pressure
• Cardiac output• Na homeostasis
• Total peripheral resistance• Lumen size• Neural and hormonal influences that
constrict or dilate these vessels
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Kidney
• Renin-produced by the JG cells of the kidney
• Transforms plasma angiotensinogen to angiotensin I
• Angiotensin I converted to angiotensin II by ACE
• Angiotensin II increases peripheral resistance and blood volume
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The Kidney Produces Vasodepressor Substances
• Prostaglandins• Kallikrein-kinin• Platelet-activation factor• Nitric oxide
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Blood volume reduced
• Glomerular filtration rate falls• Increased reabsorption of Na• Leads to conserve Na and expand blood
volume
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GFR-independent Natruretic Factors
• Atrial natriuretic factor (ANF)• Inhibits Na reabsorpton in distal tubules• Cause vasodilatation
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Essential hypertension
• Alter the relationship between volume and total peripheral resistance
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Renovascular hypertension
• Renal artery stenosis causes deceased glomerular flow
• Induces renin secretion• Induces angiotensin II-induced
vasoconstriction• Increased peripheral resistance• Aldosterone causes increased sodium
reabsorption and inceased blood volume
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Genetic factors
• Environmental factors• Salt, stress, smoking• Obesity, physical inactivity
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Mechanisms
• Renal retention of excess sodium• Vasoconstriction and vascular
hypertrophy• Thickened wall• Narrowed lumen
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Vascular pathology
• Hyaline Arteriolosclerosis• Hyalinized walls with narrowed lumen
• Hyperplastic arteriosclerosis• Concentric, laminated thickening of wall
(onion-skin)• Progressive narrowing of the lemen
• Necrotizing arteriolitis-fibroid necrosis
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Hyaline arteriosclerosis
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Hyperplastic arteriosclerosis - malignant hypertension
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Hyperplastic arteriosclerosis - malignant hypertension