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Pathology of Hypertension:

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splinter & Lacunar hemorrhages. Hyperplastic Arteriolosclerosis: Onion Skin Thickening ... Lacunar Infarcts: Chronic hypertension ... – PowerPoint PPT presentation

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Title: Pathology of Hypertension:


1
Pathology of Hypertension
  • Dr. Venkatesh M. Shashidhar.
  • Senior Lecturer in Pathology
  • Fiji School of Medicine

2
Hypertension - Introduction
  • Silent Killer painless complications
  • dizziness, headache, and visual difficulties,
  • It is the leading risk factor MI, DM, Stroke
  • Responsible for the majority of office visits,
  • Number one reason for drug prescription.
  • 25 of population, lt35 aware. lt5 ..!
  • Complications bring to diagnosis but late
  • Chronic, vascular end organ damage.

3
Introduction
  • Sustained increase in blood pressure
  • Systolic gt140, Diastolic gt 90 mm of Hg
  • Normal lt 130 lt85 (120/80 /- 10/5)
  • Mild 20, Moderate 40 Severe 80
  • Malignant - gt 210/120

4
Regulation of BP
  • BP Cardiac Output x Peripheral Resistance
  • Endocrine Factors
  • Renin, Angiotensin, ANP, ADH, Aldosterone.
  • Neural Factors
  • Sympathetic Parasympathetic
  • Blood Volume
  • Sodium, Mineralocorticoids, ANP
  • Cardiac Factors
  • Heart rate Contractility.

5
Control of Blood Pressure
Humoral Factors
Vasoconstrictors Angiotensin II Catecholamines
Vasodilators Pg Kinins
Blood Volume Na, Aldosterone
Cardiac Factors Rate Contract..
Local Factors pH, Hypoxia
  • Neural Factors
  • Adrenergic Cons
  • ß Adrenergic - Dil

6
Etiologic Classification
  • Primary or Essential Hypertension(95)
  • Secondary Hypertension (5-10)
  • Renal GN, RAS, Renin tumors
  • Endocrine Cushing, OCP, Thyrotoxicosis Myxdema,
    Pheochromocytoma, Acromegaly.
  • Vascular Coarctation of Aorta, PAN, Aortic
    insufficiency.
  • Neurogenic Psychogenic, Intracranial pressure,
    olyneuritis etc.

7
Pathogenesis of Hypertension
  • ? Pathogenesis in Essential hypertension -
    Multifactorial
  • Increased blood volume - Sodum retention ADH,
    Aldosterone.
  • Increased sympathetic tone - Adrenal tumours,
    sympathetic stimulation.
  • Increased vasoactive hormones - Cushings,
    Pheochromocytoma,

8
Pathogenesis of Renovascular HTN
?GFR
Renin by JGA
Angiotensin II
Aldosterone
Vasoconstriction ? P. Resistance
Sodium Retention ?Blood Volume
Hypertension
9
Consequences of Hypertension
  • Blood Vessels
  • Atherosclerosis and its complications aneurism,
    Dissection, Rupture, necrosis. Arteriolosclerosis,
  • Heart
  • Hypertensive cardiomyopathy, IHD, MI.
  • Kidney
  • Benign/Malignant nephrosclerosis. Infarction
  • Eyes
  • Hypertensive retinopathy
  • Brain
  • Haemorrhage, infarction,
  • splinter Lacunar hemorrhages

10
Hyperplastic Arteriolosclerosis
Narrow Lumen
Onion Skin Thickening Of arterioles.
11
Benign Nephrosclerosis
Leathery Granularity due to minute scarring
12
Left Ventricular Hypertrophy
Left Ventricular Hypertrophy
13
Cerebral Infarction (Stroke)
Haemorrhagic Necrosis
14
Subarachnoid Haemorrhage
  • Cerebral Blood vessels
  • Special features
  • Thin walled
  • End arteries
  • Cong. Aneurisms

15
Lacunar Infarcts
  • Chronic hypertension
  • Arteriolosclerosis of deep penetrating arterioles
    of brain stem.
  • Single or multiple cavitary infarcts lacunes.
  • Lenticular nucleus, thalamus
  • Slit Haemorrhages.

16
Renal Artery stenosis - Atrophy
Leathery Granularity Benign Nephrosclerosis
17
Normal Retina - Fundoscopy
18
Hypertensive Retinopathy
  • Grade I Thickening of arterioles.
  • Grade II Focal Arteriolar spasms. Vein
    constriction.
  • Grade III Hemorrhages (Flame shape), dot-blot
    and Cotton wool and hard waxy exudates.
  • Grade IV - Papilloedema

19
Malignant Hypertension
  • May complicate any type of HTN.
  • Necrotizing arteriolitis.
  • Intravascular thrombosis.
  • Rapidly progressive end organ damage.
  • Renal failure
  • Hypertensive encephalopathy.
  • Left ventricular failure.

20
Necrotizing arteriolitis
Thrombosis
Fibrinoid Necrosis
21
Conclusions
  • Persistent increased blood pressure (140/90)
  • 95 Essential, 5 secondary - Renovascular
  • Benign and Malignant types (gt120Diastolic)
  • Vessel damage Arteriolosclerosis
  • Complicates - Atherosclerosis, Diabetes, IHD
  • Ischemia or Infarction in end organs.
  • Kidney, Brain, Heart Eyes.
  • Nephrosclerosis, renal damage, IHD, MI, Stroke
    Retinopathy.

22
Self Assessment Questions
  • Define essential, hypertension?
  • Briefly describe pathogenesis of renal damage in
    hypertension.
  • Classify hypertension, briefly describe
    pathogenesis in each?
  • Summarize common complications of hptn?
  • What is nephrosclerosis? Briefly describe its
    pathogenesis?
  • What is meant by malignant hypertension? Briefly
    describe clinical and pathological features?
  • What are lacunar infarcts? arteriolosclerosis?
  • How does hptn causes stroke? Damage heart?

23
Do what you love, love what you do, and deliver
more than you promise Harvey Mackay
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