Lifes battles dont go always to the stronger or faster man,

1
Lifes battles dont go always to the stronger
or faster man,
Sooner or later, the man who wins is the man who
thinks he can
2
Pathology of Hypertension

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

3
Hypertension - Introduction

• Silent Killer late symptoms dizziness,
  headache, and visual difficulties,
• It is the leading risk factor
• Responsible for the majority of office visits,
• Number one reason for drug prescription.
• lt35 unaware,
• 21 have good control..!
• Complications bring to diagnosis but late

4
Introduction

• Sustained increase in blood pressure
• Systolic gt140 Diastolic gt 90 mm of Hg
• 25 of general population..!! (5)
• Chronic, end organ vascular damage
• disastrous late complications.
• Atherosclerosis, IHD, Renal damage, Stroke

5
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.

6
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

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
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.

9
Pathogenesis of Renovascular HTN
?GFR
Renin by JGA
Angiotensin II
Aldosterone
Vasoconstriction ? P. Resistance
Sodium Retention ?Blood Volume
Hypertension
10
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

11
Patho-Physiology
12
PathophysiologyOf Hypertension
13
Patho-Physiology
14
Severity of Hypertension
Normal lt140 lt90 Stage 1 (mild) 140-159
90-99 Stage 2 (mod.) 160-179 100-109 Stage 3
(severe) 180-209 110-119 Stage 4 (very severe)
gt210 gt120
15
Malignant Hypertension

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

16
Necrotizing arteriolitis
Thrombosis
Fibrinoid Necrosis
17
Left ventricular Hypertrophy
Left Ventricular Hypertrophy
18
Hyaline Arteriolosclerosis
19
Hyperplastic Arteriolosclerosis
Narrow Lumen
Onion Skin Thickening Of arterioles.
20
Cerebral Infarction (Stroke)
Haemorrhagic Necrosis
21
Cerebral Infarction
22
Subarachnoid Haemorrhage
23
Lacunar Infarcts

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

24
Renal Causes Polycystic Kidney

• Renal artery atherosclerosis
• Congenital -Polycystic D
• Glomerulonephritis (A/C)
• Renal artery stenosis
• Renal vasculitis
• Renin producing tumors.

25
Benign Nephrosclerosis
Leathery Granularity due to minute scarring
26
Renal Artery stenosis - Atrophy
Leathery Granularity Benign Nephrosclerosis
27
Normal Retina - Fundoscopy
28
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

29
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.

30
Thank You

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