Hypertension | Anatomy2Medicine
Hypertension Stages

Hypertension

 

  • Essential hypertension

 

      • hypertension of unknown etiology (MCQ)
      • accounts for the majority of cases
      • Risk factors of essential hypertension
        • Family history of hypertensive disease is seen in three of four patients with the disorder. (MCQ)
        • dietary sodium intake has link with hypertension prevalence
        • Stress, is a factor

 

  • obesity, cigarette smoking
  • physical inactivity.
  • Results of essential hypertension
  • retinal changes

 

        • left ventricular hypertrophy and cardiac failure

 

  • benign nephrosclerosis. (MCQ)

 

        • It can predispose to ischemic heart disease or stroke.

 

  • Secondary hypertension

 

      • Renal disease is the most common cause of secondary hypertension. (MCQ)

 

  • Causes of renal hypertension
  • Disorders of the renal parenchyma
  • postinfectious glomerulonephritis
  • diabetic nephropathy
  • adult polycystic disease

 

        • Unilateral renal artery stenosis
          • caused by atherosclerosis or unilateral fibromuscular dysplasia. (MCQ)
          • marked by atrophy of the affected kidney and may be corrected surgically.

 

  • Mechanism of renal hypertension
  • occurs through stimulation of the renin-angiotensin system.
  • Juxtaglomerular cells respond to decreased vascular tone by secreting renin

 

          • renin facilitates the conversion of angiotensinogen to angiotensin I, which is further converted to angiotensin II.
          • Angiotensin II promotes hypertension by acting both as a

 

  • vasoconstrictor  
  • activator of aldosterone secretion.

 

          • Aldosterone promotes sodium and water retention.

 

  • Endocrine disorders
  • Primary aldosteronism, or Conn syndrome(MCQ)

 

          • usually associated with an adrenocortical adenoma or bilateral adrenal hyperplasia.
          • It causes hypertension, mincreased serum sodium and reduced serum potassium and metabolic alkalosis(MCQ)
          • Increased aldosterone secretion; sodium and water retention,

 

  • Acromegaly

 

        • Cushing syndrome of pituitary or adrenocortical origin
        • pheochromocytoma,

 

  • hyperthyroidism

 

        • Diabetes mellitus when complicated by diabetic glomerulosclerosis

 

  • Congenital adrenal hyperplasia(MCQ)
  • Occurs in several forms; hypervolemia mediated by increased production of mineralocorticoids in 17-hydroxylase deficien and 11-hydroxylase deficiency(MCQ)
  • Hyperparathyroidism(MCQ)

 

      • Other causes
        • coarctation of the aorta
          • causes hypertension limited to the upper body
        • toxemia of pregnancy
        • CNS disorders, especially brain tumors;

 

  • amphetamines and steroids. (MCQ)
  • Poisoning by lead, cadmium(MCQ)
  • Oral contraceptive use(MCQ)
  • Malignant hypertension

 

      • can be a complication of either essential (primary) or secondary hypertension.
      • It follows an accelerated clinical course.
      • Characteristic features include
        • marked increase in diastolic blood pressure

 

  • focal retinal hemorrhages and papilledema
  • left ventricular hypertrophy

 

        • left ventricular failure.

 

  • It most often results in early death from congestive heart failure, cerebrovascular accident, or renal failure.
  • Renal changes of malignant nephrosclerosis:
  • “flea-bitten” kidney(MCQ)

 

          • arterioles or glomerular capillaries rupture
          • results in “flea-bitten” kidney, multiple pinpoint petechial hemorrhages on the kidney surface

 

  • large, swollen kidneys

 

      • necrotizing arteriolitis and glomerulitis with fibrinoid necrosis (MCQ)
      • hyperplastic arteriolosclerosis, affecting both the glomeruli and arterioles. (MCQ)