Hypertension Pathology

Definitions

Sustained increase of Arterial blood pressure

Hypertension in adults: 2020 International Society of Hypertension (ISH) and 2014 JNC 8: persistent SBP ≥ 140 mm Hg and/or DBP ≥ 90 mm Hg

Primary hypertension: hypertension with no identifiable cause

Secondary hypertension: hypertension caused by an identifiable underlying condition

Acute severe Hypertension (Malignant HPTN): An increase in systolic blood pressure above 180 mmHg or diastolic blood pressure above 120 mmHg.

Epidemiology

Prevalence Hypertension affects between approximately one-third and one-half of adults in the US.

Primary hypertension: 90%-95% of cases in adults .
Secondary Hypertension: 5-10% of cases in adults

Prevalence increases with age: Approx 65–75% of adults develop it by 65–74 years of age. ∼ 60–87% of overweight & ∼ 73–95% of obese patients are affected.

Sex –♂ > ♀ below 65 years of age –After menopause, prevalence increases in women.

C.L. Features

Hypertension is usually asymptomatic until:
- Complications of end-organ damage arise
- Or an acute increase in blood pressure occurs (“Hypertensive crisis”)
Nonspecific symptoms of primary hypertension
- Headaches, esp. early morning or waking headache
- Dizziness, tinnitus, blurred vision
- Flushed appearance
- Epistaxis
- Chest discomfort, palpitations
- Strong, bounding pulse on palpation
- Nervousness
- Fatigue, sleep disturbances
- Secondary hypertension usually manifests with symptoms of the underlying disease.

Complications

Arterial hypertension is the most common risk factor for cardiovascular disease
It leads to chronic changes in the vascular endothelium, particularly of the small vessels, and can therefore affect any organ system.
Acute severe hypertension causes “Hypertensive crisis”

Vascular: - Macro-angiopathy: Atherosclrosis & - Micro-angiopathy: Arteriolosclerosis (hyaline or hyperplastic)
Heart: LVH, Hypertensive cardiomyopathy → IHD, MI
Kidney: Hypertensive nephrosclerosis
Eyes: Hypertensive retinopathy
Brain:

Cardiovascular system (hypertensive vascular disease)

Left ventricular hypertrophy, hypertrophic cardiomyopathy, dilated cardiomyopathy
Congestive heart failure
Coronary artery disease and myocardial infarction
Atrial fibrillation
Aortic aneurysm
Aortic dissection
Carotid artery stenosis
Peripheral artery disease
Atherosclerosis