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18.kidney in pregnancy, HTN.pptx
- 1. HYPERTENSION Dr Samiyah Syeed Profof Pathology SABVMCRI
- 2. Introduction • High bloodpressure is a common condition, afflicting 29% of the adult population of the United States • It is a major risk factor for myocardial infarction, heart failure, stroke, dementia, kidney disease, and progressive atherosclerosis
- 3. Definition JNC 7 (JointNational Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure) Classification BP classification Systolic BP (mmHg) Diastolic BP (mmHg) Normal <120 and <80 Pre-hypertension 120 - 139 or 80 - 89 Stage 1 hypertension 140 – 159 or 90 – 99 Stage 2 hypertension > 160 or > 100
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- 5. Types and Causesof Hypertension (Systolic and Diastolic) 1. Essential hypertension (90% to 95% of cases) 2. Secondary hypertension A) Renal • Acute glomerulonephritis • Chronic renal disease • Polycystic disease • Renal artery stenosis • Renal vasculitis • Renin-producing tumors
- 6. B) Endocrine • Adrenocorticalhyperfunction: Cushing syndrome, primary aldosteronism, congenital adrenal hyperplasia) • Exogenous hormones: Glucocorticoids, oral contraceptives • Pheochromocytoma • Acromegaly • Hypothyroidism (myxedema) • Hyperthyroidism (thyrotoxicosis) • Pregnancy-induced
- 7. C) Cardiovascular • Coarctationof aorta • Polyarteritis nodosa • Increased intravascular volume • Increased cardiac output • Rigidity of the aorta D) Neurologic • Psychogenic • Increased intracranial pressure • Sleep apnea • Acute stress, including surgery
- 8. Regulation of NormalBlood pressure
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- 10. Pathogenesis of hypertension Essentialhypertension is a complex and multifactorial disorder. 1. Decreased renal sodium excretion: It is probably the key feature. Decreased excretion of sodium by kidney → leads to an increase in fluid volume, cardiac output, and peripheral vasoconstriction → raises the blood pressure. 2. Raised vascular resistance: Factors that produce vasoconstriction structural changes in the vessel wall → result in an increase in peripheral vascular resistance → cause primary hypertension 3. Genetic factors: They play an important role in the development of hypertension 4. Environmental factors: These include stress, obesity, smoking, lack of physical activity and heavy intake of sodium salt.
- 11. Consequences of hypertension 1.Risk factor: Hypertension is one of the major modifiable risk factors for atherosclerosis. 2. Lesions/diseases produced: Cardiac hypertrophy, congestive heart failure and ischemic heart disease , multi-infarct dementia, aortic dissection, stroke, subarachnoid hemorrhage, hypertensive encephalopathy, retinal ischemia/ infarction and renal failure. 3. Malignant hypertension: It is characterized by rapid raise in blood pressure i.e. systolic pressure over 200 mm Hg, diastolic pressure over 120 mm Hg) → renal failure, and retinal hemorrhages and exudates, with or without papilledema. • develops in ~5%, of hypertensive persons. If not treated, death occurs within a year or two
- 12. Comparison of benignand malignant hypertension Benign Malignant Aetiology Usually essential if secondary, commonly of endocrine type A few cases arise out of benign essential. Majority are secondary to renal disease Age Benign younger than 45 years but is prolonged into 6 and 7 decades Young adults 25-35 years Sex Female > Male Female = Male Prevalence Very common – at least 15% of population in western societies Rare Course Very slow – may years RAPID – months to 1-2 years Blood pressures Diastolic 90-120 mm Hg very slow rise 120+ Rapid rise Arteries Accelerates Arteriosclerosis; Potentiates atheroma Accelerates arteriosclerosis; Causes intimal fibrous thickening Hyaline thickening Fibroid necrosis of vessel wall and thrombosis, especially affecting kidney and abdominal viscera
- 13. • EFFECTS ANDMAIN COMPLICATIONS IN VARIOUS ORGANS • Effects and complication are proportional to the height of the blood pressure. • Therefore drug treatment which lowers the BP lowers the incidence of complications, but the diseased vessels do not return to normal and organ perfusion may be inadequate at levels of BP which would usually be considered physiological. • Modern drug therapy has greatly reduced the morbidity and mortality from malignant hypertension. Heart Hypertrophy of left ventricle Hypertrophy of left ventricle ± focal myocardial necrosis Heart failure Common Acute heart failure Cerebral haemorrhage Due to rupture of damaged artery – 30% of cases Encephalopathy (fits and loss of consciousness) due to cerebral oedema and haemorrhage Kidney Varying degree of nephrosclerosis but usually not serious Severe renal damage – death in uranemia Eyes Arterial narrowing – retinal exudation Papilloedema; arterial narrowing; haemorrhage and exudates.
- 14. Vascular pathology inhypertension • Hypertension accelerates atherogenesis and causes degenerative changes in the walls of large and medium arteries that can lead to aortic dissection and cerebrovascular hemorrhage. Morphology • Hypertension is associated with two forms of small blood vessel disease: 1. Hyaline Arteriolosclerosis: • Arterioles show homogeneous, pink hyaline thickening with associated luminal narrowing.
- 15. 2. Hyperplastic Arteriosclerosis: •Occurs in severe (malignant) hypertension; • vessels exhibit "onion-skin lesions," characterized by concentric, laminated thickening of the walls and luminal narrowing . • The laminations consist of smooth muscle cells with thickened, reduplicated basement membranes; • In malignant hypertension they are accompanied by fibrinoid deposits and vessel wall necrosis (necrotizing arteriolitis), particularly in the kidney.
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