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高血高血压病理学病理学高血压病理学高血压病理学高血压病理学HypertensionHypertension-IntroductionSilent Killer painless complicationsdizziness,headache,and visual difficulties,It is the leading risk factor MI,DM,StrokeResponsible for the majority of office visits,Number one reason for drug prescription.25%of population,35%aware.140,Diastolic 90 mm of Hg*Normal*130 210/1202021/4/273Introduction“Sustained increasRegulation of BP:BP=Cardiac Output x Peripheral ResistanceEndocrine FactorsRenin,Angiotensin,ANP,ADH,Aldosterone.Neural FactorsSympathetic&ParasympatheticBlood VolumeSodium,Mineralocorticoids,ANPCardiac FactorsHeart rate&Contractility.2021/4/274Regulation of BP:BP=Cardiac Control of Blood Pressure:BPCardiac OutputPeripheralResistanceBlood VolumeNa+,AldosteroneVasoconstrictorsAngiotensin IICatecholaminesVasodilatorsPg&KininsLocal FactorspH,HypoxiaNeural FactorsaAdrenergic Cons Adrenergic-DilCardiac FactorsRate&Contract.Humoral Factors2021/4/275Control of Blood Pressure:BPCaEtiologic Classification:Primary or Essential Hypertension(95%)Secondary Hypertension(5-10%)Renal GN,RAS,Renin tumorsEndocrine Cushing,OCP,Thyrotoxicosis Myxdema,Pheochromocytoma,Acromegaly.Vascular Coarctation of Aorta,PAN,Aortic insufficiency.Neurogenic Psychogenic,Intracranial pressure,olyneuritis etc.2021/4/276Etiologic Classification:PrimaPathogenesis of Hypertension:?Pathogenesis in Essential hypertension-MultifactorialIncreased blood volume-Sodum retention ADH,Aldosterone.Increased sympathetic tone-Adrenal tumours,sympathetic stimulation.Increased vasoactive hormones-Cushings,Pheochromocytoma,2021/4/277Pathogenesis of Hypertension:?Pathogenesis of Renovascular HTN:GFRRenin by JGAAngiotensin IIVasoconstriction P.ResistanceSodium RetentionBlood VolumeAldosteroneHypertension2021/4/278Pathogenesis of Renovascular HConsequences of Hypertension:Blood VesselsAtherosclerosis and its complications aneurism,Dissection,Rupture,necrosis.Arteriolosclerosis,HeartHypertensive cardiomyopathy,IHD,MI.KidneyBenign/Malignant nephrosclerosis.InfarctionEyes:Hypertensive retinopathyBrain:Haemorrhage,infarction,splinter&Lacunar hemorrhages2021/4/279Consequences of Hypertension:BHyperplastic Arteriolosclerosis:Onion Skin ThickeningOnion Skin ThickeningOf arterioles.Of arterioles.Narrow LumenNarrow Lumen2021/4/2710Hyperplastic ArteriolosclerosiBenign Nephrosclerosis:Leathery Granularity Leathery Granularity due to minute scarringdue to minute scarring2021/4/2711Benign Nephrosclerosis:LeatheLeft Ventricular Hypertrophy:Left Ventricular HypertrophyLeft Ventricular Hypertrophy2021/4/2712Left Ventricular Hypertrophy:LCerebral Infarction(Stroke):HaemorrhagicHaemorrhagicNecrosisNecrosis2021/4/2713Cerebral Infarction(Stroke):Subarachnoid Haemorrhage:Cerebral Blood vesselsSpecial features:Thin walled*End arteries*Cong.Aneurisms2021/4/2714Subarachnoid Haemorrhage:CerebLacunar Infarcts:Chronic hypertensionArteriolosclerosis of deep penetrating arterioles of brain stem.Single or multiple cavitary infarcts lacunes.Lenticular nucleus,thalamusSlit Haemorrhages.2021/4/2715Lacunar Infarcts:Chronic hyperRenal Artery stenosis-AtrophyLeathery GranularityBenign Nephrosclerosis2021/4/2716Renal Artery stenosis-AtrophNormal Retina-Fundoscopy2021/4/2717Normal Retina-Fundoscopy2021Hypertensive 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-Papilloedema2021/4/2718Hypertensive Retinopathy:GradeMalignant Hypertension:May complicate any type of HTN.Necrotizing arteriolitis.Intravascular thrombosis.Rapidly progressive end organ damage.Renal failureHypertensive encephalopathy.Left ventricular failure.2021/4/2719Malignant Hypertension:May comNecrotizing arteriolitis:Fibrinoid NecrosisFibrinoid NecrosisThrombosisThrombosis2021/4/2720Necrotizing arteriolitis:FibriConclusions:Persistent increased blood pressure(140/90)95%Essential,5%secondary-RenovascularBenign and Malignant types(120Diastolic)Vessel damage&Arteriolosclerosis Complicates-Atherosclerosis,Diabetes,IHDIschemia or Infarction in end organs.Kidney,Brain,Heart&Eyes.Nephrosclerosis,renal damage,IHD,MI,Stroke&Retinopathy.2021/4/2721Conclusions:Persistent increasSelf 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?2021/4/2722Self Assessment Questions:Defi“Do what you love,love what you do,and deliver more than you promise”Harvey Mackay 2021/4/2723“Do what you love,love what y谢谢观赏！2020/11/524谢谢观赏！2020/11/524
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