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,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,#,Pathology of,Hypertension:,Dr.Venkatesh M.Shashidhar.,Senior Lecturer in Pathology,Fiji School of Medicine,Hypertension-Introduction,Silent Killer painless complications,dizziness,headache,and visual difficulties,It is the leading risk factor MI,DM,Stroke,Responsible for the majority of office visits,Number one reason for drug prescription.,25%of population,35%aware.,140,Diastolic 90 mm of Hg*,Normal*130 210/120,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.,Control of Blood Pressure:,BP,Cardiac,Output,Peripheral,Resistance,Blood Volume,Na+,Aldosterone,Vasoconstrictors,Angiotensin II,Catecholamines,Vasodilators,Pg&Kinins,Local Factors,pH,Hypoxia,Neural Factors,Adrenergic Cons,Adrenergic-Dil,Cardiac Factors,Rate&Contract.,Humoral Factors,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.,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,Pathogenesis of Renovascular HTN:,GFR,Renin by JGA,Angiotensin II,Vasoconstriction,P.Resistance,Sodium Retention,Blood Volume,Aldosterone,Hypertension,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,Hyperplastic Arteriolosclerosis:,Onion Skin Thickening,Of arterioles.,Narrow Lumen,Benign Nephrosclerosis:,Leathery Granularity,due to minute scarring,Left Ventricular Hypertrophy:,Left Ventricular Hypertrophy,Cerebral Infarction(Stroke):,Haemorrhagic,Necrosis,Subarachnoid Haemorrhage:,Cerebral Blood vessels,Special features:,Thin walled*,End arteries*,Cong.Aneurisms,Lacunar Infarcts:,Chronic hypertension,Arteriolosclerosis of deep penetrating arterioles of brain stem.,Single or multiple cavitary infarcts lacunes.,Lenticular nucleus,thalamus,Slit Haemorrhages.,Renal Artery stenosis-Atrophy,Leathery Granularity,Benign Nephrosclerosis,Normal Retina-Fundoscopy,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,Malignant Hypertension:,May complicate any type of HTN.,Necrotizing arteriolitis.,Intravascular thrombosis.,Rapidly progressive end organ damage.,Renal failure,Hypertensive encephalopathy.,Left ventricular failure.,Necrotizing arteriolitis:,Fibrinoid Necrosis,Thrombosis,Conclusions:,Persistent increased blood pressure(140/90),95%Essential,5%secondary-Renovascular,Benign and Malignant types(120Diastolic),Vessel damage&Arteriolosclerosis,Complicates-Atherosclerosis,Diabetes,IHD,Ischemia or Infarction in end organs.,Kidney,Brain,Heart&Eyes.,Nephrosclerosis,renal damage,IHD,MI,Stroke&Retinopathy.,Self 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?,“Do what you love,love what you do,and deliver more than you promise”,Harvey Mackay,
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