Commonent condition of CVS,Civilization disease

1. HYPERTENSION
Dr. Jyoti Priyadarshini Shrivastava
Associate Professor
Department of Pathology
Gajra Raja Medical College

3. Blood Pressure
Blood pressure is the force exerted by
the blood against the walls of the blood
vessels

5. Hypertension (HTN or HT),
also known as high blood
pressure (HBP), is a long-term
medical condition in which the
blood pressure in the arteries is
persistently elevated.

8. DEFINITION

10. BLOOD PRESSURE CLASSIFICATION
BP Classification SBP mmHg DBP 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
*newly recognized, requiring
lifestyle modifications

12. Danger zone of high blood pressure?
Physicians recommend that you maintain blood pressure at
or below 120/80 mmHg
High blood pressure is medically defined as any reading
higher than 140/90 mmHg.
Readings of 121 to 139 systolic or 81 to 89 diastolic are
considered prehypertension
warning that blood pressure may soon rise into the danger zone.

13. HYPERTENSION
For persons over age 50, SBP is more
important than DBP as a CVD risk factor
Starting at 115/75 mmHg, CVD risk doubles
with each increment of 20/10 mmHg
throughout the BP range.

14. HTN Scenario in India

18. Aetiology

20. Types of HYPERTENSION
 Primary/Essential: Unknown (80-95%)
 Secondary Hypertension: (5-20%)
 Both Primary and Secondary can be-----
1.Benign
2.Malignant

26. Hypertension During Pregnancy
6-8% cases of pregnancy
First pregnancy
Etiology:
1.Hormonal change
3.Preeclampsia (complication)

27. Etiologic Classification of Hypertension
 Essential Hypertension
1.Genetic Factors
2.Racial
3.Environmental Factors
4.Risk Factors modifying the course of Essential HTN
 Secondary Hypertension
1.Renal:
a.Renovascular
b.Renal Parenchymal Disease
2.Endocrine:
a.Adrenocortical Hyperfunction
b.Hyperparathyroidism
c.Oral Contraceptives
3.Coarctation of Aorta
4.Neurogenic

28. Essential Hypertension
Genetic Factors:
1.Familial Aggregation
2.HTN in twins
3.Racial:African Americans> Whites
4.Environmental : Salt intake
Obesity
Skilled Occupation
Higher Living standards
Stress

29. Essential Hypertension
Risk Factors modifying the course of Essential HTN
Age: Younger the age
Left untreated
Sex : Females respond better
Atherosclerosis: + Cigarette
Elevated serum cholesterol
Glucose Intolerance
Obesity
Other Risk Factors: Smoking
Alcohol
Diabetes Mellitus
Persistant High D.P
End Organ Damage

30. PATHOGENESIS

31. Secondary Hypertension
 RENAL HTN:
1.Renal vascular Hypertension
Occlusion of major vs.
Pre-Eclampsia
Eclampsia
PAN
Fibro-muscular Dysplasia of Renal artery
2. Renal Parenchymal HTN:
Glomerulonephritis
Pyelonephritis
Diabetic Nephropathy
Amyloidosis
Polycystic kidney Disease
Renin producing tumours

32.  Activation of Renin-Angiotensin Aldosterone
System(RAAS)
The most important system involved in the regulation of
systemic blood pressure, renal blood flow and glomerular
filtration rate is called the renin-angiotensin-aldosterone
system, or (RAAS) .
The Renin-Angiotensin System and Blood Pressure Control.
The renin-angiotensin system or RAS regulates blood
pressure and fluid balance in the body.
When blood volume or sodium levels in the body are low, or
blood potassium is high, cells in the kidney release the
enzyme, renin.

36. B.Sodium-Water Retention:
Blood volume and Cardiac Output ---Regulate BP
Regulated by Sodium
Sodium regulates the extracellular fluid volume .
Blood conc. Of Na is regulated by:
Aldosterone
Reduce GFR
Release of Atriopeptin Hormone

37. c.Release of Vasodepressor Material
 Prostaglandins
 Urinary kallikrein-kinin Vasopressor+Anti HTN
 Platelet –activating factor
Angiotensin II

38. ENDOCRINE HTN
1.Adrenal Gland-Primary
Aldosteronism,Cushings Syndrome,Adrenal
Virilism,
2.Parathyroid Gland: Hypercalcemia in
Hyperparathyroidism
3.Oral Contraceptives: Oestrogen

39. COARCTATION OF AORTA
Systolic HTN in upper part of the
body due to constriction
Diastolic HTN due to changes in
circulation

40. NEUROGENIC
 Psychogenic
 Poluneuritic
 Increased Intracranial Pressure

41. Clinical Effects

42. Three Main Organs
1.Heart and its Blood Vessels
2.Nervous System
3.Kidneys

43. Renal changes
Lab. Investigations
1.Microalbuminuria by RIA(30-300
mg/day)
2. Macroalbuminuria- >150 mg/day
3. Random Urine Albumin/Creatinine
Ratio->300mg/gram Creatinine

44. Renal Effects contd.
Benign Nephrosclerosis
Benign phase of Hypertension
Commonest form of Renal Disease >60 years
Severity Increases with Hypertension and
Diabetes Mellitus.

45. Morphology
 Gross:
Bilateral infiction
Reduced in size and weight.
Weight: 100 gm or less
Capsule is adherent
Surface Granular
V-shaped Scars
 Cut Surface:
Firm kidney
Narrowed cortex

53.  Clinical features
Headache
Dizzness
Palpitation
Nervousness
Urine-RM,RFT---wnl
Mildpoteinuria
Rarely,renal failure

54. Malignant Nephrosclerosis

55.  Malignant /Accelerated Hypertension
 Superimposed Complication
 Kidneys: Small,Shrunken,reducedweight
 Surface: Granular
Flea –Bitten Kidney
Cut surface: Red ,yellow mottled appearance

57. MICROSCOPY

60. Studies have shown that daily banana
consumption, can help lower blood
pressure.
One study in particular said just two
bananas a day can reduce your blood
pressure by 10 percent!
Other potassium-rich foods include
potatoes, dates, and avocados

61. HYPERTENSIVE HEART DISEASE
 Gross: Hypertrophy of Heart
 Wt.-500 gm
 LVW-UPTO 20 mm
 Concentric hypertrophy

62. Microscopy

64. THANK YOU