This document discusses hypertensive diseases and their complications. It begins by outlining various hypertensive diseases that can affect the cerebrovascular system, eyes, heart and kidneys. It then defines hypertension and hypertensive emergencies/urgencies. The remainder of the document provides more details on specific hypertensive diseases and complications, including hypertensive encephalopathy, cerebrovascular accidents, retinopathy, left ventricular hypertrophy, coronary artery disease, cardiac arrhythmias, congestive heart failure, benign and malignant nephrosclerosis. It also discusses diagnostic criteria and management of various hypertensive conditions.

1. Dr. Chinedu Ibeh(MBBS; MPH; MWACP)

2.  Introduction
 Hypertensive Cerebrovascular diseases
 Hypertensive Encephalopathy
 Cerebrovascular Accidents
▪ Ischaemic CVA
▪ Haemorrhagic CVA
 Hypertensive Eye Disease
 Retinopathy
 Hypertensive Heart Diseases
 LeftVentricular Hypertrophy
 Coronary Artery Disease
 Cardiac Arrhythmias and
 Congestive Heart Failure
 Hypertensive Kidney diseases
 Benign Nephelosclerosis
 Malignant Nephelosclerosis

3.  Hypertension is a condition in which the blood vessels have
persistently raised pressure.1
 Blood pressure is the product cardiac output and systemic vascular
resistance.1
 Hypertensive Urgency is defined as severely elevated BP with no
evidence of target organ damage.2
 Hypertensive Emergency is a condition in which elevated blood
pressure (BP) results in target organ damage.2
 End Organ damage usually refers to damage to major organs fed by the
circulatory system which can sustain damage due uncontrolled
hypertension, hypotension or hypovolemia.5
 World Hypertension Day(May 17; 2018 theme: Know your numbers).

4. American College of Cardiology 2017 Guideline on
Categories of BP in Adults. 6
BP Category SBP DBP
Normal <120 mmHg and <80 mmHg
Elevated 120–129 mm Hg and <80 mmHg
Stage 1 130–139 mm Hg or 80–89 mm Hg
Stage 2 ≥140 mm Hg or ≥90 mm Hg

5.  Factors that play a role in the pathogenesis of Hypertension:
 Genetics
 Activation of neuro-hormonal systems
▪ Sympathetic nervous system
▪ Renin-angiotensin-aldosterone system
 Obesity, Increased salt intake
 Factors involved in short term and long term regulation of BP
for adequate tissue perfusion
 Cardiac output and circulatory blood volume
 Vascular caliber , elasticity and reactivity
 Humoral mediation, Neural stimulation
.Complications are largely attributed to the
▪ remodeling of the arterial wall, including accelerated atherosclerosis

6. Vision Eye Institute. Hypertensive retinopathy 2017 . Available from
https://visioneyeinstitute.com.au/eyematters/hypertensive-retinopathy/. [accessed on 19/3/18]

7.  Hypertensive Encephalopathy
 Cerebrovascular accidents
 Haemorrhagic CVA
 Ischaemic CVA

8.  This is a syndrome consisting of a sudden elevation of
arterial pressure usually preceded by severe headache
and followed by convulsions, coma or a variety of
transitory cerebral phenomena.3
 Symptoms may include
 Headache
 Vomiting
 Trouble with balances
 confusion
 Onset is generally sudden
 Complications include
 Seizures

9.  CVA is a medical name for
stroke.
 A stroke is a sudden death
of some brain cells due to
lack of oxygen when
blood flow to a part of the
brain is impaired either by
blockage or rupture of a
blood vessel.
 World stroke day: 29/10
 Theme: 1/6 of us will suffer a
stroke in our lifetime; we all
have good reason to prevent
stroke.

10.  Muscular: difficulty walking, paralysis with weak muscles,
problems with coordination, stiff muscles, overactive reflexes,
or paralysis of one side of the body
 Whole body: balance disorder, fatigue, light-headedness, or
vertigo
 Visual: blurred vision, double vision, sudden visual loss, or
temporary loss of vision in one eye
 Speech: difficulty speaking, slurred speech, or speech loss
 Sensory: pins and needles or reduced sensation of touch
 Facial: muscle weakness or numbness
 Limbs: numbness or weakness
 Also common: difficulty swallowing, headache, inability to
understand, mental confusion, or rapid involuntary eye
movement

11.  Ischemic stroke occurs when an artery to the
brain is blocked.
 Ischemic stroke can be divided into two main
types: thrombotic and embolic.
 A thrombotic stroke occurs when diseased cerebral
arteries become blocked by blood clot within the
brain-responsible for almost 50 percent of all strokes.
 An embolic stroke is also caused by a clot within an
artery outside the brain itself.
 This results in near-immediate physical and
neurological deficits.

12.  Medical history to identify risk factors for
atherosclerotic and cardiac disease:
 Hypertension, Diabetes mellitus,Tobacco use
 High cholesterol, History of coronary artery disease,
coronary artery bypass, or atrial fibrillation
 In younger patients, elicit a history of the following:
 Recent trauma, Coagulopathies
 Illicit drug use (especially cocaine)
 Migraines, Oral contraceptive use
 Nausea, vomiting, headache, and a sudden change
in the patient’s level of consciousness are more
common in hemorrhagic strokes

13.  Hemiparesis, monoparesis, or (rarely) quadriparesis
 Hemisensory deficits
 Monocular or binocular visual loss
 Visual field deficits
 Diplopia
 Dysarthria
 Facial droop
 Ataxia
 Vertigo (rarely in isolation)
 Aphasia
 Sudden decrease in the level of consciousness
 No historical feature distinguishes ischemic from
hemorrhagic stroke,.

14.  Cranial nerves
 Motor function
 Sensory function
 Cerebellar function
 Gait
 Language (expressive and receptive capabilities)
 Mental status and level of consciousness

15.  A hemorrhagic stroke is either a
brain aneurysm burst or a weakened blood
vessel leak.
 Blood spills into or around the brain and
creates swelling and pressure, damaging cells
and tissue in the brain.
 There are two types of hemorrhagic stroke
called
 intracerebal and
 subarachnoid.

16.  Blood vessel inside the brain ruptures and
leaks blood into surrounding brain tissue.
 High blood pressure and aging blood vessels
are the most common causes of this type of
stroke.
 Sometimes intracerebral hemorrhagic stroke
can be caused by an arteriovenous
malformation (AVM).

17.  This type of stroke involves bleeding in the area
between the arachnoid membrane and the pia
mater known as the subarachnoid space.
 This type of stroke is most often caused by a
burst aneurysm.
 Other causes include:
 Artero-Venous Malformation
 Bleeding disorders
 Head injury
 Blood thinners

18.  Generalized symptoms, including
 nausea, vomiting, and headache, as well as an
altered level of consciousness, may indicate
increased
▪ intracranial pressure and are more common with
hemorrhagic strokes and large ischemic strokes.
 Seizures are more common occurring in 28%
of hemorrhagic stroke generally at the
 onset of the intracerebral hemorrhage or within
the first 24 hours..

19.  Focal symptoms of stroke include the following:
 Weakness or paresis that may affect a single extremity, one half of the body,
or all 4 extremities
 Facial droop
 Monocular or binocular blindness
 Blurred vision or visual field deficits
 Dysarthria and trouble understanding speech
 Vertigo or ataxia
 Aphasia
 Symptoms of subarachnoid hemorrhage may include the following:
 Sudden onset of severe headache
 Signs of meningismus with nuchal rigidity
 Photophobia and pain with eye movements
 Nausea and vomiting
 Syncope - Prolonged or atypical

20.  Time is of essence in the diagnosis of stroke.
 There is urgency to make the diagnosis and determine
whether treatment with thrombolytic medications (clot-
busting drugs) to “reverse” the stroke is a possibility.
 The time frame to intervene is narrow and may be as short
as 3 to 4 ½ hours after onset of symptoms
 AHA and ASA recommend that everybody be aware
of “FAST“ in recognizing stroke:
 Face Drooping, ArmWeakness, Speech Difficulty,Time to
Call 9-1-1(emergency line 112 for Nigeria)
 In the emergency department, doctors may perform a
more in depth and standardized neurologic
examination..

21.  Radiological tests including
 CT is used to look for bleeding or masses.
 CT perfusion scan done to check brain blood supply (perfusion).
 An MRI of the brain may be possibly indicated.
 Blood tests may include a
 Full blood count
 SEUCr,
 FBS,
 Blood Clotting function with international normalized ratio
(INR), prothrombin time (PT) and partial thromboplastin time
(PTT).
 An ECG may be performed to check the heart's rate and
rhythm.

22.  Hypertensive retinopathy is retinal
vascular damage caused by
hypertension.
 Symptoms usually do not develop until
late in the disease and include blurred
vision or visual field defects.
 Signs usually develop late in the
disease.
 Funduscopic examination shows
 arteriolar constriction,
 arteriovenous nicking,
 vascular wall changes,
 flame-shaped hemorrhages,
 cotton-wool spots,
 yellow hard exudates, and
 optic disk edema
▪ World sight day: 2nd Thursday of october(11/10)

24.  HHD is a term applied generally to heart
diseases that are caused by the direct or
indirect effects of elevated BP such as
 LeftVentricular Hypertrophy
 Coronary Artery Disease
 Cardiac Arrhythmias and
 Congestive Heart Failure
▪ World Heart Day: 29/09

25.  Left ventricular hypertrophy is the enlargement
and thickening of the walls of the left ventricle.
 Left ventricular hypertrophy is more common in
people who have uncontrolled high blood
pressure

26.  Left ventricular hypertrophy usually develops
gradually.
 One may experience no signs or symptoms, especially
during the early stages of the condition.
 As left ventricular hypertrophy progresses, you may
experience:
 Shortness of breath
 Fatigue
 Chest pain, often after exercising
 Sensation of rapid
 Palpitations
 Dizziness or fainting

27.  Develops when the major blood vessels that supply
the heart with blood, oxygen and nutrients (coronary
arteries) become damaged or diseased.
 This is due to deposition of Cholesterol-containing
deposits (plaque) in the coronary arteries.

28.  Chest pain (angina).
 pressure or tightness in the chest usually occurs on the
middle or left side of the chest which is generally triggered
by physical or emotional stress.
 this pain may be fleeting or sharp and felt in the neck, arm
or back.
 Shortness of breath.
 Heart attack.
 A completely blocked coronary artery may cause a heart
attack.
 The classic signs and symptoms of a heart attack include
▪ crushing pressure in the chest and
▪ pain in the shoulder or arm, sometimes with shortness of breath
and sweating.

29.  A cardiac arrhythmia is any abnormal heart rate or
rhythm.
 In normal adults, the heart beats regularly at a rate of 60
to 100 beats per minute, and the pulse matches the
contractions of the ventricles.
 Cardiac arrhythmias sometimes are classified according to
their origin as
 ventricular arrhythmias or
 supraventricular arrhythmias
 They also can be classified according to their effect on the heart
rate,
▪ with bradycardia indicating a heart rate of less than 60 beats per
minute and
▪ tachycardia indicating a heart rate of more than 100 beats per minute.

30.  Asymptomatic
 Dizziness
 Fainting
 Extreme fatigue.
 Palpitations
 Lightheadedness
 Loss of consciousness

31.  Congestive heart failure(CHF) is a condition in
which the heart's function as a pump is
inadequate to meet the body's needs.
 The symptoms of congestive heart failure
vary, but can include:
 Easy fatiguability
 Diminished exercise capacity,
 shortness of breath and
 swelling (edema).

32.  Hypertensive kidney disease is a medical
condition referring to damage to the kidney due
to chronic high blood pressure.
 HN can be divided into two types:
 benign and malignant.
 Benign nephrosclerosis is common in individuals over
the age of 60
 Malignant nephrosclerosis is uncommon and affects
1-5% of individuals with high blood pressure, that
have diastolic blood pressure passing 130 mm Hg.
▪ World kidney day(8/03); theme: kidneys & women’s health:
include, value, empower.

33.  Chronic high blood pressure causes damages
to kidney tissue including
 the small blood vessels, glomeruli, kidney tubules
and interstitial tissues.
 The tissue hardens and thickens which is known
as nephrosclerosis.[4]
 The narrowing of the blood vessels means less
blood is going to the tissue and so less oxygen is
reaching the tissue resulting in tissue death
(ischemia).

34.  Glomerular ischemia
 High blood pressure damages the endothelium which
leads to a build-up of plaques and eventual renal arteries
stenosis with consequent ischemic kidney disease leading
to a decrease in the size of the kidneys.
 Glomerular hypertension and glomerular
hyperfiltration
 An alternative mechanism of hypertensive nephropathy is
prolonged glomerular hypertension and hence glomerular
hyperfiltration. As a compensatory mechanism, the
unaffected nephrons vasodilate to increase blood flow to
the kidney and increase glomerular filtration across
undamaged glomeruli.

35.  Damage to the glomeruli allows proteins that are
usually too large to pass into the nephron to be
filtered.
 This leads to an elevated concentration of albumin in
the urine.
 Protein in the urine is best identified from a 24-hour
urine collection.
 Haematuria
 Definitive diagnosis requires morphological
examination.
 Common histological features include Glomerulosclerosis
which is either focally or globally and characterized by
hardening of the vessel walls..

36.  Thank you for your attention
 Questions and contributions

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