This document discusses the sequelae and complications of hypertension. It begins by outlining its effects on the nervous system, including risks of transient ischemic attack, stroke, cerebral hemorrhage, dementia, and mild cognitive impairment. Kidney damage is also detailed, such as hypertensive nephropathy, glomerulosclerosis, kidney failure, and renal artery aneurysms. Additional complications covered include retinal damage causing retinopathy, choroidopathy, and optic neuropathy; sexual dysfunction; osteoporosis; and obstructive sleep apnea. Hypertensive crises of urgencies and emergencies are defined in relation to end-organ dysfunction. Quizzes are also provided to test understanding.

1. HYPERTENSION
Sequel of Hypertension - 2
Mohammad Ilyas, M.D.
Assistant Clinical Professor
University of Florida / Health Sciences Center
Jacksonville, Florida USA
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2. Outline
1. Definition, Regulation and Pathophysiology
2. Measurement of Blood Pressure, Staging of Hypertension and Ambulatory Blood
Pressure Monitoring
3. Evaluation of Primary Versus Secondary
4. Sequel of Hypertension and Hypertension Emergencies
5. Management of Hypertension (Non-Pharmacology versus Drug Therapy)
6. The Relation Between Hypertension: Obesity, Drugs, Stress and Sleep Disorders.
7. Hypertension in Renal diseases and Pregnancies
8. Pediatric, Neonatal and Genetic Hypertension
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3. 1. Nervous System
• Transient ischemic attack (TIA)
• Stroke, intracerebral and subaracnoid hemorrhage.
• Cerebral atrophy and dementia
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4. 1a. Transient Ischemic Attack (TIA)
• Sometimes called a mini-stroke, a transient ischemic attack is a brief,
temporary disruption of blood supply to brain.
• It's often caused by atherosclerosis or a blood clot — both of which can
arise from high blood pressure.
• A transient ischemic attack is often a warning that patient is at risk of a full-
blown stroke.
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5. 5

6. 1b. Stroke
• A stroke occurs when part of brain is deprived of oxygen and nutrients,
causing brain cells to die.
• Uncontrolled high blood pressure can lead to stroke by damaging and
weakening brain's blood vessels, causing them to narrow, rupture or leak.
• High blood pressure can also cause blood clots to form in the arteries
leading to brain, blocking blood flow and potentially causing a stroke.
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7. Intracerebral Hemorrhage (ICH)Cerebral Aneurysm
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8. 8

9. Stroke mortality related to blood pressure and age
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10. 1c. Dementia
• Dementia is a brain disease resulting in problems with thinking, speaking,
reasoning, memory, vision and movement. There are a number of causes of
dementia.
• One cause, vascular dementia, can result from narrowing and blockage of
the arteries that supply blood to the brain. It can also result from strokes
caused by an interruption of blood flow to the brain.
• In either case, high blood pressure may be the culprit.
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11. 11

12. 1d. Mild Cognitive Impairment
• Mild cognitive impairment is a transition stage between the changes in
understanding and memory that come with aging and the more-serious
problems caused by Alzheimer's disease.
• Like dementia, it can result from blocked blood flow to the brain when high
blood pressure damages arteries.
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13. 2. Effects on Kidneys
• High blood pressure can injure both the blood vessels in and leading to
kidneys, causing several types of nephropathy.
• Having diabetes in addition to high blood pressure can worsen the damage.
• Glomerular sclerosis leading to impaired kidney function and finally end
stage kidney disease.
• Ischemic kidney disease especially when renal artery stenosis is the cause of
HTN
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14. 2a. Hypertensive Nephropathy
• Arterial hypertension leads to hyaline accumulation in the wall of small
arteries and arterioles, producing the thickening of their walls and the
narrowing of the lumina — hyaline arteriolosclerosis.
• Consequent ischemia will produce tubular atrophy, interstitial fibrosis,
glomerular alterations and periglomerular fibrosis.
• Glomerular damage resulting in proteinuria and hematuria.
• In advanced stages, renal failure will occur. Functional nephrons have
dilated tubules, often with hyaline casts in the lumens.
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15. Hypertensive nephropathy
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16. 2b. Glomerulosclerosis
• Glomerulosclerosis is caused by scarring of the glomeruli due to
hypertension
• Glomerulosclerosis can progress and leading to kidney failure.
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17. 2c. Kidney Failure
• High blood pressure is one of the most common causes of
kidney failure.
• That's because it can damage both the large arteries leading to
kidneys and the tiny blood vessels (glomeruli) within the kidneys.
• Damage to either makes it so kidneys can't effectively filter waste
from blood.
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18. 18

19. 2d. Kidney Artery Aneurysm
• An aneurysm is a bulge in the wall of a blood vessel.
• When it occurs in an artery leading to the kidney, it's known as a kidney
(renal) artery aneurysm.
• One potential cause is atherosclerosis, which weakens and damages the artery
wall. Over time, high blood pressure in a weakened artery can cause a section
to enlarge and form a bulge — the aneurysm.
• Aneurysms can rupture and cause life-threatening internal bleeding.
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20. Kidney artery aneurysm
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21. 3. The Eyes
• Retinopathy, retinal hemorrhages and impaired vision.
• Vitreous hemorrhage, retinal detachment
• Neuropathy of the nerves leading to extraoccular muscle paralysis and
dysfunction
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22. 3a. Retinopathy
• High blood pressure can damage the vessels supplying blood to retina,
causing retinopathy.
• This condition can lead to bleeding in the eye, blurred vision and complete
loss of vision.
• If patient has both diabetes and high blood pressure, he is at an even greater
risk.
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23. Retina Normal and Hypertensive Retinopathy
Normal Retina Hypertensive Retinopathy A: Hemorrhages
B: Exudates (Fatty Deposits)
C: Cotton Wool Spots (Micro
Strokes)
A B
C
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24. Stage I- Arteriolar Narrowing
Arteriolar Narrowing
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25. Stage II - AV Nicking
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26. 3b. Choroidopathy
• In this condition, fluid builds up under retina because of a leaky blood vessel
in a layer of blood vessels located under the retina.
• Choroidopathy (kor-oid-OP-uh-thee) can result in distorted vision or in
some cases scarring that impairs vision.
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27. Stage III- Hemorrhages (H), Cotton Wool Spots and Exudates (E)
H
E
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28. Punctate
Choroidopathy
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29. 3c. Optic Neuropathy
• Optic nerve damage
• This is a condition in which blocked blood flow damages the optic nerve.
• It can kill nerve cells in eyes, which may cause bleeding within eye or vision
loss.
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30. Stage IV- (Stage III + Papilledema)
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31. 4. Sexual dysfunction
• In men, high blood pressure damages the lining of blood vessels in penis
and causes arteries to harden and narrow (atherosclerosis), limiting blood
flow makes it difficult to achieve and maintain erections lead to erectile
dysfunction.
• In women, high blood pressure can reduce blood flow to vagina leads to a
decrease in sexual desire or arousal, vaginal dryness, or difficulty achieving
orgasm.
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32. 5. Other complications of HTN
• 5a. Osteoporosis. High blood pressure can increase the amount of calcium
that's in urine. That excessive elimination of calcium may lead to loss of
bone density (osteoporosis), which in turn can lead to broken bones. The
risk is especially increased in older women.
• 5b. Obstructive sleep apnea. Trouble sleeping occurs in more than half of
those with high blood pressure. It's now thought that high blood pressure
itself may help trigger sleep apnea.
• Sleep deprivation resulting from sleep apnea can raise your blood pressure.
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33. 6. Hypertensive Crises
• Hypertensive Urgencies: No progressive target-organ dysfunction.
(Accelerated Hypertension)
• Hypertensive Emergencies: Progressive end-organ dysfunction.
(Malignant Hypertension)
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34. 6a. Hypertensive Urgencies
• Severe elevated BP in the upper range of stage II hypertension.
• Without progressive end-organ dysfunction.
• Examples: Highly elevated BP without severe headache, shortness of breath
or chest pain.
• Usually due to under-controlled HTN.
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35. 6b. Hypertensive Emergencies
• Severely elevated BP (>180/120mmHg).
• With progressive target organ dysfunction.
• Require emergent lowering of BP.
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36. Summery
• Hypertensive encephalopathy.
Problems with your brain, marked
by memory loss, personality
changes, trouble concentrating,
irritability or progressive loss of
consciousness Stroke
• Acute left ventricular failure with
pulmonary edema
• Acute MI or unstable angina
pectoris
• Dissecting aortic aneurysm
• Preeclampsia or eclampsia
• Acute renal failure
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37. 37

38. Quiz 8. Hypertension can cause all of the following
Nervous System symptoms EXCEPT?
A. Transient ischemic attack (TIA)
B. Alzheimer disease
C. Seizure
D. Intracerebral and subaracnoid hemorrhage.
E. Cerebral atrophy and dementia
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39. Quiz 8. Hypertension can cause all of the following
Nervous System symptoms EXCEPT?
A. Transient ischemic attack (TIA)
B. Alzheimer disease
C. Seizure
D. Intracerebral and subaracnoid hemorrhage.
E. Cerebral atrophy and dementia
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40. Quiz 9. All of the following statement are true about Stroke,
EXCEPT?
A. A stroke occurs when part of brain is deprived of oxygen and nutrients.
B. Uncontrolled high blood pressure can lead to stroke by damaging and weakening brain's
blood vessels, causing them to narrow, rupture or leak.
C. High blood pressure can also cause blood clots to form in the arteries leading to brain,
blocking blood flow and potentially causing a stroke.
D. Stroke mortality decreases with increasing age.
E. A transient ischemic attack is often a warning for a full-blown stroke.
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41. Quiz 9. All of the following statement are true about Stroke,
EXCEPT?
A. A stroke occurs when part of brain is deprived of oxygen and nutrients.
B. Uncontrolled high blood pressure can lead to stroke by damaging and weakening brain's
blood vessels, causing them to narrow, rupture or leak.
C. High blood pressure can also cause blood clots to form in the arteries leading to brain,
blocking blood flow and potentially causing a stroke.
D. Stroke mortality decreases with increasing age.
E. A transient ischemic attack is often a warning for a full-blown stroke.
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42. Quiz 10. Which of the following statement is false about the effects
of HTN on Kidneys
A. High blood pressure can injure both the blood vessels in and leading to kidneys, causing
several types of nephropathy.
B. Having diabetes in addition to high blood pressure can worsen the damage.
C. Glomerular sclerosis leading to impaired kidney function and finally end stage kidney
disease.
D. Ischemic kidney disease especially when renal artery stenosis is the cause of HTN
E. HTN is the number one cause of renal failure worldwide
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43. Quiz 10. Which of the following statement is false about the effects
of HTN on Kidneys
A. High blood pressure can injure both the blood vessels in and leading to kidneys, causing
several types of nephropathy.
B. Having diabetes in addition to high blood pressure can worsen the damage.
C. Glomerular sclerosis leading to impaired kidney function and finally end stage kidney
disease.
D. Ischemic kidney disease especially when renal artery stenosis is the cause of HTN
E. HTN is the number one cause of renal failure worldwide
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44. Quiz 11. Following Eyes changes has been described
in patient with hypertension except?
A. Retinopathy
B. Vitreous hemorrhage
C. Uveitis
D. Retinal detachment
E. Neuropathy
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45. Quiz 11. Following Eyes changes has been described
in patient with hypertension except?
A. Retinopathy
B. Vitreous hemorrhage
C. Uveitis
D. Retinal detachment
E. Neuropathy
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46. Quiz 12. TRUE & FALSE about Hypertensive Urgencies
1. Urgent HTN is a severe elevated BP in the upper range of stage II
hypertension.
2. Urgent HTN is with progressive end-organ dysfunction.
3. Highly elevated BP with severe headache, shortness of breath or chest pain.
4. Usually due to poor-controlled HTN.
5. Urgent HTN is often needs hospitalizations
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47. Quiz 12. TRUE & FALSE about Hypertensive Urgencies
1. Urgent HTN is a severe elevated BP in the upper range of stage II
hypertension. TRUE
2. Urgent HTN is with progressive end-organ dysfunction. FALSE
3. Highly elevated BP with severe headache, shortness of breath or chest pain.
FALSE
4. Usually due to poor-controlled HTN. TRUE
5. Urgent HTN is often needs hospitalizations. FALSE
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