Increment in blood pressure above a level that is harmful to the organs of the body
Optimal 120/ 80
Normal 130 /85
High normal 130–139 /85–89
Stage 1 (mild) 140–159 90–99
Stage 2 (moderate) 160–179/ 100–109
Stage 3 (severe) 180 /110
Isolated systolic hypertension140/ 90
Malignant HTN= accelerated HTN+papilledema
Hypertension can broadly be divided into :
BENIGN HYPERTENSION: 90 – 95% of cases.
MALIGNANT/ ACCELERATED HYPERTENSION: 5%
Rapidly rising blood pressure that if untreated leads to end organ failure and death within 1 or 2 years.
Clinically - Severe hypertension - diastolic pressure over 120 mm Hg, renal failure, and retinal hemorrhages and exudates, with or without papilledema.
MORPHOLOGY: Blood vessels show fibrinoid necrosis or concentric hyperplasia of smooth muscle-cells – Hyperplastic arteriosclerosis -- onion-skin changes. These hyperplastic changes are accompanied by fibrinoid deposits and acute necrosis of the vessel walls, referred to as necrotizing arteriolitis, particularly in the kidney.
Causes
Essential Hypertension
Secondary Hypertension
Renal:
Acute glomerulonephritis,
Chronic renal disease,
Polycystic disease,
Renal artery stenosis,
Renal artery fibromuscular dysplasia,
Renal vasculitis,
Renin-producing tumors
Endocrine:
Adrenocortical hyperfunction (Cushing syndrome, primary aldosteronism, congenital adrenal hyperplasia, licorice ingestion)
Pheochromocytoma
Acromegaly
Hypothyroidism (myxedema)
Hyperthyroidism (thyrotoxicosis)
Exogenous hormones (glucocorticoids, estrogen [including pregnancy-induced and oral contraceptives]
Sympathomimetics and tyramine-containing foods, monoamine oxidase inhibitors
Pregnancy-induced (Pre eclampsia)
Cardiovascular:
Coarctation of aorta,
Polyarteritis nodosa (or other vasculitis),
Increased intravascular volume,
Increased cardiac output,
Rigidity of the aorta
Increased intracranial pressure
Sleep apnea
BP regulation
Complications of HTN
Hypertensive Encephalopathy and Cerebral Atrophy
Sub arachnoid and intracerebral hemorrhage
Hypertensive Retinopathy
Hypertensive Cardiomyopathy
Hypertensive nephropathy: Nephrosclerosis and chronic renal failure
Exacerbation of atherosclerosis
Aortic dissection and aneurysm formation
Resorption, fibrosis
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