48,584
edits
Difference between revisions of "Hypertension"
Jump to navigation
Jump to search
→See also
m (→Microscopic: +link) |
|||
| (21 intermediate revisions by the same user not shown) | |||
| Line 1: | Line 1: | ||
'''Hypertension''' is very common and affects multiple organs. Clinically, it is usually classified as primary (idiopathic) and secondary. | [[Image:Thrombotic microangiopathy - very high mag.jpg|thumb|right|250px|Micrograph of blood vessels in the kidney showing the changes of chronic [[thrombotic microangiopathy]], as may be seen in malignant hypertension.]] | ||
'''Hypertension''', also '''high blood pressure''', is very common and affects multiple organs. Clinically, it is usually classified as primary (idiopathic) and secondary. | |||
Hypertensive crisis, if untreated, is associated with damage to the [[brain]], [[heart]], [[eye]] and [[kidney]]s.<ref name=pmid19899722>{{cite journal |author=Janota T |title=[Hypertensive crisis--the present view] |language=Czech |journal=Cas. Lek. Cesk. |volume=148 |issue=8 |pages=370–3 |year=2009 |pmid=19899722 |doi= |url=}}</ref> | Hypertensive crisis, if untreated, is associated with damage to the [[brain]], [[heart]], [[eye]] and [[kidney]]s.<ref name=pmid19899722>{{cite journal |author=Janota T |title=[Hypertensive crisis--the present view] |language=Czech |journal=Cas. Lek. Cesk. |volume=148 |issue=8 |pages=370–3 |year=2009 |pmid=19899722 |doi= |url=}}</ref> | ||
Pulmonary hypertension is dealt with separately in the article ''[[pulmonary hypertension]]''. | Pulmonary hypertension is dealt with separately in the article ''[[pulmonary hypertension]]''. | ||
==Classification== | |||
It is classified by etiology. | |||
===Primary=== | |||
*Idiopathic. | |||
*Most common. | |||
===Secondary=== | |||
Renovascular: | |||
*[[Fibromuscular dysplasia]] of the renal artery | |||
*[[Atherosclerosis]] of the renal artery. | |||
*Compression of renal artery by a tumour. | |||
Endocrine related - tumours: | |||
*[[Juxtaglomerular cell tumour]] - produces renin. | |||
*[[Pheochromocytoma]]. | |||
*[[Renal cell carcinoma]]. | |||
*[[Adrenal cortical adenoma]] (aldosterone producing) - Conn syndrome. | |||
*[[Adrenal cortical carcinoma]] (aldosterone producing). | |||
*[[Wilms tumour]]. | |||
Other endocrine: | |||
*Hyperthyroidism. | |||
Other: | |||
*Renal failure. | |||
*[[Scleroderma]]. | |||
*Sleep apnea. | |||
*Drugs - notably [[alcohol]]. | |||
==Brain== | ==Brain== | ||
| Line 52: | Line 83: | ||
===General=== | ===General=== | ||
*Treated with antihypertensives. | *Treated with antihypertensives. | ||
*Mechanism of death: (ventricular) arrhythmia.<ref name=pmid15860963/> | *Mechanism of death: (ventricular) [[Cardiac arrhythmia|arrhythmia]].<ref name=pmid15860963/> | ||
====Associated pathology<ref name=pmid15860963>{{cite journal |author=Prisant LM |title=Hypertensive heart disease |journal=J Clin Hypertens (Greenwich) |volume=7 |issue=4 |pages=231–8 |year=2005 |month=April |pmid=15860963 |doi= |url=}}</ref>==== | ====Associated pathology<ref name=pmid15860963>{{cite journal |author=Prisant LM |title=Hypertensive heart disease |journal=J Clin Hypertens (Greenwich) |volume=7 |issue=4 |pages=231–8 |year=2005 |month=April |pmid=15860963 |doi= |url=}}</ref>==== | ||
*Left atrial enlargement and atrial fibrillation. | *Left atrial enlargement and [[atrial fibrillation]]. | ||
===Gross=== | ===Gross=== | ||
| Line 64: | Line 95: | ||
*In the autopsy context, significant [[valvular heart disease]] should be absent. | *In the autopsy context, significant [[valvular heart disease]] should be absent. | ||
*A heart > ~400 g is considered good enough for the cause of death ''hypertensive heart disease'', if no other significant findings are present.<ref>MSP. 29 September 2010.</ref> | *A heart > ~400 g is considered good enough for the cause of death ''hypertensive heart disease'', if no other significant findings are present.<ref>MSP. 29 September 2010.</ref> | ||
*Right ventricular hypertrophy is commonly seen.<ref name=pmid22392315>{{Cite journal | last1 = Sant'Anna | first1 = MP. | last2 = Mello | first2 = RJ. | last3 = Montenegro | first3 = LT. | last4 = Araújo | first4 = MM. | title = [Left and right ventricular hypertrophy at autopsy of hypertensive individuals]. | journal = Rev Assoc Med Bras | volume = 58 | issue = 1 | pages = 41-7 | month = | year = | doi = | PMID = 22392315 }}</ref><ref name=pmid18800141>{{Cite journal | last1 = Cuspidi | first1 = C. | last2 = Valerio | first2 = C. | last3 = Sala | first3 = C. | last4 = Negri | first4 = F. | last5 = Esposito | first5 = A. | last6 = Masaidi | first6 = M. | last7 = Giudici | first7 = V. | last8 = Zanchetti | first8 = A. | last9 = Mancia | first9 = G. | title = Metabolic syndrome and biventricular hypertrophy in essential hypertension. | journal = J Hum Hypertens | volume = 23 | issue = 3 | pages = 168-75 | month = Mar | year = 2009 | doi = 10.1038/jhh.2008.119 | PMID = 18800141 }}</ref> | |||
Gross DDx: | Gross DDx: | ||
*Hypertrophic cardiomyopathy. | *[[Hypertrophic cardiomyopathy]]. | ||
===Microscopic=== | ===Microscopic=== | ||
| Line 73: | Line 105: | ||
**Fibrosis of media. | **Fibrosis of media. | ||
*Peirarteriolar fibrosis. | *Peirarteriolar fibrosis. | ||
*Nuclear enlargement (6-7 micrometres).<ref name=pmid16723792>{{Cite journal | last1 = Koda | first1 = M. | last2 = Takemura | first2 = G. | last3 = Okada | first3 = H. | last4 = Kanoh | first4 = M. | last5 = Maruyama | first5 = R. | last6 = Esaki | first6 = M. | last7 = Li | first7 = Y. | last8 = Miyata | first8 = S. | last9 = Kanamori | first9 = H. | title = Nuclear hypertrophy reflects increased biosynthetic activities in myocytes of human hypertrophic hearts. | journal = Circ J | volume = 70 | issue = 6 | pages = 710-8 | month = Jun | year = 2006 | doi = | PMID = 16723792 | URL = http://www.ncbi.nlm.nih.gov/corehtml/query/egifs/http:--linkout.jstage.jst.go.jp-logo.gif}}</ref> | |||
**Normal cardiac myocyte nucleus ~4-5 micrometers.<ref name=pmid16723792/> | |||
==Kidney== | ==Kidney== | ||
:See: ''[[hyperplastic arteriolosclerosis]]''. | |||
:See: ''[[thrombotic microangiopathy]]''. | |||
===General=== | ===General=== | ||
*May result in renal failure. | *May result in renal failure. | ||
*Hypertension in the kidney may be: | |||
*#Primary, i.e. seen in isolation. | |||
*#Secondary, i.e. it arises due to another kidney disease. | |||
===Gross=== | |||
*Granular appearance of the surface. | |||
Note: | |||
*Normal kidneys have a smooth surface. | |||
Image: | |||
*[http://www.sciencephoto.com/media/257407/enlarge Hypertensive kidney (sciencephoto.com)]. | |||
===Microscopic=== | ===Microscopic=== | ||
Features:<ref name=pmid9356598>{{cite journal |author=Ono H, Ono Y |title=Nephrosclerosis and hypertension |journal=Med. Clin. North Am. |volume=81 |issue=6 |pages=1273–88 |year=1997 |month=November |pmid=9356598 |doi= |url=}}</ref> | Features:<ref name=pmid9356598>{{cite journal |author=Ono H, Ono Y |title=Nephrosclerosis and hypertension |journal=Med. Clin. North Am. |volume=81 |issue=6 |pages=1273–88 |year=1997 |month=November |pmid=9356598 |doi= |url=}}</ref> | ||
*Fibrinoid necrosis of afferent and interlobular arteries (due to endothelial cell damage). | *[[Fibrinoid necrosis]] of afferent and interlobular arteries (due to endothelial cell damage). | ||
Malignant hypertension - characterized by:<ref>{{Ref Klatt|7}}</ref> | Malignant hypertension - characterized by:<ref>{{Ref Klatt|7}}</ref> | ||
*[[Hyperplastic arteriolosclerosis]] - onion skin-like appearance of intima & media with luminal narrowing. | *[[Hyperplastic arteriolosclerosis]] - onion skin-like appearance of intima & media with luminal narrowing (chronic change). | ||
Note: | |||
*Diabetes mellitus has changes in the afferent and efferent arteriole (see ''[[medical kidney diseases]]''). | *[[Diabetes mellitus]] has changes in the afferent and efferent arteriole (see ''[[medical kidney diseases]]''). | ||
==Malignant hypertension== | |||
===General=== | |||
*A medical emergency. | |||
Defined as either of the following:<ref name=pmid14689106/><ref>{{Cite journal | last1 = Lenz | first1 = K. | title = [Treating a hypertensive emergency]. | journal = MMW Fortschr Med | volume = 146 | issue = 15 | pages = 42, 44, 46-8 | month = Apr | year = 2004 | doi = | PMID = 15373020 }}</ref> | |||
# >220 mmHg systolic BP. | |||
# >120 mmHg diastolic BP. | |||
Prognosis: | |||
*Depends on the acute rise in blood pressure.<ref name=pmid14689106>{{Cite journal | last1 = Gegenhuber | first1 = A. | last2 = Lenz | first2 = K. | title = [Hypertensive emergency and urgence]. | journal = Herz | volume = 28 | issue = 8 | pages = 717-24 | month = Dec | year = 2003 | doi = 10.1007/s00059-003-2506-8 | PMID = 14689106 }}</ref> | |||
**Adverse outcomes may arise even when the BP is not at the levels given above. | |||
*Usually better than with [[HUS]].<ref name=pmid18497467>{{Cite journal | last1 = Zhang | first1 = B. | last2 = Xing | first2 = C. | last3 = Yu | first3 = X. | last4 = Sun | first4 = B. | last5 = Zhao | first5 = X. | last6 = Qian | first6 = J. | title = Renal thrombotic microangiopathies induced by severe hypertension. | journal = Hypertens Res | volume = 31 | issue = 3 | pages = 479-83 | month = Mar | year = 2008 | doi = 10.1291/hypres.31.479 | PMID = 18497467 }}</ref> | |||
===Microscopic=== | |||
Features: | |||
*See: ''[[thrombotic microangiopathy]]''. | |||
Histomorphologic DDx (thrombotic microangiopathy): | |||
*[[HUS]]. | |||
*[[TTP]]. | |||
*[[DIC]]. | |||
*[[Scleroderma]] renal crisis. | |||
*[[ALPA syndrome]]. | |||
*Drug reaction, e.g. calcineurin inhibitors. | |||
==See also== | ==See also== | ||
*[[Pulmonary hypertension]]. | *[[Pulmonary hypertension]]. | ||
*[[Portal hypertension]]. | |||
*[[Sudden natural death]]. | *[[Sudden natural death]]. | ||
*[[Vascular disease]]. | *[[Vascular disease]]. | ||
*[[Decidual vasculopathy]] - seen in gestational hypertension. | |||
==References== | ==References== | ||