Hypertension
Hypertension, also high blood pressure, is very common and affects multiple organs. Clinically, it is usually classified as primary (idiopathic) and secondary.
![](/w/images/thumb/7/78/Thrombotic_microangiopathy_-_very_high_mag.jpg/250px-Thrombotic_microangiopathy_-_very_high_mag.jpg)
Hypertensive crisis, if untreated, is associated with damage to the brain, heart, eye and kidneys.[1]
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
Charcôt-Bouchard aneurysms
General
- AKA miliary aneurysms and microaneurysm.[2]
- Associated with Intracerebral hemorrhages.
- Classically found in the basal ganglia or the pons.[3]
Microscopic
Features:[4]
- Small aneurysms (~300 micrometers) with a fusiform shape.
- Vessel wall changes:
- Early:
- Proliferation of arteriolar smooth muscle
- Late:
- Apoptotic smooth muscle cell death and collagen deposition.
- Early:
Image: C-B aneurysm (ucsf.edu).[5]
Intracerebral hematoma
Most common sites:[6]
- Subcortex.
- Putamen.
- Pons.
- Thalamus.
- Cerebellum.
Notes:
- Memory device:
- Ps and the major structures behind 'em: putamen + thalamus, pons + cerebellum.
- Two papers[7][8] say putamen is #1 and thalamus is #2.
Lacunar infarcts
General
- Common.
- May be located in the putamen.[9]
Hypertension and the eye[10]
- Hypertensive retinopathy.
- Aneurysms.
- Branch retinal vein occlusion (BRVO).
- Vitreous hemorrhage.
Hypertensive heart disease
General
- Treated with antihypertensives.
- Mechanism of death: (ventricular) arrhythmia.[11]
Associated pathology[11]
- Left atrial enlargement and atrial fibrillation.
Gross
Features:[12]
- Left ventricular hypertrophy (concentric).
Notes:
- 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.[13]
- Right ventricular hypertrophy is commonly seen.[14][15]
Gross DDx:
Microscopic
Features:[12]
Kidney
General
- 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:
Microscopic
Features:[17]
- Fibrinoid necrosis of afferent and interlobular arteries (due to endothelial cell damage).
Malignant hypertension - characterized by:[18]
- 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).
Malignant hypertension
General
- A medical emergency.
Defined as either of the following:[19][20]
- >220 mmHg systolic BP.
- >120 mmHg diastolic BP.
Prognosis:
- Depends on the acute rise in blood pressure.[19]
- Adverse outcomes may arise even when the BP is not at the levels given above.
- Usually better than with HUS.[21]
Microscopic
Features:
Histomorphologic DDx (thrombotic microangiopathy):
- HUS.
- TTP.
- DIC.
- Scleroderma renal crisis.
- ALPA syndrome.
- Drug reaction, e.g. calcineurin inhibitors.
See also
References
- ↑ Janota T (2009). "[Hypertensive crisis--the present view]" (in Czech). Cas. Lek. Cesk. 148 (8): 370–3. PMID 19899722.
- ↑ Kojima H, Eguchi H, Mizutani T, Tanaka K, Kikuchi Y, Fukudome N (2007). "Three-dimensional analysis of pathological characteristics of a microaneurysm". Clin. Neuropathol. 26 (2): 74–9. PMID 17416106.
- ↑ URL: http://missinglink.ucsf.edu/lm/introductionneuropathology/Response%20_to_Injury/Microvascular.html. Accessed on: 24 September 2010.
- ↑ Auer RN, Sutherland GR (December 2005). "Primary intracerebral hemorrhage: pathophysiology". Can J Neurol Sci 32 Suppl 2: S3–12. PMID 16450803.
- ↑ URL: http://missinglink.ucsf.edu/lm/introductionneuropathology/Response%20_to_Injury/Microvascular.html. Accessed on: 26 November 2010.
- ↑ Tanaka A, Ueno Y, Nakayama Y, Takano K, Takebayashi S (August 1999). "Small chronic hemorrhages and ischemic lesions in association with spontaneous intracerebral hematomas". Stroke 30 (8): 1637–42. PMID 10436114.
- ↑ Hung TP, Chen ST (December 1993). "[Cerebral hemorrhage in Taiwan]" (in Chinese). J. Formos. Med. Assoc. 92 Suppl 4: S161–8. PMID 7910073.
- ↑ Weisberg LA (September 1990). "How to identify and manage brain hemorrhage". Postgrad Med 88 (3): 169–75. PMID 2204896.
- ↑ URL: http://moon.ouhsc.edu/kfung/jty1/neurotest/Q04-Ans.htm. Accessed on: 26 October 2010.
- ↑ URL: http://health.indiamart.com/eye-care/hypertension-and-eye.html. Accessed on: 23 September 2010.
- ↑ 11.0 11.1 Prisant LM (April 2005). "Hypertensive heart disease". J Clin Hypertens (Greenwich) 7 (4): 231–8. PMID 15860963.
- ↑ 12.0 12.1 Schwartzkopff B, Strauer BE (2000). "Coronary reserve and arteriolosclerosis in hypertensive heart disease". Z Kardiol 89 Suppl 9: IX/132–5. PMID 11151783.
- ↑ MSP. 29 September 2010.
- ↑ Sant'Anna, MP.; Mello, RJ.; Montenegro, LT.; Araújo, MM.. "[Left and right ventricular hypertrophy at autopsy of hypertensive individuals].". Rev Assoc Med Bras 58 (1): 41-7. PMID 22392315.
- ↑ Cuspidi, C.; Valerio, C.; Sala, C.; Negri, F.; Esposito, A.; Masaidi, M.; Giudici, V.; Zanchetti, A. et al. (Mar 2009). "Metabolic syndrome and biventricular hypertrophy in essential hypertension.". J Hum Hypertens 23 (3): 168-75. doi:10.1038/jhh.2008.119. PMID 18800141.
- ↑ 16.0 16.1 Koda, M.; Takemura, G.; Okada, H.; Kanoh, M.; Maruyama, R.; Esaki, M.; Li, Y.; Miyata, S. et al. (Jun 2006). "Nuclear hypertrophy reflects increased biosynthetic activities in myocytes of human hypertrophic hearts.". Circ J 70 (6): 710-8. PMID 16723792.
- ↑ Ono H, Ono Y (November 1997). "Nephrosclerosis and hypertension". Med. Clin. North Am. 81 (6): 1273–88. PMID 9356598.
- ↑ Klatt, Edward C. (2006). Robbins and Cotran Atlas of Pathology (1st ed.). Saunders. pp. 7. ISBN 978-1416002741.
- ↑ 19.0 19.1 Gegenhuber, A.; Lenz, K. (Dec 2003). "[Hypertensive emergency and urgence].". Herz 28 (8): 717-24. doi:10.1007/s00059-003-2506-8. PMID 14689106.
- ↑ Lenz, K. (Apr 2004). "[Treating a hypertensive emergency].". MMW Fortschr Med 146 (15): 42, 44, 46-8. PMID 15373020.
- ↑ Zhang, B.; Xing, C.; Yu, X.; Sun, B.; Zhao, X.; Qian, J. (Mar 2008). "Renal thrombotic microangiopathies induced by severe hypertension.". Hypertens Res 31 (3): 479-83. doi:10.1291/hypres.31.479. PMID 18497467.