Hypertensive Vasular Disease For 2nd Yr Pharma

Hypertensive Vasular Disease
For 2nd Year Pharmacy Students

By Dr Tsion W.
2024 G.C
Outline
 Introduction
 BP Regulation
 Definition of Hypertension
 Classification
 Etiology
 Patho-physiology
 Complications
 Management Principles
Introduction
Hypertension
 “Elevated blood pressure”
 Sustained DBP greater than 90 mm Hg, or a
sustained SBP in excess of 140 mm Hg
 ~25% of persons in the general population are
hypertensive
 Affects more than 800 million individuals
worldwide
 Prevalence and vulnerability to complications
increase with age and, for unknown reasons, are
high in African Americans
 Common health problem with occasionally
devastating outcomes
 Epidemiologically speaking SBP is more important
than DBP as a determinant of CV risk, except in
youngs
 Remains asymptomatic until late in its course
 Contributes in the pathogenesis of
o Coronary heart diseases
o Cerebrovascular accidents
o Heart failure ( usually by hypertensive heart disease)
o Aortic dissection
o Renal failure
Blood Pressure Regulation
 Blood pressure is one of the most variable but well
regulated functions of the body
 Main determinants are cardiac output and
peripheral vascular resistance
Cardiac output = SV X HR
 Peripheral vascular resistance reflects change in the
radius of the arterioles as well as viscosity of the
blood
Poiseuille's equation
TPR = viscosity of blood/(radius of arteriole) 4
Mechanisms of BP Regulation
 Short term regulation – intended to correct
temporary imbalances in BP eg. during physical
exertion and change in body position
–Neural mechanisms – baro receptor reflex and
chemoreceptor mediated reflex
–Hormonal mechanisms – Renin-Angiotensin
aldosterone mechanism, vasopressin (ADH)
 Long term regulation – mainly renal mechanisms

 Cardiac output
–Affected by blood volume, itself strongly
dependent on sodium concentrations
 Peripheral resistance
–Regulated mainly at the level of arterioles
–Influenced by neural and hormonal inputs
 The integrated function of these systems ensures

adequate systemic perfusion, despite regional
demand differences!!!
Classification of HTN
 Etiological
 Essential hypertension - idiopathic
- 90 % to 95% of HTN
 Secondary hypertension
- Hypertension as a result of other disorders
- 5% to 10% of HTN
- Causes include Primary aldosteronism, Cushing
syndrome, Pheochromocytoma, Renovascular
diseases, Coarctation of aorta, Drugs etc,..
Essential Hypertension
 Results from an interplay of multiple genetic and
environmental factors affecting CO and/or peripheral
resistance
 Exact cause is unknown
 Risk factors
–Family history
–Age
–Race
–Insulin resistance and metabolic abnormalities
–Lifestyle factors (sedentary, excess alcohol, smoking)
–Oral contraceptives
Causes of Secondary HTN
 Clinical course classification
1.Benign hypertension (95%)
–A chronic and relatively mild increase in systemic
arterial BP (DBP <= 110 to 120 mm Hg)
–may or may not have an underlying cause
–compatible with long life, unless acute
complications supervene
2. Accelerated or Malignant hypertension
 In ~ 5% of hypertensive persons rapidly rising
BP that if untreated leads to death within 1-2 yrs
 Clinical syndrome is cxzed by:
o Severe hypertension (SBP>200 mm Hg or
DBP>120mmHg)
o Renal failure
o Retinal hemorrhages & exudates, + or - papilledema.
 Usually superimposed on preexisting benign
hypertension.
Diagnosis of HTN
 Obtaining one elevated BP record should not
constitute the diagnosis of hypertension
 Two or more readings at each of the two or more
visits
 BP should be taken when a person
–Relaxed and rested for at least 5 minutes
–Has not smoked or ingested caffeine within 30
minutes
 Currently,
Stages Value
Normal <120/80 mmHg
Elevated !20-129/<80 mmHg
Stage I 130-139/80-89 mmHg
Stage II >140/90 mmHg
Hypertensive Urgency >=180/110 mmHg
Hypertensive Emergency >=180/110 mmHg with
end organ damage
Isolated Systolic >=140/,90 mmHg
Hypertension
Clinical Manifestations
 Essential HTN is typically asymptomatic
 Symptoms are usually due to long term effects of
HTN on other organs
i.e Hypertension is a major risk factor
for atherosclerosis.
Target Organ Damage
 Heart
 Most common cause of death in HTN patients is heart
disease
 Can cause –Left ventricular hypertrophy
–Diastolic heart failure
–Coronary artery disease
–Cardiac arrhythmia
 Brain
 Risk of brain infarction and hemorrhage
 Malignant HTN
– Failure of cerebral auto regulation with
vasodilatation and hyper perfusion
– Causes severe headache, nausea, vomiting, focal
deficits,& altered mentation
– If not treated promptly- stupor, coma, seizure and
death within hours
 Kidney
 Risk of renal injury and ESRD
 Also accelerates the rate of progression of other
kidney disease types (DM pts BP should be < 130/80)
 Malignant HTN
– fibrinoid necrosis of the afferent arterioles
sometimes extending into the glomerulus causing
focal necrosis of glomerular tuft
 Vessels
 Accelerates atherogenesis
 Hypertension-associated degenerative changes in
walls of large & medium arteries  aortic dissection
and cerebrovascular hemorrhage
Peripheral arteries
 Atherosclerotic ds 2ndary to long standing HTN
 Intermittent claudication is the classic symptom of
peripheral arterial disease
i.e Aching pain in the calves and buttocks
while walking that is relieved by rest
Small blood vessel
1. Hyaline arteriolosclerosis
 Homogeneous pink hyaline thickening of the walls
of arterioles
 In elderly patients, & DM pts
 More generalized and severe in HTNsive pts
 Reflect leakage of plasma components across
vascular endothelium and excessive ECM
production by SMCs secondary to the chronic
hemodynamic stress of hypertension
2. Hyperplastic Arteriolosclerosis
 Related to more acute or severe elevations of BP
 Is characteristic of (but not limited to) malignant
HTN
 "onion-skin," concentric, laminated thickening of the
walls of arterioles with luminal narrowing
 Accompanied by fibrinoid deposits and vessel wall
necrosis (necrotizing arteriolitis), particularly
prominent in the kidney
 Eyes/Hypertensive Retinopathy
- Arteriovenous nicking
- Hemorrhage of retinal vessels
- Exudates
- Pappiledema
Treatment of Hypertension
 Target BP
–Maintain BP < 140/90 mmHg
–In patients with Diabetes or other renal disease,
BP<130/80 mmHg
 For patients with secondary hypertension efforts
should be made to correct or control the disease
condition causing hypertension
 Lifestyle modification
 Pharmacologic (Anti-HTNsive) treatment
THANK YOU!

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Hypertensive Vasular Disease

For 2nd Year Pharmacy Students

 Long term regulation – mainly renal mechanisms

 The integrated function of these systems ensures

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