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PATHOFISIOLOGI KARDIOVASKULAR 

Dr.Abdul Majid SpPD-KKV

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Bagian Fisiologi FK – USU Medan

“ 

Dr.Abdul Majid

THEPATHOPHYSIOLOGY

OF HYPERTENSION

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Types of hypertension

• Essential (Primary) Hypertension

hypertension with no apparent cause 90-95%

• Secondary Hypertensionhypertension of known cause

• chronic renal diseases 2.5-5%

• Renovascular diseases 0.5-4%

•

Oral contraceptive pills 0.2-1%• oarctation o! the Aorta 0.1-1%

• "ri#ar$ aldosteronis# 0.1-0.5%

• "heochro#oc$to#a 0.1-0.2%

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• In primary hypertension , the precise

etiology is unknown, but it is probablymulti factorial.

• Predisposing factors include –

 !ge – "besity

 – #$cessie alcohol intake

 – &igh salt intake

 – 'enetic susceptibility

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W H O 1999

I S H 1999

Hypere!"i#! pra$i$e

Guidelines

2003 Canadian

Recommendations

for the Management ofHypertension

ESC 2003

 JNC 72003

%rii"& S#$iey #'

Hypere!"i#!())*+()),

Kaplans

ClinicalHypertension

2002

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ESH 2003 ! "#C $%%(2003)ESH-ESC 2003

BP Classi!a"i#n

BP BP JNC $II%2003&

B'

Classi!a"i#n

&ptimal '20 '*0 '20'*0 #ormal

#ormal 20+2, *0+*- 20+2, *0+*- Prehypertension

High normal 30+3, *.+*, 30+3, *.+*, Prehypertension

/rade Hypertension (mild)

-0+., ,0+,, -0+., ,0+,, Stage Hypertension

/rade 2

Hypertension(moderate)

0+1, 00+

0, 0 00

Stage 2

Hypertension

/rade 3Hypertension(seere)

*0 0

%solated SystolicHypertension %solated SystolicHypertension( )*0 + 90

ESC 2003

 JNC 72003

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• &ypertension is defined as an arterial

pressure greater than )*090 mm &g in

adults on at least three consecutie isits

to the doctors office.

• ymptoms, nonspecific/ headaches,

fatigue, and diiness

• 1the silent killer 1

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"athoph$siolo$ o! bloodpressure chanes

BLOO(PRESS)RE

CAR(IAC

O)TP)T

PERIPHERAL

RESISTANCE

&'OOD (O')M*

O+,RA,',

")'/* RA,*/,R),)RA' "*R,RO"

)+,O+A'(A/OO+/,R,O+

+or#al Re#odelin

&'OOD (/O/,

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H*'e+"ensi#n S*nd+#,e

It’s More Than Just Blood

Pressure ecreased

Arterial

Compliance

Endothelial

ysfunction

A.n#+,al

Glu!#se/e"a.#lis,Neurohormona

l

ysfunction

Renal-Fun!"i#nCan1es

lood-

Clotting

Mechanism

Changes

Obesity

Abnormal

Insulin

Metabolism

L$ H*'e+"+#'*and (*sun!"i#n

Accelerated

Atherogenesi

s

Abnormal

Lipid

Metabolism

H*'e+"ensi#n

2annel 34. JAMA. )99/675)57)-)57. 3eber 8! et al. J Hum Hypertens.

)99)/5*)7-*6. :au ;< et al. J Cardiovas !harmaol . )99/6)=suppl )>)-5.

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&ypertensie ascular disease

• &ypertension not only accelerates

atherosclerosis, but it also results in

characteristic changes to arterioles and

small arteries, include

• In arteries ? muscular hypertrophy of the

media, reduplication of the e$ternal

lamina, and intimal thickening• In arterioles ? hyaline arteriosclerosis

=hyaline deposits in walls>

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• In essels of the brain ? micro aneurysms

=@harcot ? 4ouchard aneurysms> can

occur.

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&ypertensie heart disease

ystemic =left ? sided> hypertensie heart

disease

• &istory of hypertension =()*090 mm&g>

• Aeft entricular hypertrophy =wall thickness

measuring ()5 mm, weighing ( 500mg>

•  !bsence of any other causes of

hypertrophy

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Pulmonary hypertensie heart

disease =cor pulmonale>• Pulmonary hypertensie heart disease

can defined as right entricular

hypertrophy =wall thickness measuring (

)0 mm> as a result in the pulmonarycirculation caused by a lung disorder 

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• Pulmonary hypertension can be classified

as either/ – Bight entricular hypertrophy and failure

=chronic pulmonary hypertension or corpulmonale>

 –  !cute pulmonary hypertension =a sudden

onset, usually after a large pulmonaryembolus>

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@linical Presentation

• absent in early hypertension

• in adanced seere cases/ – hypertensie retinopathy =ie, narrowed

arterioles seen on funduscopic e$amination>,

retinal hemorrhages and e$udates along with

swelling of the optic nere head =papilledema>

 –

left entricular hypertrophy – renal hypertension

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IMPACT OF "*R,*+/O+

 ON TARGET ORGANS

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Retinopath$

  eart diseases

/troe or ,A

+ephropath$3"roteinuria3 rl

"eripheral arterialDisease atherosclerotic

pla6ue iliac3carotid3!e#oral arter$3 aorta7

/e6uelae o!$pertension

o#plications o! ,+

Cardiac

C#S

$asc4lar 

Retinal

Renal

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Thank You

Le" i"

.ea"