Hypertension lecture nicvd

7/27/2019 Hypertension lecture nicvd

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HYPERTENSION:COMPLICATION



DR GOURANGA KUMAR SAHA

MBBS,MD,FESC,FACCAssociate Professor Cardiology

NICVD, DHAKA



Definition

Hypertension is defined as systolic

blood pressure (SBP) of 140 mm Hg or greater, or diastolic blood pressure

(DBP) of 90 mm Hg or greater or taking

antihypertensive medication.



Classification of HYPERTENSION

Classification Systolic pressure Diastolic pressure

mmHg kPa (kN/m2) mmHg kPa (kN/m

2)

Normal 90 –119 12 –15.9 60 –79 8.0 –10.5

Prehypertension 120 –139 16.0 –18.5 80 –89 10.7 –11.9

Stage 1 140 –159 18.7 –21.2 90 –99 12.0 –13.2

Stage 2 ≥160 ≥21.3 ≥100 ≥13.3

Isolated systolichypertension

≥140 ≥18.7 <90 <12.0

Source: American Heart Association (2003).[8]

http://en.wikipedia.org/wiki/MmHg

http://en.wikipedia.org/wiki/Pascal_(unit)

http://en.wikipedia.org/wiki/Isolated_systolic_hypertension





http://en.wikipedia.org/wiki/Pascal_(unit)

http://en.wikipedia.org/wiki/MmHg



Complications of Hypertension

*Heart:

Left ventricular hypertrophyCoronary artery disease: angina or myocardial infarction

Heart failure

Cardiac arrhythmias especially AF

*Brain:

CVA:Stroke or transient ischemic attackEncephalopathy

*Chronic kidney disease

*Peripheral arterial disease

*Retinopathy



Terminology, definitions, and

misconceptions

Hypertensive crises: include hypertensive urgency &

hypertensive emergencies.

Severe or accelerated' hypertension: patients with a systolic blood

pressure greater than 179 mmHg or a diastolic blood pressure that is greater than 109 mmHg are usually defined as having 'severe or accelerated'hypertension. Accelerated hypertension is associated with group 3Keith-Wagener-Barker retinopathy, which is characterized by retinalhemorrhages and exudates .

'hypertensive urgency' : it has been used for patients with severely elevatedblood pressure without acute end-organ damageand it requires reduction in

blood pressure within 24-48 hours. Hypertensive emergencies: as a sudden increase in systolic and diastolic

blood pressures associated with 'acute end-organ damage' (i.e. cardiovascular,renal, central nervous system) that requires immediate management. Itrequires a prompt reduction in blood pressure within minutes or hours.



Terminology, definitions, and

misconceptions : continued

Malignant hypertension is marked hypertension withpapilledema. There may also be renal involvement,

called malignant nephrosclerosis. Malignanthypertension as is associated with group 4 Keith-Wagener-Barker retinopathy i.e. papilledema,heralding the neurologic impairment from anelevated intracranial pressure.

However, this term has been removed from nationaland international blood pressure control guidelinesand this condition is best referred to as ahypertensive emergency or crisis.



Hypertensive emergencies/crises

Hypertensive encephalopathy

Dissecting aortic aneurysm

Acute left ventricular failure with pulmonary edema

Acute myocardial ischemia

Eclampsia

Acute renal failure Symptomatic microangiopathic hemolytic anemia



Hypertensive heart disease

Hypertensive heart disease refers to coronary artery disease,Heart failure and enlargement of the heart that occur

because of high blood pressure.



Left ventricular hypertrophy:LVH

http://upload.wikimedia.org/wikipedia/commons/b/ba/Heart_left_ventricular_hypertrophy_sa.jpg



Left ventricular hypertrophy:LVH

Of patients with hypertension, 15-20% develops LVH.

The risk of LVH is increased 2-fold by associated obesity.

The development of LVH is characterized by myocytehypertrophy and by an imbalance between the myocytes andthe interstitium of the myocardial skeletal structure.

Various patterns of LVH have been described, includingconcentric remodeling, concentric LVH, and eccentric LVH.

While the development of LVH initially plays a protective role in

response to increased wall stress to maintain adequate cardiacoutput, later it leads to the development of diastolic and,ultimately, systolic myocardial dysfunction.



Heart failure

The prevalence of asymptomatic diastolicdysfunction in patients with hypertension and

without LVH may be as high as 33%. LVH can adversely affect both the active

early relaxation phase and late compliancephase of ventricular diastole .

Later in the course of disease, the LVH fails tocompensate by increasing cardiac output in theface of elevated BP and the left ventricular cavity begins to dilate to maintain cardiacoutput.



Hypertensive encephalopathy

Hypertensive encephalopathy describes the transientmigratory neurologic symptoms associated with themalignant hypertensive state in hypertensive

emergency. The clinical symptoms usually arereversible with prompt initiation of therapy.

Hypertensive encephalopathy is due to the presenceof cerebral edema caused by breakthroughhyperperfusion from severe and sudden rises in bloodpressure.

The clinical manifestations of hypertensiveencephalopathy are due to increased cerebralperfusion from the loss of blood-brain barrier integrity,resulting in exudation of fluid into the brain.



Hypertensive retinopathy:classification



Hypertensive nephropathy

Hypertensive nephropathy (or "hypertensive "hypertensivenephrosclerosis", or "Hypertensive renal disease") is a medicalcondition referring to damage to the kidney due to chronic highblood pressure.

There are 2 cases of hypertensive nephropathy. These aremalignant nephrosclerosis and benign nephrosclerosis.

http://en.wikipedia.org/wiki/Kidney

http://en.wikipedia.org/wiki/High_blood_pressure




http://en.wikipedia.org/wiki/Kidney



Thank you

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Hypertension lecture nicvd