Chronic Hypertension: Complications
Chronic Hypertension
Long term Blood Pressure (BP) ≥ 135/85 (on ambulatory or home blood pressure measurement) in patients without diabetes, or BP ≥ 130/80 in patients with diabetes
Authors: Samin Dolatabadi, Yan Yu* Reviewers: Meena Assad, Jessica Krahn Juliya Hemmett* * MD at time of publication
↑ Afterloadà ↑ Resistance to left ventricle ejection
To overcome resistance and preserve cardiac
output, the myocardium undergoes structural and functional changes
Left ventricular hypertrophy and fibrosis
Stiff ventricle
↓ Contractility of the left ventricle
Impaired forward flow of blood from heart
Chronic stress on the endothelium of systemic blood vessels
↑ Blood pressure in retinal circulation
Hypertensive Retinopathy (See
slide on Chronic Hypertensive Retinopathy: Pathogenesis and Clinic Findings)
Smooth muscle of kidney’s
afferent arterioles constricts to prevent transmission of ↑ blood pressure to glomerulus
Overtime, smooth muscles of afferent arterioles hypertrophy from prolonged vasoconstriction
Chronic stress and trauma on endothelial and smooth muscle cells of kidney
Injury leads to excretion of cytokines and extracellular matrix such as fibrin and collagen into subendothelial layer
Endothelial dysfunction (See slide on Atherosclerosis: Pathogenesis)
Atherosclerosis
Loss of normal arterial architecture in the brain due to stress of ↑ blood pressure
Weakening of cerebral arteries
Formation and rupture of microaneurysms
Intracerebral Hemorrhage
Accumulation of plaques in
the walls of cerebral arteries
↓ Cerebral blood flow
Ischemic Stroke
Accumulation of plaques in
the walls of coronary arteries
↓ Myocardial blood flow
Oxygen supply- demand mismatch
Coronary Artery Disease
Thickening of arteriolar wall and narrowing of afferent arterioles
↓ Glomerular blood flow
Glomerular and tubular ischemia
Glomerular sclerosis and tubular atrophy
Blood backs up into lungs
↓ perfusion of blood throughout the bodyà inability of the heart to meet metabolic demands
Congestive Heart Failure
Hypertensive Nephrosclerosis
Legend:
Pathophysiology
Mechanism
Sign/Symptom/Lab Finding
Complications
Published December 4, 2021 on www.thecalgaryguide.com