高血压病理学.pptVIP

Pathology of  Hypertension: Dr. Venkatesh M. Shashidhar. Senior Lecturer in Pathology Fiji School of Medicine Hypertension - Introduction Silent Killer – painless – complications dizziness, headache, and visual difficulties, It is the leading risk factor – MI, DM, Stroke Responsible for the majority of office visits, Number one reason for drug prescription. 25% of population, 35% aware. 5% ..! Complications bring to diagnosis but late… Chronic, vascular end organ damage. Introduction “Sustained increase in blood pressure” Systolic 140, Diastolic 90 mm of Hg* Normal* 130 85 (120/80 +/- 10/5) Mild + 20, Moderate +40 Severe +80 Malignant - 210/120 Regulation of BP: BP = Cardiac Output x Peripheral Resistance Endocrine Factors Renin, Angiotensin, ANP, ADH, Aldosterone. Neural Factors Sympathetic Parasympathetic Blood Volume Sodium, Mineralocorticoids, ANP Cardiac Factors Heart rate Contractility. Control of Blood Pressure: Etiologic Classification: Primary or Essential Hypertension(95%) Secondary Hypertension (5-10%) Renal – GN, RAS, Renin tumors Endocrine – Cushing, OCP, Thyrotoxicosis Myxdema, Pheochromocytoma, Acromegaly. Vascular – Coarctation of Aorta, PAN, Aortic insufficiency. Neurogenic – Psychogenic, Intracranial pressure, olyneuritis etc. Pathogenesis of Hypertension: ? Pathogenesis in Essential hypertension - Multifactorial Increased blood volume - Sodum retention ADH, Aldosterone. Increased sympathetic tone - Adrenal tumours, sympathetic stimulation. Increased vasoactive hormones - Cushings, Pheochromocytoma, Pathogenesis of Renovascular HTN: Consequences of Hypertension: Blood Vessels Atherosclerosis and its complications aneurism, Dissection, Rupture, necrosis. Arteriolosclerosis, Heart Hypertensive cardiomyopathy, IHD, MI. Kidney Benign/Malignant nephrosclerosis. Infarction Eyes: Hypertensive retinopathy Brain: Haemorrhage, infarction, splinter Lacunar hemorrhages Hyperplastic Arteriolosclerosis: Benign Nephrosclerosis: Left Ventricular