高血压病理学.ppt

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1、PathologyofHypertension:Dr.VenkateshM.Shashidhar.SeniorLecturerinPathologyFijiSchoolofMedicineHypertension-IntroductionSilentKiller–painless–complicationsdizziness,headache,andvisualdifficulties,Itistheleadingriskfactor–MI,DM,StrokeResponsibleforthemajorityofo

2、fficevisits,Numberonereasonfordrugprescription.25%ofpopulation,<35%aware.<5%..!Complicationsbringtodiagnosisbutlate…Chronic,vascular&endorgandamage.Introduction“Sustainedincreaseinbloodpressure”Systolic>140,Diastolic>90mmofHg*Normal*<130<85(120/80+/-10/5)Mild+

3、20,Moderate+40Severe+80Malignant->210/120RegulationofBP:BP=CardiacOutputxPeripheralResistanceEndocrineFactorsRenin,Angiotensin,ANP,ADH,Aldosterone.NeuralFactorsSympathetic&ParasympatheticBloodVolumeSodium,Mineralocorticoids,ANPCardiacFactorsHeartrate&Contracti

4、lity.ControlofBloodPressure:BPCardiacOutputPeripheralResistanceBloodVolumeNa+,AldosteroneVasoconstrictorsAngiotensinIICatecholaminesVasodilatorsPg&KininsLocalFactorspH,HypoxiaNeuralFactorsAdrenergic–ConsßAdrenergic-DilCardiacFactorsRate&Contract..HumoralFactor

5、sEtiologicClassification:PrimaryorEssentialHypertension(95%)SecondaryHypertension(5-10%)Renal–GN,RAS,RenintumorsEndocrine–Cushing,OCP,ThyrotoxicosisMyxdema,Pheochromocytoma,Acromegaly.Vascular–CoarctationofAorta,PAN,Aorticinsufficiency.Neurogenic–Psychogenic,I

6、ntracranialpressure,olyneuritisetc.PathogenesisofHypertension:?PathogenesisinEssentialhypertension-MultifactorialIncreasedbloodvolume-SodumretentionADH,Aldosterone.Increasedsympathetictone-Adrenaltumours,sympatheticstimulation.Increasedvasoactivehormones-Cushi

7、ngs,Pheochromocytoma,PathogenesisofRenovascularHTN:GFRReninbyJGAAngiotensinIIVasoconstrictionP.ResistanceSodiumRetentionBloodVolumeAldosteroneHypertensionConsequencesofHypertension:BloodVesselsAtherosclerosisanditscomplicationsaneurism,Dissection,Rupture,ne

8、crosis.Arteriolosclerosis,HeartHypertensivecardiomyopathy,IHD,MI.KidneyBenign/Malignantnephrosclerosis.InfarctionEyes:HypertensiveretinopathyBrain:Haemorrhage,infarction,splinter&L