Post on 14-Apr-2018
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HYPERTENSION:COMPLICATION
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DR GOURANGA KUMAR SAHA
MBBS,MD,FESC,FACCAssociate Professor Cardiology
NICVD, DHAKA
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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.
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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]
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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
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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.
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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.
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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
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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.
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Left ventricular hypertrophy:LVH
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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.
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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.
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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.
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Hypertensive retinopathy:classification
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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.
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Thank you