Complications of hypertension

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Main complications of persistent high blood pressure

Complications of hypertension are clinical outcomes that result from persistent elevation of blood pressure.[1] Hypertension is a risk factor for all clinical manifestations of atherosclerosis since it is a risk factor for atherosclerosis itself. [2][3][4][5][6] It is an independent predisposing factor for heart failure,[7][8] coronary artery disease,[9][10][11] stroke,[1] renal disease,[12][13][14] and peripheral arterial disease.[15][16] It is the most important risk factor for cardiovascular morbidity andmortality, in industrialized countries.[17]
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1 Complications affecting the heart 2 Complications affecting the brain 3 Complications affecting the eye 4 Complications affecting the kidneys 5 Complications associated to diabetes and hypertension 5.1 Treatment for diabetic patients with hypertension 6 References

Hypertensive cardiomyopathy. which is a measure of systolic function. [22] CHF. [19] Individuals with left ventricular hypertrophy are at increased risk for.[27] Abnormalities of diastolic function. neuro-hormonal.[33][34] Diastolic dysfunction is an early consequence of hypertension-related heart disease and is exacerbated by left ventricular hypertrophy[20][34] and ischemia. mainly resulting in a fibroblastic proliferation.[22] Aggressive control of hypertension can regress or reverse left ventricular hypertrophy and reduce the risk of cardiovascular disease.Complications affecting the heart Main articles: Left ventricular hypertrophy. stroke. Patients with diastolic heart failure have a preserved ejection fraction. mainly leading to myocyte hypertrophy.[22] and sudden death.[9][10][19] and cardiac arrhythmias. and Myocardial infarction Left ventricular hypertrophy Hypertensive heart disease is the result of structural and functional adaptations[18] leading to left ventricular hypertrophy. [18][20] CHF. Complications affecting the brain .[31][32] are common in hypertensive patients.[23] [24][25][26] left ventricular hypertrophy are seen in 25% of the hypertensive patients and can easily be diagnosed by using echocardiography. [27] Underlying mechanisms of hypertensive left ventricular hypertrophy are of 2 types: mechanical. ranging from asymptomatic heart disease[28][29] [30] to overt heart failure. abnormalities of blood flow due to atherosclerotic coronary artery disease[18] and microvascular disease.[19][20][21] diastolic dysfunction.

Untreated.[41] Complications affecting the eye Main article: Hypertensive retinopathy . meningitis.[52][53][54][55] It is important to distinguish hypertensive encephalopathy from other neurologic syndromes that may be associated with hypertension.[51] Signs and symptoms ofhypertensive encephalopathy may include severe headache. coma.[41] The incidence of stroke rises progressively with increasing blood pressure levels. hypertensive encephalopathy may progress to stupor.g. mass lesions.[1][10] [35][36][37][38][39][40] Approximately 85% of strokes are due to infarction and the remainder are due to hemorrhage. anduremic encephalopathy. traumatic or chemical injury to the brain. particularly systolic blood pressure in individuals >65 years.[42] [43][43][44][45] Hypertension-related cognitive impairment and dementia may be a consequence of a single infarct due to occlusion of a "strategic" larger vessel[46] or multiple lacunar infarcts due to occlusive small vessel disease resulting in subcortical white matter ischemia. seizure disorder. and alterations in mental status. Treatment of hypertension convincingly decreases the incidence of both ischemic and hemorrhagic strokes. and death within hours.cerebral ischemia.[48][49][50] Cerebral blood flow remains unchanged over a wide range of arterial pressures (mean arterial pressure of 50–150 mmHg) through a process termed autoregulation of blood flow. e. focal neurologic signs. pseudotumor cerebri..Main articles: Hypertensive encephalopathy and Cerebrovascular accident Hypertension is an important risk factor for brain infarction and hemorrhage. nausea and vomiting (often of a projectile nature). seizures.[41] Hypertension is also associated with impaired cognition in an aging population. either intracerebral hemorrhage or subarachnoid hemorrhage. although this remains an active area of investigation.[43][45][47][47][47] Several clinical trials suggest that antihypertensive therapy has a beneficial effect on cognitive function. hemorrhagic or thrombotic stroke. acute intermittent porphyria. delirium tremens.

These changes are manifested in the retina as microaneurysms. malignant hypertension is rarely seen. and hyalinedegeneration in the subsequent.[56] It was first described by Liebreich in 1859.[59] This is followed by an exudative stage. and retinal ischemia. Because better methods for the control of blood pressure are now available in the general population. and alterations in the arteriolar light reflex (i. stage.. widening and accentuation of the central light reflex. hemorrhages.e. hard exudates. sclerotic.vasoconstrictive stage. This stage is seen clinically as a generalized narrowing of the retinal arterioles. other retinal vascular . changes in the arteriolar and venular junctions.Hypertensive retinopathy with AV nicking and mild vascular tortuosity Hypertensive retinopathy is a condition characterized by a spectrum of retinal vascular signs in people with elevated blood pressure. and cotton-wool spots. malignant hypertension). Swelling of the optic disk may occur at this time and usually indicates severely elevated blood pressure (i.[57] The retinal circulation undergoes a series of pathophysiological changes in response to elevated blood pressure. there is vasospasm and an increase in retinal arteriolar tone owing to local autoregulatory mechanisms. in which there is disruption of the blood– retina barrier. In contrast. This stage corresponds to more severe generalized and focal areas of arteriolar narrowing. Persistently elevated blood pressure leads to intimal thickening. necrosis of the smooth muscles and endothelial cells.[58] In the initial.e. or "copper wiring").. hyperplasia of the media wall. exudation of blood and lipids.

[70][71][72][73][74] The atherosclerotic. such asretinal hemorrhage or microaneurysm.[68] [69] and black men are at greater risk than white men for developing ESRD at every level of blood pressure.[41] Complications associated to diabetes and hypertension Diabetes has several complications of which one is hypertension or high blood pressure. are not uncommon in patients with chronically elevated blood pressure. macroalbuminuria (a random urine albumin/creatinine ratio > 300 mg/g) or microalbuminuria (a random urine albumin/creatinine ratio 30– 300 mg/g) are early markers of renal injury. Glomerular pathology progresses to glomerulosclerosis.[58] The exudative signs are nonspecific. hypertension-related vascular lesions in the kidney primarily affect the preglomerular arterioles.[41]Glomerular injury may also be a consequence of direct damage to the glomerular capillaries due to glomerular hyperperfusion. and may result in focal necrosis of the glomerular tuft.complications of hypertension.[77][78] and eventually the renal tubules may also become ischemic and gradually atrophic. The high blood pressure is gradual at early stages and may take at least 10–15 years to fully develop. Data indicate that at least 60-80 percent of individuals whom develop diabetes will eventually develop high blood pressure.[58][60] For example. may be seen in eyes that do not have features of the sclerotic stage.[79][80][81][82][83][84][85] sometimes extending into the glomerulus.[61][62][63][64][65][66][67] Renal risk appears to be more closely related to systolic than to diastolic blood pressure. These are also risk factors for renal disease progression and for cardiovascular disease. such as macroaneurysms and branch-vein occlusions. Complications affecting the kidneys Main article: Hypertensive nephropathy Hypertension is a risk factor for renal injury and ESRD. These stages of hypertensive retinopathy however. signs of retinopathy that reflect the exudative stage. .[68][75][76] resulting in ischemic changes in the glomeruli and postglomerular structures. The renal lesion associated with malignant hypertension consists of fibrinoid necrosis of the afferent arterioles. since they are seen in diabetes and other conditions. may not be sequential.[81][86][87] Clinically.

Sometimes. The other fact about diabetes is that it affects both large and small blood vessels in the body. fewer than 25 percent of diabetics have good control of their blood pressure.[90] Treatment for diabetic patients with hypertension Once blood pressure is found to be high in diabetics. Other medications used to treat high blood pressure include water pills.[89] Blood pressure readings do vary but experts recommend that blood pressure should not range above 130/80. When the blood supply to the feet is compromised. Over time. other factors that may also increase high blood pressure include obesity. Secondly. In general. insulin resistance and high cholesterol levels. Studies have shown that diabetics with even a slight elevation in blood pressure have 2-3 times the risk of heart disease compared to individuals without diabetes.Besides diabetes. All diabetics should know that even mild elevations in blood pressure can be detrimental to health. Many studies have shown that ACEI should be the drugs of first choice in diabetics with high blood pressure. The high blood pressure eventually leads to heart failure. These medications not only control blood pressure but also delay or prevent the development of kidney disease in diabetes. Diabetes tends to speed up the process of atherosclerosis. become non-compliant and lose their elasticity. the chances of infections and amputations also increases. there are ways to treat it: Medications like the Angiotensin-converting enzyme inhibitors (ACEI) are widely used to control blood pressure in diabetics. loss of libido and poor circulation of blood in the legs. The presence of high blood pressure in diabetes is associated with a 4 fold increase in death chiefly from heart disease and strokes. blood vessels become clogged with fatty depots. heart attacks. strokes.[88] The chief reason why people with diabetes develop high blood pressure is hardening of the arteries. All diabetics should quit smoking. The combination of . high blood pressure is a silent disease and thus it is vital for all diabetics to regularly check their blood pressure or have it checked at a doctor's office on a regular basis. blindness. kidney failure. The American Diabetes Association recommends that all diabetics get their blood pressure measured by a health care professional at least 2-5 times a year. The process of atherosclerosis is a lot faster in diabetic individuals whom do not have good control of their blood sugars. a combination of medications is used to treat high blood pressure.

Also. Walking twice a day for 30 minutes can be a fair substitute for those not engaged in intense gym activities. Exercise is a must for all diabetics.[91] It is also recommended to eat a healthy diet and avoid sugary foods and limit the intake of salt. and make sure that they are well balanced as the majority of complications of diabetes can be prevented by ensuring such blood sugars stay within normal limits.[92] .diabetes and smoking usually leads to amputations of the toes and feet. ensure that your cholesterol levels are under control. Measure your blood sugars regularly. Losing weight is also beneficial as this has been shown to improve blood sugar control. increase insulin sensitivity and reduce blood pressure.