HYPERTENSION: COMPLICATION

DR GOURANGA KUMAR SAHA MBBS,MD,FESC,FACC Associate Professor Cardiology NICVD, DHAKA

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.

Classification of HYPERTENSION
Classification Normal Systolic pressure mmHg 90119
2

Diastolic pressure
2

kPa (kN/m ) mmHg kPa (kN/m ) 1215.9 6079 8089 8.010.5 10.711.9

Prehypertension 120139 16.018.5

Stage 1
Stage 2 Isolated systolic hypertension

140159 18.721.2
160 140 21.3 18.7

9099
100 <90
[8]

12.013.2
13.3 <12.0

Source: American Heart Association (2003).

Complications of Hypertension
*Heart: Left ventricular hypertrophy Coronary artery disease: angina or myocardial infarction Heart failure Cardiac arrhythmias especially AF *Brain: CVA:Stroke or transient ischemic attack
Encephalopathy

*Chronic kidney disease *Peripheral arterial disease *Retinopathy

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 3

Keith-Wagener-Barker retinopathy, which is characterized by retinal hemorrhages and exudates . 'hypertensive urgency' : it has been used for patients with severely elevated blood 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. It

requires a prompt reduction in blood pressure within minutes or hours.

Terminology, definitions, and misconceptions : continued

Malignant hypertension is marked hypertension with papilledema. There may also be renal involvement, called malignant nephrosclerosis. Malignant hypertension as is associated with group 4 KeithWagener-Barker retinopathy i.e. papilledema, heralding the neurologic impairment from an elevated intracranial pressure. However, this term has been removed from national and international blood pressure control guidelines and this condition is best referred to as a hypertensive emergency or crisis.

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

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.

Left ventricular hypertrophy:LVH

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 myocyte hypertrophy and by an imbalance between the myocytes and the interstitium of the myocardial skeletal structure. Various patterns of LVH have been described, including concentric 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 cardiac output, later it leads to the development of diastolic and, ultimately, systolic myocardial dysfunction.

Heart failure

The prevalence of asymptomatic diastolic dysfunction 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 compliance phase of ventricular diastole . Later in the course of disease, the LVH fails to compensate by increasing cardiac output in the face of elevated BP and the left ventricular cavity begins to dilate to maintain cardiac output.

Hypertensive encephalopathy

Hypertensive encephalopathy describes the transient migratory neurologic symptoms associated with the malignant hypertensive state in hypertensive emergency. The clinical symptoms usually are reversible with prompt initiation of therapy. Hypertensive encephalopathy is due to the presence of cerebral edema caused by breakthrough hyperperfusion from severe and sudden rises in blood pressure. The clinical manifestations of hypertensive encephalopathy are due to increased cerebral perfusion from the loss of blood-brain barrier integrity, resulting in exudation of fluid into the brain.

Hypertensive retinopathy:classification

Hypertensive nephropathy

Hypertensive nephropathy (or "hypertensive "hypertensive nephrosclerosis", or "Hypertensive renal disease") is a medical condition referring to damage to the kidney due to chronic high blood pressure. There are 2 cases of hypertensive nephropathy. These are malignant nephrosclerosis and benign nephrosclerosis.

Thank you