1. Hypertension Robbins: 525 to 530, 1007-1009 Cecil: 167-173

2. Hypertensive Vascular Disease HTN risk factor for: Coronary heart disease Stroke LVH with heart failure Aortic dissection Renal failure

3. Hypertension Sustained: Diastolic > 90 (some >80) Systolic > 140 See table 13-8 in Cecil Essentials Normal<120And<80 Prehypertension120- 139 Or80-89 Stage 1140- 159 Or80-90 Stage 2>160Or>100

4. Causes of Hypertension 90-95% idiopathic 5-10% 2° to renal disease or renovascular hypertension All other causes rare

5. Accelerated (Malignant) hypertension Severe hypertension (diastolic >120mmHg) Renal failure Retinal hemorrhages with papilledema Seizures Strokes DIC

6. Normal Blood Pressure Cardiac output Na homeostasis Total peripheral resistance Lumen size Neural and hormonal influences that constrict or dilate these vessels

8. Kidney Renin-produced by the JG cells of the kidney Transforms plasma angiotensinogen to angiotensin I Angiotensin I converted to angiotensin II by ACE Angiotensin II increases peripheral resistance and blood volume

9. The Kidney Produces Vasodepressor Substances Prostaglandins Kallikrein-kinin Platelet-activation factor Nitric oxide

10. Blood volume reduced Glomerular filtration rate falls Increased reabsorption of Na Leads to conserve Na and expand blood volume

11. GFR-independent Natruretic Factors Atrial natriuretic factor (ANF) Inhibits Na reabsorpton in distal tubules Cause vasodilatation

12. Essential hypertension Alter the relationship between volume and total peripheral resistance

14. Renovascular hypertension Renal artery stenosis causes deceased glomerular flow Induces renin secretion Induces angiotensin II-induced vasoconstriction Increased peripheral resistance Aldosterone causes increased sodium reabsorption and inceased blood volume

16. Genetic factors Environmental factors Salt, stress, smoking Obesity, physical inactivity

17. Mechanisms Renal retention of excess sodium Vasoconstriction and vascular hypertrophy Thickened wall Narrowed lumen

18. Vascular pathology Hyaline Arteriolosclerosis Hyalinized walls with narrowed lumen Hyperplastic arteriosclerosis Concentric, laminated thickening of wall (onion-skin) Progressive narrowing of the lemen Necrotizing arteriolitis-fibroid necrosis

19. Hyaline arteriosclerosis

20. Hyperplastic arteriosclerosis - malignant hypertension