Systemic hypertension is defined medically as a blood pressure greater than 140/90 mmHg. Recently the American College of Cardiology (ACC) and American Heart Association (AHA) have changed guidelines to indicate that pressures above 130/80 mmHg will be considered hypertension, however the European Society of Cardiology (ESC) and European Society of Hypertension (ESH) continue to define hypertension as 140/90 mm Hg and recommend targeting a patient's blood pressure to less than 130/80 mmHg only in certain conditions 2.
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Clinical presentation
usually asymptomatic
may present with complications (see below)
Accelerated (malignant) hypertension
Defined as a rapid rise in blood pressure to greater than 200/120 mmHg. May occur on a background of pre-existing hypertension or as the first manifestation of hypertension. Malignant hypertension has a high mortality if untreated. Associated with hyperplastic arteriolosclerosis, renal failure, retinal hemorrhages and exudates, optic disc swelling, headache, and seizures.
Complications
accelerated atherosclerosis: especially ischemic heart disease, stroke, peripheral vascular disease
left ventricular hypertrophy
diastolic dysfunction (due to increased afterload)
aortic dissection (due to medial degeneration)
intracerebral hemorrhage (due to medial degeneration, Charcot-Bouchard aneurysms)
lacunar infarcts, deep white matter ischemia (due to hyaline arteriosclerosis)
chronic renal impairment (due to hyaline arteriolosclerosis)
accelerated (malignant) hypertension
Pathology
Etiology
essential hypertension: idiopathic (95%)
secondary hypertension: underlying cause identified (5%)
Causes of secondary hypertension:
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renal
acute glomerulopathies
chronic renal failure
renin-producing tumor
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Endocrine:
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adrenal
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other endocrine
thyroid dysfunction (hyper- or hypothyroidism)
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vascular
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neurogenic
psychogenic
severe physiological stress, e.g. surgery
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pregnancy
pregnancy-induced hypertension (pre-eclampsia)
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drugs
steroids
adrenergic agents
illicit sympathomimetic drugs: cocaine, amphetamines, 3,4-methylenedioxymethamphetamine (MDMA)
Risk factors
increasing age
obesity, lack of exercise
high salt diet
alcohol, smoking
stress
genetic factors, family history
secondary causes listed above
Treatment and prognosis
modification of lifestyle factors
antihypertensive medication
treat underlying causes
treat complications