Download MBBS Pathology PPT 3 Hypertension Lecture Notes

HYPERTENSION

Pathological classification-
BENIGN (ESSENTIAL) HYPERTENSION-

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? left ventricular hypertrophy
? left ventricular dilatation
? disease of arterioles and small arteries
MALIGNANT HYPERTENSION-
? markedly raised diastolic blood pressure, and progressive renal disease

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? Give rise to many consequences

Etiological factors-
? Essential hypertension or idiopathic (92-95%)
? Secondary hypertension-

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oRenal causes

oEndocrine causes

oCardio-vascular

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oStress

oPsychogenic

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Regulators of blood pressure

Etiopathogenesis of Essential hypertension

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Essential hypertension-
? Genetic factors-
oSingle gene disorder

oMultiple gene disorder

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? Environmental factors


Single gene disorder-

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? CYP11B2 gene-aldosterone synthase
? CYP11B1
? SCNNIB
Multiple gene disorder-
? Angiotensinogen and angiotensin receptor gene

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? Prorenin receptor gene

Essential hypertension pathogenesis-
Etiopathogenesis of secondary hypertension

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1- renal causes
? Reno-vascular
? Renal parenchymal
? Excess renin secretion- nephroblastoma
2-Endocrine causes-

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? Cushing syndrome
? Pheochromocytoma
3-oral contraceptive
? Angiotensinogenangiotensin2-> increase blood pressure

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Pathogenesis in secondary hypertension

1-Renovascular hypertension
2-Hypertensive heart disease

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Genesis of renovascular hypertension

Hypertensive heart disease
Genetic aspect of hypertension

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Gene classification

? renin-angiotensin-aldosterone system(MAJORITY)
? sodium system genes

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? signal transduction system genes
? endothelial system genes
? neurohormonal and adrenergic genes
The renin-angiotensin-aldosterone system
? REN gene located at the 1q32

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? Angiotensinogen (AGT) gene located on chromosome 1q42-43
? angiotensin-converting-enzyme (ACE) is located on chromosome

17q23

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? AGTR1 gene-located at chromosome 3q21-25

? AGTR2 gene is located on the X-chromosome
? CYP11B2 gene coded for aldosterone synthase ,located on

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chromosome 8q22
Other genes

? ECE1 gene- chr 1
? HYT3 gene ?chr 2

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? AGTR1A gene on chromosome region 3q21-q25, Caucasians
? adducin-1 (ADD1) on chromosome band 4p16.3 has been associated

with salt-sensitive essential HT

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? HYT6-high renal function on chromosome 5p

? CYP3A5 gene on chromosome band 7q22.1
? NOS3 gene-7q36 pregnancy-induced HT
? Locus in chromosome 11q- Mexican-Americans

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? HYT4 gene- chromosome 12 -Chinese family
CONSEQUENCES OF HYPERTENSION

? KIDNEY
? BRAIN

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? HEART
? EYE

? Hyaline arteriolosclerosis. Arterioles show homogeneous, pink hyaline thickening

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with associated luminal narrowing

? Hyperplastic Arteriolosclerosis. severe hypertension; laminated ("onion-skin")

thickening of the walls

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MORPHOLOGY

Hyaline arteriolosclerosis Hyperplastic Arteriolosclerosis

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Hypertensive changes in Kidney

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Benign nephrosclerosis-

? Gross-
?fibrosed and contracted kidney
?Also called granular contracted kidney

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? Microscopy-
?hyaline arteriosclerosis
?Tubular atrophy
?Interstitial fibrosis
?Glomerulosclerosis

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?Periglomerular fibrosis

? Malignant nephrosclerosis-
Gross- Flea bitten kidney (multiple red colored pin point dots)

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Microscopy-
? necrotising arteriolitis
? Hyperplastic arteriolitis (onion skin)

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KIDNEY Malignant hypertension (flea bitten)

KIDNEY(malignant hypertension)

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Renal arteriolar wall in malignant hypertension

Hypertensive changes in heart

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1-Narrowing of the arteries-coronary heart disease (CHD)

2-Thickening and enlargement of the heart-Left ventricular

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hypertrophy(LVH)


Gross-
? Early stage- concentric hypertrophy of myocardium

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? Late- cardiomegaly
Microscopy-
? Early- enlargement of myocyte
? Late stage-disorganised arrangement of myocyte with variable size

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HEART



Atherosclerotic plaque cause IHD

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Hypertensive encephalopathy

? Cerebral edema
? Cerebral infarct

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? Lacunar infarct
? Intracerebral hemorrhage
? Petechial hemorrhage
? Fibrinoid necrosis of arteriole

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Lacunar infarct Cerebral infarct


Cerebral infarct(12? 24hrs)

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Hypertensive retinopathy

Retinal changes-
? Narrowing of arterioles

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? Flame shaped hage
? Waxy exudates
? Micro infarction of nerve fibre(cotton wool spot)
? papilloedema

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Hypertensive retinopathy


cotton-wool spot

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