systemic hypertension

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.

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 arteriosclerosis, renal failure, retinal hemorrhages and exudates, papilledema, 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:

    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