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

Causes of secondary hypertension:

• renal
  • acute glomerulopathies
  • chronic renal failure
  • renal artery stenosis
  • renin-producing tumor
• Endocrine:
  • adrenal
    • Cushing syndrome
    • primary hyperaldosteronism
    • congenital adrenal hyperplasia
    • pheochromocytoma
  • other endocrine
    • thyroid dysfunction (hyper- or hypothyroidism)
    • acromegaly
• vascular
  • aortic coarctation
  • vasculitis
• neurogenic
  • psychogenic
  • raised intracranial pressure
  • severe physiological stress, e.g. surgery
• pregnancy
  • pregnancy-induced hypertension (pre-eclampsia)
• 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

Siehe auch:

• Aortenisthmusstenose
• Intrazerebrale Blutung
• Nierenarterienstenose
• Vaskulitis
• Akromegalie
• Phäochromozytom
• thorakale Aortendissektion

und weiter:

• Arterielle Hypertonie