Essential Hypertension Overview

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Questions and Answers

What is a primary characteristic of essential hypertension?

  • No specific cause can be found. (correct)
  • It is solely caused by genetic factors.
  • It is always associated with renal artery stenosis.
  • It has a single identifiable cause.

Which factor contributes to increased vascular resistance in essential hypertension?

  • Chronic vasoconstriction. (correct)
  • Dilation of small blood vessels.
  • Reduction in circulating blood volume.
  • Decreased renal sodium reabsorption.

What condition is characterized by hypertrophic changes of the arterioles due to benign hypertension?

  • Cerebrovascular hemorrhage.
  • Hyperplastic arteriolosclerosis.
  • Hyaline arteriolosclerosis. (correct)
  • Aortic dissection.

Which of the following is NOT a known environmental factor linked to hypertension?

<p>Genetic polymorphisms. (B)</p> Signup and view all the answers

What differentiates hyperplastic arteriolosclerosis from hyaline arteriolosclerosis?

<p>It is typical of severe/malignant hypertension. (C)</p> Signup and view all the answers

What mechanism contributes to the increased blood volume associated with essential hypertension?

<p>Reduced renal sodium excretion. (A)</p> Signup and view all the answers

What role do genetic factors play in the development of essential hypertension?

<p>They include multiple genes influencing renin-angiotensin regulation. (D)</p> Signup and view all the answers

Which condition is NOT associated with accelerated atherogenesis due to hypertension?

<p>Stable angina. (B)</p> Signup and view all the answers

What is the primary effect of nephrosclerosis in the kidneys?

<p>Glomerular scarring leading to renal failure (A)</p> Signup and view all the answers

What microscopic feature is indicative of nephrosclerosis?

<p>Onion skin thickening of arteriolar walls (B)</p> Signup and view all the answers

Which condition is most commonly associated with diabetic microangiopathy?

<p>Nephrosclerosis (D)</p> Signup and view all the answers

What are the consequences of atherosclerotic plaques in blood vessels?

<p>Weakening of the vessel wall leading to aneurysms (C)</p> Signup and view all the answers

What are the constituent materials found within atheromatous plaques?

<p>Soft friable lipid cores and fibrous caps (A)</p> Signup and view all the answers

How does atherosclerosis primarily affect vascular function?

<p>By causing stenosis and potential thrombosis (C)</p> Signup and view all the answers

What is a significant consequence of necrotizing arteriolitis in hypertension?

<p>Arteriolar wall necrosis and vessel obstruction (B)</p> Signup and view all the answers

What is one of the key microscopic characteristics of kidney damage in hypertension?

<p>Hyaline thickening of arteriolar walls (D)</p> Signup and view all the answers

What happens to the macrophages over time in association with atherosclerosis?

<p>They undergo atrophy and weakening. (D)</p> Signup and view all the answers

Which factor is considered a significant age-related risk factor for myocardial infarction or stroke?

<p>Age between 40-60 years (A)</p> Signup and view all the answers

What is a common modifiable risk factor specifically associated with atherosclerosis?

<p>Hyperlipidemia (D)</p> Signup and view all the answers

Which statement best describes the risk of atherosclerosis in women after menopause?

<p>Their risk can exceed that of men. (C)</p> Signup and view all the answers

Which of the following is NOT considered a constitutional risk factor for atherosclerosis?

<p>Hypertension (D)</p> Signup and view all the answers

What effect does cigarette smoking have on atherosclerosis?

<p>It increases the risk of various atherosclerosis complications. (D)</p> Signup and view all the answers

What are cholesterol and cholesterol esters primarily composed of in the context of atherosclerosis?

<p>Extracellular lipids (D)</p> Signup and view all the answers

What is a consequence of smooth muscle cell migration in atherosclerosis?

<p>Expansion of the lipid core (C)</p> Signup and view all the answers

Which area has the highest frequency of severe atherosclerotic lesions?

<p>Infrarenal abdominal aorta (A)</p> Signup and view all the answers

What type of lesions appears commonly and increases in size as a patient ages?

<p>Atherosclerotic plaques (C)</p> Signup and view all the answers

What occurs when atherosclerotic plaques undergo acute changes?

<p>Rupture or ulceration (A)</p> Signup and view all the answers

Which of the following arteries is typically spared from severe atherosclerotic lesions?

<p>Vessels of the upper extremities (B)</p> Signup and view all the answers

What does the presence of fatty streaks indicate?

<p>Lipid accumulation in macrophages (B)</p> Signup and view all the answers

What can result from the exposure of thrombogenic substances following plaque rupture?

<p>Myocardial infarction (B)</p> Signup and view all the answers

Which vascular locations are primarily affected by atherosclerotic disease by frequency?

<p>Infrarenal abdominal aorta, coronary arteries, popliteal arteries (C)</p> Signup and view all the answers

Which of the following describes an atherosclerotic plaque that has changed due to acute clinically important changes?

<p>Exposure of the lipid core (B)</p> Signup and view all the answers

What is the primary aim regarding cholesterol levels in relation to health?

<p>Decrease levels of LDL and increase levels of HDL (B)</p> Signup and view all the answers

Which statement accurately describes fatty streaks?

<p>They consist of lipid-filled foamy macrophages in early childhood. (C)</p> Signup and view all the answers

What effect does obesity have on HDL cholesterol levels?

<p>Obesity lowers HDL cholesterol levels. (B)</p> Signup and view all the answers

How do atherosclerotic plaques differ from fatty streaks?

<p>Atherosclerotic plaques lead to significant flow disturbances. (C)</p> Signup and view all the answers

What dietary components are associated with raising plasma cholesterol levels?

<p>High consumption of cholesterol and saturated fats (B)</p> Signup and view all the answers

What is the primary factor contributing to essential hypertension?

<p>Age-related increase in blood pressure and the interplay of genetic and environmental factors (D)</p> Signup and view all the answers

Which condition is NOT directly associated with hypertensive vascular disease?

<p>Chronic obstructive pulmonary disease (COPD) (B)</p> Signup and view all the answers

What mechanism is commonly understood to lead to hypertension?

<p>Increased blood volume and/or peripheral resistance due to unknown mechanisms (D)</p> Signup and view all the answers

Which type of vascular disease is characterized by cholesterol deposition leading to vessel narrowing?

<p>Atherosclerosis (D)</p> Signup and view all the answers

What is NOT a potential risk of untreated essential hypertension?

<p>Decreased blood sugar levels (A)</p> Signup and view all the answers

What leads to multifactorial hypertension in patients?

<p>An interplay of various environmental factors and genetic predispositions (D)</p> Signup and view all the answers

Which of the following is a disease affecting small blood vessels?

<p>Arteriolosclerosis (B)</p> Signup and view all the answers

Which condition is characterized by the gradual rise in blood pressure as individuals age?

<p>Essential hypertension (A)</p> Signup and view all the answers

Flashcards

Hypertensive Vascular Disease

A disease affecting the blood vessels due to high blood pressure.

Essential Hypertension

A gradual increase in blood pressure that happens as we age, and its cause isn't fully understood.

Cardiac Hypertrophy

A condition where the heart pumps blood with more force, making the heart walls thicker.

Multi-infarct Dementia

A type of stroke caused by many small blood clots blocking blood flow to the brain.

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Heart Failure

A condition where the heart struggles to pump blood effectively, leading to fluid buildup.

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Aortic Dissection

The formation of a tear in the wall of the aorta, the body's main artery.

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Renal Failure

A condition where the body is unable to filter waste products from the blood efficiently.

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Stroke

A condition where the blood supply to the brain is interrupted, leading to brain damage.

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Atherosclerosis

A buildup of fatty deposits, primarily cholesterol and cholesterol esters, within the walls of arteries, leading to narrowing and hardening of the blood vessels.

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Hypertension

A condition where blood pressure is constantly elevated, placing stress on the heart and blood vessels.

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Hyperlipidemia

An abnormal elevation of cholesterol levels in the blood, contributing to atherosclerosis.

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Peripheral Artery Disease

Impaired blood flow to the limbs, often due to atherosclerosis, leading to pain, numbness, and potential tissue damage.

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Reduced renal sodium excretion

A condition where the kidney's ability to remove sodium from the body is reduced, leading to water retention and increased blood pressure.

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Increased vascular resistance

A chronic narrowing of blood vessels, primarily arterioles (tiny arteries), which increases resistance to blood flow and raises blood pressure.

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Renal artery narrowing

A type of high blood pressure caused by narrowing of the arteries that supply blood to the kidneys.

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Renovascular hypertension

A condition where the narrowing of the renal arteries leads to excessive renin production, causing high blood pressure.

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Degenerative changes in large arteries

Changes in the aorta and other large arteries due to hypertension. This can include weakening of the artery wall or even a tear (aortic dissection).

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Hyaline arteriolosclerosis

A condition characterized by thickening of the walls of small arteries, typically seen with severe hypertension.

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Hyperplastic arteriolosclerosis

A condition characterized by narrowing of the walls of small arteries with 'onion-like' layers, seen with malignant hypertension.

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Foamy Macrophage

A type of lipid-filled macrophage found in the early stages of atherosclerosis, contributing to fatty streaks.

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Fatty Streaks

Minimally raised lesions in the wall of blood vessels, primarily composed of lipid-filled foamy macrophages.

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Atherosclerotic Plaque

A thickening of the intimal layer of a blood vessel, characterized by lipid accumulation and fibrous cap formation.

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Atherosclerotic Plaque Enlargement

The process of atherosclerotic plaques enlarging and impeding blood flow, causing narrowing of the blood vessel lumen.

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What is Hyaline Arteriolosclerosis?

A type of vascular disease affecting small arteries, especially common in people with diabetes or high blood pressure. It causes thickening of the vessel walls and a decrease in blood supply to affected organs.

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Describe the microscopic appearance of Hyaline Arteriolosclerosis.

Hyaline arteriolosclerosis is characterized by homogeneous, pink hyaline thickening of arteriolar walls, with loss of underlying structural detail and luminal narrowing, thus decreasing blood supply to the affected organs.

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What is Hyperplastic Arteriolosclerosis?

A type of vascular disease affecting small arteries. It is characterized by concentric, laminated thickening of arteriolar walls, leading to 'onion skin' appearance and luminal narrowing. It can be seen in elderly normotensives and is a possible cause of renal failure.

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What is Atherosclerosis?

A type of vascular disease affecting large and medium-sized arteries. A build-up of plaque within the vessel wall can lead to narrowed blood flow, rupture and blood clot formation, and even aneurysms.

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Describe the appearance of atheromatous plaques.

Atheromatous plaques are raised lesions (usually yellow in color) composed of soft friable lipid cores (mainly cholesterol and cholesterol esters, with necrotic debris) covered by fibrous caps. They are associated with the pathogenesis of coronary, cerebral, and peripheral vascular disease.

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What are the consequences of Atherosclerosis?

Atherosclerosis can cause narrowed blood flow (stenosis), rupture and blood clot formation (thrombosis), and even weakening of the vessel wall leading to aneurysms (ballooning of the vessel).

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Describe the composition and effects of atheromatous plaques.

Atheromatous plaques are composed of cholesterol and cholesterol esters, along with necrotic debris and covered by fibrous caps. They impede blood flow, can rupture and cause thrombosis, and can weaken the underlying media leading to aneurysms.

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How are Hyaline and Hyperplastic Arteriolosclerosis similar and different?

Hyaline arteriolosclerosis is characterized by a glassy, pink layer in the vessel wall, while hyperplastic arteriolosclerosis shows a layered appearance like an onion. Both can cause narrowing of the vessel lumen.

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Locations of Atherosclerotic Lesions

The most common location for atherosclerotic lesions is the infrarenal abdominal aorta, followed by the coronary arteries, popliteal arteries, internal carotid arteries, and the vessels of the circle of Willis.

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Plaque Rupture

A dangerous complication of atherosclerotic plaques where the plaque ruptures, exposing thrombogenic substances. This can lead to thrombus formation, blocking blood flow.

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Acute Syndrome like Myocardial Infarction

A clinical syndrome caused by complete blockage of a blood vessel, often due to plaque rupture and thrombus formation.

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Areas Usually Spared

Upper extremities and mesenteric/renal arteries are usually spared from atherosclerosis, except at their ostia (openings from the aorta).

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Ostia

The openings of blood vessels as they emerge from the aorta.

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Study Notes

Cardiovascular Diseases

  • Cardiovascular diseases are classified into hypertensive vascular disease, vascular tumors, and vasculitis.
  • Arteriolosclerosis affects arterioles.
  • Atherosclerosis is a disease affecting blood vessels in hypertension, characterized by gradual age-related increases in blood pressure.
  • Atherosclerosis is caused by cholesterol deposition, narrowing the blood vessels.
  • Increased risk factors for hypertension include stroke, atherosclerotic coronary heart disease, heart failure, aortic dissection, cardiac hypertrophy, and multi-infarct dementia.
  • The mechanisms leading to hypertension are largely unknown but involve a complex interplay of genetic factors and environmental factors.
  • Blood pressure is a function of cardiac output and peripheral resistance; increases in either will result in increased blood pressure.
  • Diagnosing hypertension requires sustained diastolic pressures over 90 mm Hg or systolic pressures over 140 mm Hg, although lower thresholds may be used for patients with other cardiovascular risk factors.
  • Hypertension is categorized into primary idiopathic and secondary types with identifiable underlying conditions.
  • Primary idiopathic hypertension (95%) has an unknown cause, often linked to aging and genetics.
  • Secondary hypertension (5%) is often associated with younger patients and an identifiable underlying condition like renal disease, and renal artery stenosis, impacting the kidney's vascular system and renin angiotensin production.
  • Essential hypertension is characterized by a gradual rise in blood pressure as individuals age.

Pathogenesis

  • Mechanisms of essential hypertension include reduced renal sodium excretion, increased vascular resistance (chronic vasoconstriction), and genetic factors.
  • Genetic factors influence renin, angiotensin, and angiotensinogen, affecting BP regulation.
  • Environmental factors like stress, obesity, smoking, and high-salt consumption are implicated in essential hypertension.
  • Accelerated atherosclerosis development is related to degenerative changes in large/medium-sized arterial walls (e.g., aortic dissection, cerebrovascular hemorrhage).
  • Small-vessel diseases such as hyaline and hyperplastic arteriolosclerosis are associated with hypertension.
  • Hyaline arteriolosclerosis is common in benign hypertension and can lead to nephrosclerosis (glomerular scarring) and renal failure.
  • Hyperplastic arteriolosclerosis is frequently found in severe/malignant hypertension.

Athero-sclerosis

  • Athero-sclerosis is intimal lesions (atheromas or atherosclerotic plaques) causing stenosis, thrombosis, or aneurysms due to compression of the underlying blood vessel media.
  • Athero-sclerotic plaques can cause impairment of blood flow resulting in coronary, cerebral, and peripheral vascular disease.
  • Athero-sclerosis begins with fatty streaks (lipid-filled macrophages) in blood vessel walls. These streaks may enlarge and form fibrous caps, leading to atherosclerotic plaques, impeding blood flow.
  • Plaques can rupture, leading to thrombosis and acute syndromes (e.g., myocardial infarction).
  • Atherosclerotic plaques can erode, develop hematomas, or form aneurysms.
  • Athero-sclerosis often involves the coronary, cerebral, and peripheral arteries but can affect other vessels as well.
  • Risk factors include genetics, age, gender, hypertension, cigarette smoking, diabetes, and hyperlipidemia.
  • Lowering blood pressure, reducing cholesterol levels, and adopting a healthy lifestyle can help prevent complications.
  • Critical stenosis frequently causes angina, bowel ischemia, stroke, and limb claudication.

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