PATHOPHYSIOLOGY OF HYPERTENSION

ESSENTIAL HYPERTENSION

(Age, family history, excess alcohol consumption, stress, diet)

Vasoconstriction of the lumen of the artery

Caused by the release of the hormones norepinephrine, epinephrine and adrenaline by the Sympathetic NS

Resulting to an increase in blood pressure and a decreased in blood flow in the kidneys

In response, the kidney produces RENIN

Hormone Angiotensinogen

Hormone aldosterone

Angiotensinogen will be converted to Angiotensinogen I

Enzyme ACE converts angiotensin I to angiotensin II

Angiotensin II (most potent vasoconstrictor)

Increased Peripheral Vasoconstriction

Increases Na ion and water reabsorption

causes an increase in blood volume resulting to an increase in CO

Increased CO

Increased Blood pressure

Increased in the end diastolic blood volume

Resulting to stretching of myocardial muscle fibers

Heart muscle thickens (ventricular hypertrophy)

Proliferation of myocardial cells

Angiotensin II compensates the destroyed cells by producing myocardial cells

Still increased in Cardiac Output

narrowed arteries

If more damage to blood vessels; more reduction of blood flow to organs

Insufficient oxygenated blood ongoing to the brain and can cause clotting

NERVOUS SYSTEM

Vascular demetia

Retinophathy

Mild cognitive impairment

Transient ischemic attack/ mini stroke

When blood supply is cut-off

Full-blown stroke

a decreased in blood flow in the kidneys.a decreased in blood flow in the kidneys.

RENAL SYSTEM

Can cause arteries around the kidneys to narrow, weaken or harden.

Not be able to deliver enough blood to the kidney tissue

Increase force of blood flow

Creates stretching and weakens the blood vessels throughout the body, including those in the kidneys

Can damage blood vessels in the kidneys

Nephrons don’t receive the O2 and nutrients

May stop filtering and removing wastes and extra fluids from the body

Dangerous levels of fluid and waste can accumulate.

a reduced amount of urine, swelling of your legs, ankles, and feet from retention of fluids caused by the failure of your kidneys to eliminate water waste, unexplained shortness of breath, excessive drowsiness or fatigue, persistent nausea, confusion, pain or pressure in your chest, seizures, coma.

Resulting to an increase in blood pressure and a decreased in blood flow in the kidneys. (eto yung gawa mo haha dugtong mo lang yung susunod)

Increase force of blood flow

Creates stretching and weakens the blood vessels throughout the body, including those in the kidneys

Can damage blood vessels in the kidneys

Nephrons don’t receive the O2 and nutrients

May stop filtering and removing wastes and extra fluids from the body

Dangerous levels of fluid and waste can accumulate.

Can cause arteries around the kidneys to narrow, weaken or harden.

Not be able to deliver enough blood to the kidney tissue

KIDNEY FAILURE

Kidney failure raises the risk of cardiovascular problems, and subsequently – the risk of heart attacks and strokes.

Damages the lining of blood vessels and causes arteries to become narrow or even to burst which limits the blood flow

REPRODUCTIVE SYSTEM IN MALES

Less blood flow is able to flow to the penis

It will be difficult to achieve and maintain erections

Insufficient calcium levels in the body due to decreased blood flow

SKELETAL SYSTEM

falling calcium levels in the blood

low calcium level will be sensed by the parathyroid gland

Parathyroid gland is stimulated to release parathyroid hormone

Parathyroid hormones targets osteoclasts cells.

Osteoclasts cells will be activated

Degrades bone matrix and releases calcium into the blood.

calcium homeostasis

If there’s kidney damage (kidneys- part of its job is to filter urine)

Excretion of too much calcium aside from urine.

Insufficient calcium in the blood

bone density decreases

OSTEOPOROSIS

Increased blood volume

INTEGUMENTARY SYSTEM

Causes an increased in capillary hydrostatic pressure

large amount of fluids is pushed to the interr space

Excessive fluid accumulation

if lymphatic system cannot cope with the excess fluids drawn from the blood vessel,.

decreased osmotic pressure (plasma osmotic pressure-draws fluid from the interstitial space to the blood vessel)

EDEMA

Decreased plasma proteins (plasma proteins are responsible for creation of osmotic pressure)

severe liver disease (liver- responsible for producing plasma proteins)

Vascular tone may be elevated

MUSCULAR SYSTEM

-Confusion

-Disorientation

-Trouble speaking or understanding speech

-Vision loss

-numbness or weakness of the face, arm or leg especially on the side of the body

-confusion or change in mental status

-trouble speaking or understanding speech

-visual disturbances

-difficulty walking, dizziness, or loss of balance or coordination

-sudden severe headache

-Depression.

-Irritability and aggression.

-Anxiety.

-Apathy.

-reduced vision

-eye swelling

-bursting of a blood vessel

-double vision accompanied by headaches

-Back pain, caused by a fractured or collapsed vertebra

-Loss of height over time

-A stooped posture

-A bone fracture that occurs much more easily than expected

-Swelling or puffiness of the tissue directly under your skin

-Stretched or shiny skin

-Skin that retains a dimple after being pressed for several seconds

-Increased abdominal size

Increase of α-adrenoceptor stimulation

and increase of release of peptides such as angiotensin or endothelins

Increase of cytosolic calcium in vascular smooth muscle

Causing vasoconstriction

Several growth factors, including angiotensin and endothelins

Cause an increase in vascular smooth muscle mass termed vascular remodelling

both an increase in systemic vascular resistance and in vascular stiffness augment the load imposed - left ventricle

this induces left ventricular hypertrophy and left ventricular diastolic dysfunction.

the digestive system is not able to perform at a normal level and can lead to a variety of digestion problems

DIGESTIVE SYSTEM

Delayed gastric emptying (slow digestion)

nutritional deficiencies, rapid fluctuation of blood glucose levels and susceptibility to bacterial infections

food that remains in the digestive tract for longer than normal can accumulate into a ball-like mass known as a bezoar.

This mass can cause gastric upset, nausea and vomiting and can cause serious blockage of the digestive tract.

Consistently fluctuating blood glucose levels caused by slow digestion can also lead to organ and tissue damage or dangerously low blood sugar levels that can lead to coma and death.

High-salt diet (HSD)

LYMPHATIC SYSTEM

Lymphatic vessels play a role in blood pressure buffering

This process is mediated by mononuclear phagocyte system (MPS)-driven tonicity-responsive enhancer-binding protein (TonEBP) and VEGF-C signaling

This signaling induces lymphatic vessel hyperplasia, resulting in increased lymphatic drainage capacity, and thus contributes to interstitial fluid and blood pressure homeostasis

This hyperplasia is promoted by VEGF-C that is secreted from MPS cells

Increase of Aldosterone

lack of aldosterone

Primary Hyperaldosterone

Addison's Disease

Aldosterone Synthase Deficiency

ENDOCRINE SYSTEM

DEATH