Blood pressure

Blood pressure

1. Major regulator: Renin

   • Juxtaglomerular cells
   • Cleaves Angiotensinogen to AT-1
     • AT-1 to AT-2
       • Stimulates adrenal gland to secrete aldosterone
         • Increases blood volume
           • -ve feedback by Myocardial natriuretic peptide
       • Increases sodium resorption
       • Vasoconstriction

2. Benign Hypertension

   • Malignant Hypertension
     • Hyperplastic arteriosclerosis
     • Decreased sodium excretion
       • Increased blood volume and blood pressure
     • Genetic factors/ Environmental factors
     • Atherosclerosis
       • Atheroma
         • Cholesterol, cholesterol esters, necrotic debris and fibrotic caps
       • Thrombosis
       • Risk Factors
         • Modifiable
           • Hyperlipidemia/ hypercholesterolemia
             • Good cholesterol
               • HDL. HDL mobilzes the cholesterols from plaques to the liver
                 • Exercise and ethanol increases HDL
                 • Smoking and obesity decreases HDL
             • Bad cholesterol
               • LDL. LDL distributes the cholesterol in the peripheral tissues
                 • Statins lower the circulating cholesterol
                   • Statins lower CRP levels
                     • CRP is synthesised by liver. It is a biomarker which predicts the risk of MI.
           • Hypertension
             • Ischemic heart disease
             • Left ventricular hypertrophy
           • Smoking
           • Diabetes mellitus
             • Atherosclerosis related GANGRENE
             • Myocardial infarction
         • Constitutional/ nonmodifiable
           • Genetics
             • Familial hypercholesterolemia
           • Age
             • 40-60 yrs
           • Gender
             • Males are more prone. Postmenopausal women are also at more risk compared to premenopausal
       • Coronary Artery Disease
         • Lipoprotein-a : Apolipoprotein B100 and Apolipoprotein-a
       • Atherogenesis
         • Endothelial injury
         • Endothelial dysfunction
         • Monocyte-macrophages
         • Platelet adhesion
         • Smooth muscle recruitment
         • Lipid accumulation
         • Fatty streaks
           • Atherosclerotic plaques
             • Smooth muscle cells, T-cells and macrophages
             • Intracellular and extracellular lipid accumulation
             • ECM, collagen, elastin, proteoglycans
             • LEADS TO THROMBOSIS
               • EMBOLISM
               • Plaque rupture
               • Plaque erosion
               • Plaque hemorrhage
   • Hyaline arteriosclerosis
     • Nephrosclerosis