Hypertension & Hyperlipidaemia

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Malignant (accelerated) hypertension:

Severe hypertension (Sys >200 mm Hg, Dias>130 mm Hg) accompanied by end-organ damage - eg, encephalopathy, dissection, pulmonary oedema, nephropathy, eclampsia, papilloedema and/or angiopathic haemolytic anaemia.

Essential hypertension: 10-15% cases

Secondary causes:

Renal disease - approximately 75% are from intrinsic renal disease: glomerulonephritis, polyarteritis nodosa, systemic sclerosis, chronic pyelonephritis, or polycystic kidneys.

Approximately 25% are due to renovascular disease - most frequently atheromatous (eg, elderly cigarette smokers with peripheral vascular disease) or fibromuscular dysplasia (more common in younger females).

Endocrine disease:

Cushing's syndrome

Conn's syndrome

Phaeochromocytoma

Acromegaly

Hyperparathyroidism

Coarctation of the aorta.

Pre-eclampsia and hypertension in pregnancy.

Drugs and toxins - eg, alcohol, cocaine, ciclosporin, tacrolimus, erythropoietin, adrenergic medications, decongestants containing ephedrine and herbal remedies containing licorice.

Consequences:

Heart attack or stroke. hardening and thickening of the arteries (atherosclerosis), which can lead to a heart attack, stroke or other complications.

Cardiac arrythmias

Brain infarct or hemorrhage

Aneurysm. Increased blood pressure can cause your blood vessels to weaken and bulge, forming an aneurysm. If an aneurysm ruptures, it can be life-threatening.

Heart failure. To pump blood against the higher pressure in your vessels, your heart muscle thickens (LV Hypertrophy). Eventually, the thickened muscle may have a hard time pumping enough blood to meet your body's needs, which can lead to heart failure.

Damaged and narrowed blood vessels in your kidneys. Damage to glomeruli, ischaemia and necrosis of renal tubules, leading to albuminuria.

Hypertensive retinopathy, with swelling of optic disk, retinal ischaemia, exudates and hemorrhage.This can result in vision loss.

Metabolic syndrome. increased waist circumference; high triglycerides; low high-density lipoprotein (HDL); high blood pressure; and high insulin levels.

The more components you have, the greater your risk of developing diabetes, heart disease or stroke.

Trouble with cognition processes. Trouble with memory or understanding concepts is more common in people with high blood pressure.

Link between cholesterol and vascular risk:

1% increase in coronary heart disease (CHD) risk for each 1% increase in LDL-C.

2-3% reduction in CHD risk for each 1% increase in HDL-C.

Higher levels of total cholesterol increase the risk of cardiovascular disease, particularly coronary heart disease.

Levels of LDL or non-HDL cholesterol both predict future coronary heart disease, which is the better predictor is disputed.

HTN

Hyperlipid