MT 25 MEDICAL PATHOPHYSIOLOGY

Topic Outline: d.) Salt

o Hypertension e.) Stress
o Kidneys f.) Obesity, lack of exercise
o Drugs to treat HTN g.) Smoking

Secondary HTN
• Unlike essential HTN, secondary HTN has a specific
cause for the elevated blood pressure
• Kidney Disease
• Pheochromocytoma – a type of tumor that makes
too much epinephrine or too much
catecholamines
• Cushing’s Disease
• Pregnancy
• Vascular Anomalies
• Neurologic Disease

Symptoms of HTN
• As blood is pumped through the arteries, it o HTN usually has NO symptoms
creates pressure within the wall of the arteries o It is usually detected on a routine visit to a
• As the heart contracts, this increased pressure is medical clinic
called the systolic pressure o HTN can cause many symptoms
• As the heart relaxes and fills, this decreased o Headache and visual changes, especially during
pressure is called the diastolic pressure stress are common early symptoms

Blood Pressure When HTN is severe enough to cause acute visual,

• Blood pressure is written as a fraction of systolic neurologic, or any other organ damage this is called
over diastolic pressure in mmHg(mercury) MALIGNANT HYPERTENSION
• Normal is 120/80 mmHg
• Blood pressure is VITAL to life HTN damages BLOOD VESSELS
• A blood pressure of zero is a sign of death • Long term sustained hypertension damages blood
• Blood pressure is a VITAL sign vessels
• Blood vessels exposed to high blood pressures
Hypertension become thickened and hardened, making them
o Is High Blood Pressure less flexible - arteriosclerosis
o HTN • Fatty deposits can form on the arteries called
o Hypertension plaques, which cause the artery to narrow and
o Is measured by consistent elevation in blood become blocked - atherosclerosis
pressure, either
o Systolic ≥ 140mmHg
o Diastolic ≥90mmHg Arteriosclerosis - Blood vessels exposed to high blood
o Hypertension pressures become thickened and hardened, making them
o Long standing, uncontrolled HTN damages blood less flexible
vessels resulting in many types of organ damage
Atherosclerosis - Arteries get hard and narrow, which can
Essential Hypertension restrict blood flow and lead to blood clots, heart attack or
• Essential HTN is the most common form of HTN stroke.
• Cause of essential HTN is unknown

Essential Hypertension has many risk factors:

a.) Family history of HTN
b.) Sex
c.) Race
LOPEZ, MJC | BSMT II – 1ST SEM | SILLIMAN UNIVERSITY
MT 25 MEDICAL PATHOPHYSIOLOGY
Know the difference between:
Arteriosclerosis vs Atherosclerosis HTN damages the EYES
• Because HTN damages blood vessels, HTN
damages the blood supply to the eyes, and can
lead to blindness

Normal Retina

Infarction
• When narrow arteries become blocked and blood
supply to an organ is stopped, organ damage
results HTN damages the KIDNEYS
• This damage is called infarction • Because HTN damages the blood vessels, HTN
damages the kidneys, this is called
HTN damages the BRAIN nephrosclerosis, and can lead to kidney failure
• HTN is a major cause of stroke
- brain attack Nephron
- cerebrovascular accident (CVA)
- cerebral infarction
- apoplexy

HTN damages the HEART

• Because HTN damages the blood vessels, HTN
damages the heart by infarction, hypertrophy or
cardiomyopathy
a.) Myocardial Infarction

Aneurysm
• With high blood pressure, a weakening of the
arterial wall may balloon out (aneurysm) and
burst causing hemorrhage (bleeding) and even
death
• Although aneurysm can occur on any artery, the
two most common places for aneurysm are:
a.) Brain – cerebrovascular aneurysm
b.) Aorta – abdominal aortic aneurysm
LOPEZ, MJC | BSMT II – 1ST SEM | SILLIMAN UNIVERSITY
MT 25 MEDICAL PATHOPHYSIOLOGY

b.) Ventricular Hypertrophy

Kidneys are Filters
• The kidneys contain millions of microscopic
filtering units, called nephrons which are the
working components of the kidneys.
• Many substances cannot pass through the filter
and remain in the blood
• Many substances pass through the filters (like
glucose) but are reabsorbed back into the blood
• Many substances pass through the filters and are
excreted into the urine

Kidneys regulate blood volume

• When blood volume decreases, kidneys will retain
salt and water
c.) Dilated Cardiomyopathy • When blood volume increases, kidneys will
excrete salt and water

Renal Hormones and Volume Control

• Blood volume is monitored by the kidneys and
continually adjust water and salt levels to help
maintain consistent blood pressure
• The blood vessels supplying the nephrons contain
special cells that detect blood pressure
• If blood pressure falls below a set point, a renal
hormone called Renin is secreted into the blood
stream

Renin and Volume Control

• Renin converts angiotensin to angiotensin 1,
Kidneys which is converted to angiotensin 2 by the lungs
The kidneys help regulate blood pressure • Angiotensin 2 causes vasoconstriction which
• The kidneys play an important role in the long- increases blood pressure
term regulation of blood pressure • Angiotensin 2 also stimulates the adrenal cortex
to produce aldosterone
Immediate Control
• Parasympathetic Nervous System Aldosterone and Volume Control
• Sympathetic Nervous System/Adrenergic NS • Aldosterone acts on the kidneys to keep salt and water
in the blood, resulting in increased blood volume
Long Term Control
• Kidneys

Kidneys and Blood Pressure

• Kidneys help regulate the balance of salt and
water in the body
• Kidneys excrete water soluble waste substances,
salt and water

LOPEZ, MJC | BSMT II – 1ST SEM | SILLIMAN UNIVERSITY

MT 25 MEDICAL PATHOPHYSIOLOGY

• Medulla – inside
- epinephrine (adrenaline)
• Cortex – outside
- aldosterone (mineralocorticoid)
- hydrocortisone (glucocorticoid)

Antidiuretic Hormone (ADH) and Volume Control

• Antidiuretic Hormone (ADH) is also called Vasopressin,
secreted by the brain in response to low blood
pressure, acts on the kidneys to retain water, resulting
in increased blood volume

Drugs for HTN

• Adrenergic Antagonists
- β-blockers
- “Beta Blockers”
a) Propanolol
b) Atenolol

• Adrenergic Antagonists
- α-blockers
- alpha-blockers
a) Doxazosin

• Central α-agonist
b) clonidine – stimulates alpha adrenoreceptors in
the brain stem. This action results in reduced
sympathetic outflow from the central nervous
system and in decreased in peripheral resistance,
renal vascular resistance, heart rate and blood
pressure.

• Thiazide diuretic
- Hydrochlorothiazide (HCTZ)

• Angiotensin Converting Enzyme (ACE) Inhibitors

- Captopril

• Angiotensin II receptor blockers

- Losartan

• Calcium Channel Blockers

a) dilates arterioles
b) relaxes smooth muscle
c) come in 3 classes
- Nifedipine is a dihydropyridine CCB
- Verapamil is a phenylalkylamine CCB
- Diltiazem is a benzothiazepine CCB

LOPEZ, MJC | BSMT II – 1ST SEM | SILLIMAN UNIVERSITY