PATHOPHYSIOLOGY OF HYPERTENSION

Flowchart nodes

• 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