Pathophysiology and Diagnosis of Hypertension

[Music] our ninja so with hypertension it's important for us to be able to understand the definition of what I pretension is because we can define hypertension is basically an elevated systolic blood pressure or an elevated diastolic blood pressure all right so when we define hypertension what is hypertension obviously it's elevated blood pressure but we have to further define that because you can have what's called systolic hypertension or diastolic hypertension according to the American Heart Association they say that normal blood pressure is when the systolic is less than 120 millimeters of mercury right which is the pressure that the left ventricle exerts okay diastolic pressure is considered to be normal when it's less than 80 millimeters of mercury which is the pressure at rest in the aorta okay now we say that pre hypertension so when someone's starting to kind of get on the verge of high blood pressure but they aren't there yet is when someone's systolic blood pressure is anywhere from 120 to 129 millimeters of mercury so it's a little bit elevated right we say the diastolic can still be considered prehypertension though if it's less than 80 millimeters of mercury let's go up to the next one now the next thing is you have stage 1 hypertension all right so stage 1 hypertension is blood pressures going up just a little bit now and now we're gonna go from 130 anywhere from 130 to 139 millimeters of mercury is considered to be stage 1 it's a Stalag hypertension and if you're anywhere between 80 to 89 millimeters of mercury diastolic that's considered to be stage 1 hypertension as well you can have both a mix type of hypertension or you could have isolated systolic and isolated diastolic hypertension now we go to stage 2 the blood pressure starts rising even more and we consider to be stage 2 whenever is greater than or equal to 140 millimeters of mercury systolic or greater than or equal to 90 millimeters of mercury diastolic so that is how we define hypertension according to the American Heart Association guidelines right the next thing to have to understand is when we diagnose hypertension it's very simple you take the person's blood pressure here's the thing that you got to be careful of there is some people who have what's called white coat hypertension and it's a real thing and this is basically they have normal blood pressure right so outside of the office outside of the office they have a normal BP okay they have a normal blood pressure so technically anywhere less than or equal to 120 over 80 okay but then inside the office the blood pressure is high okay they have a elevated blood pressure and why is this it's related to anxiety it's related to the stress of being in the office and knowing that the doctor is going to be seeing you so that can be a little nerve-racking so that's the question how do we diagnose hypertension technically the definition is we say you need to be able to take two separate blood pressure measurements on two separate office visits and if they are any point in time greater than 140 over 90 we consider it to be stage 2 hypertension if it's stage one where it's greater than 130 over 80 you can say it's stage 1 hypertension and we might start treating them it just depends on their cardiovascular risk factors and we'll talk about that in another video all right so that's the question is if they come into the office and their blood pressure is high all the time how do we really diagnose these people there is a specific test that can diagnose people with white coat hypertension and this is called ambulatory blood pressure monitoring and it's a 24-hour blood pressure kind of monitoring system that over that 24 hour period when the patient takes at home it gives them an average blood pressure of the entire day their average blood pressure in the morning their average blood pressure at night and based upon those findings we can determine if they truly have hypertension or really is just a white coat hypertension all right so that's what we need to know about hypertension the second thing that you need to know is hypertension has many different causes most of the time the causes are of primary type what does that mean it's essential hypertension we don't really know the exact pinpoint reason why it happens but this is the most common type so most of them are going to be essential hypertension or primary hypertension 95% of the cases now what are these different things that we think might be related to the primary hypertension some people okay may have hypertension because they have a hyper sensitive sympathetic nervous system what does that mean so we know that the sympathetic nervous system right is basically important in regulating our actual blood vessel tone right because we have sympathetic neurons and what these sympathetic neurons do when they come out of the thoracolumbar region is they go to the arterioles and they can act on different receptors on these arterioles right so you have this increased sympathetic nervous system so we'll put increase sympathetic nervous system activity that's going to lead to releasing norepinephrine onto these different receptors on the smooth muscle and leading to vasoconstriction right so we're gonna get vaso constriction so these people might have a hyper responsive sympathetic nervous system that leads to vasoconstriction that increases their total peripheral resistance and that increases the patient's blood pressure that's one way that we can have it another situation is if you remember the kidneys have a specific system in here called the juxtaglomerular apparatus so if you guys remember the juxtaglomerular cells they respond to this epinephrine right on their specific receptors and they see create what's called renin and if you guys remember what does renin do it leads eventually to this increased production of angiotensin 2 an angiotensin 2 increases blood pressure through multiple different ways right by increase aldosterone production increasing ADH production by causing vaso constricted mechanisms so that's another way another thing is very interesting not only is one of the causes people having a hyperactive sympathetic nervous system but sometimes for some weird reason some people can have a hyperactive renin-angiotensin-aldosterone axis in other words for some reason they release renin in large amounts of it and if they have a lot of written production that means increased angiotensin ii production and if there's increased angiotensin ii production there's technically going to be an elevation in their blood pressure so that's another reason so one is increased sympathetic nervous system activity the other one is an increased sensitivity of the renin-angiotensin-aldosterone axis what else can a sympathetic nervous system do besides cause vasoconstriction in the renin-angiotensin system it can also act on your heart right and act on the SA node and if you remember what does it do to the SA node it increases heart rate increasing heart rate increases cardiac output increase in cardiac output increases the patient's blood pressure another thing is it can also act on the ventricular myocardium that contractile cells and cause an increase in the contractility the force right if you increase contractility you increase your stroke volume therefore you increase cardiac output and you increase your blood pressure so this is gonna be two common reasons why another one and this is common in elderly individuals and it's also common in african-american individuals and it's called a low renin hypertension for some reason and these patients they have their kidneys they decrease the excretion of sodium so let's write that down here the third reason the third reason is a decreased salt excretion now you're probably wondering how in the heck does that cause it let's explain if there's less salt in the urine what does that mean then that means more of that actual sodium is gonna be retained in your blood right so if you have an increase basically decreased sodium output means increased sodium retention so there's an increase in the sodium retention what does that mean that increases your blood volume because that pulls with it water and if you increase the blood volume that technically increases the blood pressure that's one way but here's something else that's super interesting if you increase blood pressure because of the increased blood volume what does that do to the j.g cells in the kidney if there's high blood pressure are you gonna want to release renin no because the job of renin is to lead to angiotensin ii to increase your blood pressure so if you already have high blood pressure that's not going to help us so guess what that does it inhibits the renin-angiotensin-aldosterone system so now that means that there is a low renin production if there's decreased renin production that means decrease angiotensin ii and that means it's not going to cause that blood pressure to be high secondary to their elevated renin levels that's why we call this low renin hypertension because their cause is related to sodium retention blood volume and available elevated blood pressure here's another thing that's very interesting if sodium retention is occurring it's not completely known how this site of cellular mechanism occurs but they know that sodium has the ability to cause vasoconstriction and if these patients have vasoconstriction due to the elevated sodium concentration so increased sodium concentration initiate zvezda constriction what does that do to the total peripheral resistance it increases the total peripheral resistance and that increases their blood pressure so it's pretty cool so I want you to remember three specific primary hypertensive things that can occur in these patients one hypersensitive hyper activity of the sympathetic nerve system hyperactivity of the renin-angiotensin-aldosterone axis and the third thing is decreased sodium excretion which is related to african-americans and elderly who have what's called low renin hypertension alright so the last thing I want to talk about before we go into causes of secondary hypertension is again these are some underlying genetic environmental things that can happen in these patients because of that having a hyperactive sympathetic renin-angiotensin-aldosterone axis or their kidneys playing an altered role in nature rhesus which is again sodium excretion there is risk factors that increase the risk of someone developing hypertension what are some of those things it's very simple if they're diabetic because diabetics have hyperinsulinemia hyperinsulinemia can cause actually an increase high blood pressure or high blood pressure other ones obesity being is having a sedentary lifestyle obstructive sleep apnea is on the rise as one of the biggest causes of people having hypertension someone having a Type A personality being a very excited kind of person very neurotic in that way other ones is surprisingly vitamin deficiencies like vitamin D deficiency other ones is if you have a family history if you smoke if you drink alcohol these are all things that play a big role even your ethnicity plays a significant role in these patients having higher risk factors for hypertension but again these are kind of the underlying genetic environmental aspect just remember the risk factors big ones smoking family history alcohol again obesity obstructive sleep apnea diabetes in combination with these things increases the risk of someone developing primary hypertension one last thing is primary hypertension primarily occurs in the age range around 25 to 55 years of age anything outside of that age range like less than 25 and someone developing hypertension it's probably not primary hypertension it's probably secondary hypertension so now it's going to talk about that alright guys so let's go ahead and talk about causes of secondary hypertension now remember this is not as common if you think about the percentage of people that actually develop hypertension secondary it's usually like 5% so it's not super common but who are the patients that you have to think about descent commonly whenever they present this kind of stuff on you know boards or exam questions they're gonna be saying you have a younger individual less than 25 years of age who has some underlying type of disease and has developed hypertension what are these underlying diseases that we have to elucidate the big one is your kidneys your kidneys play a huge role in basically developing hypertension if they're damaged so let's talk about that sometimes if the actual parenchymal tissue of the kidney right so basically all the structure inside of it where all the kidney tubules are which play a significant role in reabsorption and excretion if these are all jacked up you have a renal parenchymal disease that can also cause increased sodium retention increased water retention which can increase your blood pressure what are some of these renal parenchymal diseases so again the disease is of the actual renal tissue right it has nothing to do with the blood vessels supplying the tissue it's to do with damage of the actual collecting ducts the proximal convoluted tubules the loop of Henle your glomeruli all of those structures are damaged so now that we know that this is due to damage of the underlying perennial tissue what are some of those conditions well what can damage the actual glomeruli glomerulonephritis so if someone has an underlying glomerular nephritis right and there's multiple types of these we're not going to go through all of these right now we're just gonna say this is one of them another type of condition which is the most common cause of end-stage renal disease is patients who have what's called diabetic nephropathy right so they have a lot of basically glomerulosa sclerosis so they have damage to a lot of the actual glomeruli which is basically the structure that filters a lot of your plasma so diabetes can also damage the glomeruli or you can have an underlying glomerular nephritis rated later to multiple different conditions okay for example sometimes IgA nephropathy poster up Takako glomerulonephritis there's so many different kinds lupus nephritis if you guys want a couple of them again another thing is what if I damaged the tubules what if I caused multiple cysts to form like in polycystic kidney disease so if someone has polycystic kidney disease that can also alter the reabsorption and excretion of different substances which again can lead to increased sodium retention water retention and cause hypertension the next thing I want you guys to remember what if it's not renal parenchymal but renal vascular causes so the blood vessels that are actually going to the kidneys which again the kidneys play a significant role in excretion of water and solutes right particularly things like sodium what if that's damaged so what if you have stenosis what if you have a big old like kind of atherosclerosis within the wall of the renal artery so what is this here called it's the nosing it right it's narrowing that air at that little blood foe passageway so decreased blood flow is going to be able to get past this and that decreased blood flow means that there's going to be decreased urinary excretion right and that's gonna allow for more of the actual what a lot of the water the salt all the blood plasma to build up and increase hypertension right increase the risk of it so this is one cause this could be things like renal artery stenosis that's what this little plaque here is renal artery stenosis so one could be renal artery stenosis what if there's agitation what if somebody actually develops an inflammation due to maybe antibody deposition into this actual vascular wall maybe polyarteritis nodosa maybe it's some type of Wegener's granulomatosis or some type of vascularity that's causing this that could be another situation so what if someone has a vasculitis and that is actually causing inflammation it's causing narrowing and altering the actual amount of blood flow through the renal artery what if somebody has what's called fibro muscular dysplasia so sometimes what can happen is people who are young 20 30 year old females they get these proteinaceous deposits sometimes within the vessel wall and it can cause them to become this plastic and again cause narrowing of the lumen and decrease the blood flow into the kidney again you decrease the blood flow you increase water and salt retention and that's going to lead to high blood pressure that's another common cause all right that's the renal causes let's talk about the endocrine causes here so you know your adrenal gland has multiple different functions right one of the big things is you have this outer layer here called the zona glomerulosa you know the zona glomerulosa makes a hormone right called aldosterone well sometimes in what's called Kahn syndrome right so you can have what's called Kahn syndrome and Kahn syndrome is basically whenever someone produces large amounts of aldosterone what does that mean if you have high amounts of aldosterone that means increased sodium and water reabsorption that means increased blood volume and an increase in blood volume means an increase in blood pressure right that's gonna be another cost so if someone that's Kahn syndrome what if their zona fasciculata you know the zona fasciculata which is this middle layer here it releases a specific type of hormone called cortisol so what if somebody has elevated cortisol levels and a condition called Cushing's syndrome so if someone has Cushing's syndrome that could be another cause why what does cortisol do cortisol actually increases the norepinephrine and epinephrine receptor sensitivity if you increase the sensitivity of the norepinephrine and epinephrine receptors what's that going to do whenever epinephrine and norepinephrine bind on to them what's that gonna happen it's going to cause that are binding to produce a more profound amplified effect what is epinephrine and norepinephrine you onto your actual peripheral vessels initiate vasoconstriction so now if you have high cortisol you're gonna increase the receptor sensitivity so whenever they buy more they're gonna be more constrictive what's that going to do that's going to increase their blood pressure speaking of epinephrine and norepinephrine you have another layer of your actual adrenal gland here right in here is the adrenal medulla the adrenal medulla can make a hormone okay actually we should say neurotransmitter and again whenever it's produced in large amounts you can make lots of epinephrine or increase amounts of norepinephrine and this is in a condition called pheochromocytoma so when someone has pheochromocytoma they produce large amounts of epinephrine and norepinephrine what does that do that can actually do so many things it can actually increase your contractility right so it can increase heart rate it can increase stroke volume and it can also increase the renin-angiotensin-aldosterone axis and all of these things collectively through their own specific way can increase the patient's blood pressure right now here's other things that you got to think about with these patients if someone has elevated aldosterone levels they're probably gonna have electrolyte deficiencies or electrolyte abnormalities maybe they're gonna have high sodium low potassium right and elevated aldosterone levels if someone has Cushing syndrome they're gonna have pendular obesity they're gonna have a buffalo hump they're gonna have a moon face they're gonna hyperglycemia an abdominal striae if they have pheochromocytoma they're gonna have headaches they're gonna be diaphoretic they're gonna have episodic palpitations also right if someone has kidney disease what do you think is gonna happen if they have underlying kidney disease they'll have an elevated bu in or creatinine or maybe even a possibly a decreased GFR or maybe even proteinuria so those are other things that you got to think about let's go to the next thing the thyroid thyroid actually plays a pretty big role here so now you your thyroid this is what's super weird about the thyroid okay your thyroid sometimes you can make too much of it right so you have hyperthyroidism so you can have what's called hyper thyroidism and in hyperthyroidism you have elevated t3 and t4 this elevated t3 and t4 guess what it does it acts just like cortisol so it can do two things actually it can increase your heart rate and it can increase the norepinephrine epinephrine receptor sensitivity regardless this is going to increase contractility it's going to increase basal constriction and even increase heart rate but collectively what's this going to do this is going to lead to a increase in the patient's blood pressure that's one thing here's what's super weird people can also have secondary hypertension secondary to hypothyroidism it's weird guys I know but what happens is is whenever there's low t3 and low t4 for some reason it acts on the kidneys and when it acts on the kidneys it causes an increase in sodium retention for some reason it acts on the kidneys and when it acts on the kidneys it leads to an increase in sodium retention so an increase in sodium retention is actually going to lead to a increase in blood volume because it's gonna pull with the water and that's going to increase the patient's blood pressure so that's one way that it can happen another thing is we don't that's kind of confusing how but t3 and t4 can also increase the patient's diastolic blood pressure and again we're not quite sure how but we know that it plays role an increased sodium excrete a sodium absorption or retention more likely and also can increase diastolic blood pressure last thing another condition is when someone makes too much parathyroid hormone in a condition called hyper parathyroid ism if someone has hyperparathyroidism they make too much PTH if they make too much PTH they increase their calcium concentration the blood if you increase calcium through it ways it can increase calcium by increasing osteoclast activity which breaks down some of the bone leading to bone resorption it can cause calcium reabsorption across the kidneys and it can activate vitamin D to increase calcium absorption across the gut so that increase in calcium it's can act on your smooth muscle cells it's going to load those smooth muscle cells with cations and initiate what's called vaso constriction that vasoconstriction is going to lead to an increase in the total peripheral resistance and that is going to lead to an increase in the blood pressure okay so how would you diagnose someone with having secondary hyper hyper tension due to hyperthyroidism they would have an elevated t3 t4 with a low TSH assuming that it's coming from the thyroid what if it's hypothyroid they'll have a low t3 t4 with an elevated TSH assuming it's from the thyroid what if they have a hyperparathyroidism have an elevated PTH and an elevated calcium level so these are other ways that we can determine this all right what are some other causes besides endocrine and renal let's come over here some children especially we have what's called Turner syndrome and other congenital conditions can have what's called a co arc did aorta and all that means it's a narrow portion of the aorta if you have coarctation of the aorta so this you see this portion here this is our ascending aorta aortic arch and then we're going into the descending aorta this little notched area right here is called a corking aorta so people can have what's called a co arc tayden a ortus or Korek tation of the aorta so when that one has korrok tation of the aorta they have this little narrowing area what does that do to the pressure just proximal to that narrowing it increases it right so if I increase the pressure in this area what am I going to do I'm technically I'm narrowing it I'm increasing that total peripheral resistance if I increase the total peripheral resistance that's one way to do a couple things it's one way to increase the blood pressure but now the pressure in this area here is gonna be so high that my ventricle is gonna have to pump harder so not only is the diastolic blood pressure gonna go up but my ventricle is gonna have to work harder and try to be able to pump more blood against this high-pressure system now next thing I want you guys to remember sometimes that people have what's called a high intracranial pressure this is not always that common but it's a common test question someone can have high intracranial pressure right maybe there's a a brain bleed for some reason maybe they have significant cerebral edema whatever it is they have a high intracranial pressure it produces this thing called a Cushing's triad right and Cushing's triad says a couple things okay one is the patient will have hypertension so high blood pressure they'll have a decreased heart rate so they'll be Brady Karthik and they'll have irregular respirations okay most likely slow respirations so if someone is having high intracranial pressure and you find signs of that maybe they have nausea maybe they have vomiting maybe they have papilledema maybe they have focal neuro deficits and they have a history of hitting their head or some type of intracranial bleed you can find that this could be the cause of their hypertension okay next thing if someone is pregnant right and let's say they're in their point of around their second trimester right so they're greater than 20 weeks and you start noticing that their blood pressure is high that's really something that you should be very aware of if someone comes in all right they're pregnant and let's say that they're greater than 20 weeks okay gestation if someone has hypertension the big thing you got to think about first off is what's called preeclampsia which is basically when a pregnant woman greater than 20 weeks has high blood pressure plus so they have hypertension and they have proteinuria and the best way to determine this is to do a 24-hour urine test to test for any protein okay you can also do a protein and creatinine ratio as well but again you're just going to be doing a 24-hour protein urine test okay the reason why you have to be careful of this patients who are greater than 20 weeks with high blood pressure it can cause a lot of problems to the feet it's a lot of fetal distress but it can actually progress and once you're scared of it progressing into is what's called eclampsia and again that's where the patient has hypertension they have proteinuria but they start having signs of possibly seizures and you don't want this to happen so the best way to treat these patients and we'll talk about a little bit later is dropping their blood pressure and to prevent eclampsia the seizures you treat them with magnesium sulfate okay but you can try to control their blood pressure we'll talk about it later with like the methyl dopa hydralazine labetalol or nifedipine but again preventing eclampsia with magnesium sulfate so again keep this in your differential with someone who's high blood pressure and they're pregnant greater than 20 weeks and they have protein in their urine all right so the last thing I want you guys to think about here with causes of secondary hypertension you got to be thinking about it is medications especially on these exams one of the big ones is actually oral contraceptives surprisingly so with oral contraceptives specifically let's actually put combined oral contraceptives so they contain estrogen what happens is if people have estrogen okay what happens is it's very weird but it can increase the production of angio can sin again by the liver right that's weird and if you increase angiotensinogen you technically will increase the production of angiotensin 2 what does angiotensin 2 do you guys should know by now it's gonna increase their blood pressure through multiple mechanisms right we should already know this it's ingrained into our head so one drug that you need to be thinking about and asking the patient do you take oral contraceptives that might be the reason why okay second thing is if there on certain types of drugs like any type of herbs sympathy my medic so let me give you an example of just a couple of them adderall okay adderall ritalin vyvanse any of those things are basically sympathomimetic McCue medications that have the ability to initiate maser constriction increase your heart rate and contractility basically mimic the sympathetic nervous system another one that people also undo unfortunately is cocaine right and that also can have this similar effect as well so think about it do you have a patient who's also using cocaine are they on adderall for their ADHD or are they taking vyvanse for another reason sometimes it can be used in binge eating disorder are they taking too much of it these are all things that you got to be thinking about the other one that I want you guys to remember here and I don't know why but they love to ask this question on the exams as well is what's called serotonin syndrome sometimes in serotonin syndrome patients who either take too much of their antidepressant right so they take very very large amounts maybe they take multiple antidepressants okay particularly SSRIs or maybe SNR eyes this is one big thing sometimes even people take multiple SSRIs or they take too much of an SSRI with an SNRI or they take these in the you sometimes Saint John's wort that also has the ability to do it as well if you have this sometimes serotonin syndrome can present with hyperthermia they can present with rigidity they can present with hyperreflexia and they can also present with other symptoms as well maybe even pupillary changes as well so that's another thing to be thinking about the last one that I want you guys to remember here is another one it's a super weird one but it's also probably another one that can come up on the exams is people who use monoamine oxidase inhibitors and he use it with tyramine which is basically in cheese so if they're eating cheese and they're taking a monoamine oxidase inhibitors particularly drugs like Raja lean and sell a Helene these are drugs that are used to treat very resistant depression so refractory depression that didn't respond to SSRIs SNRIs TCAs maybe even antipsychotics if you're going to try those as well maybe they didn't even respond to ECT you can try these drugs the problem is though sometimes if people take monoamine oxidase inhibitors and they eat cheese products or even certain wines it can create a hypertensive crisis so you got to think about that sometimes also in certain patients as well with secondary hypertension okay alright so in this video we've been able to come up with the definition of hypertension how to basically differentiate true hypertension from white coat hypertension the causes of primary hypertension and who it's more common in secondary hypertension and those causes and who those are more common in and what we're gonna do now is we're gonna briefly go through if someone has a hypertensive crisis what that's defined as and there's two different types the different types of end organ damage that you have to look for in a severe crisis and in another video we'll talk about Diagnostics more in detail and treatment of hypertension and their crises alright so a couple areas that you have to remember for patients with a hypertensive crisis is their eyes right might be a little bit difficult for some patients unless you really are good with the the ophthalmoscope is that you can look for signs of retinopathy okay so you want to also look for signs of hypertensive retinopathy and it might not be that you're able to see it in their eyes you might actually have to ask them do you are you having any visual changes are you having any blurry vision have you lost vision those are things that you have to be careful of if you really want to know sometimes what can happen is is you can develop these little like dot hemorrhages that can develop with inside of the retina you might even develop what's called flame hemorrhages which can develop into the retina you might get these little exudates of protein and lipids that deposit into the retina called cotton-wool spots or hard exudates and sometimes you can even cause basically thickening of the vest that are coming through the actual basically the central retinal artery and cause AV nicking copper wiring silver wiring but the real big thing that you have to watch out for is if you really can is papilledema so those are things that you want to watch out for but really ask the patient are they having any visual changes any blurred vision any vision loss okay the next thing that you can be looking at here is how it can affect the heart so hypertension puts a lot of stress on that left ventricle and over time what can happen is that stress on that left ventricle can cause to become really thick and hypertrophic right so over time it can cause that ventricle become really really thick so what this can do is it can lead to what's called left ventricular hypertrophy right and that over time might develop into diastolic heart failure we've talked about that I know heart failure video right other things that can happen is is through that left ventricular hypertrophy here's another thing that can happen you can also cause maybe bundle branch blocks maybe you cause what's called a left bundle branch block maybe it leads to ischemic heart disease so maybe they actually develop an ischemic heart disease which can lead to a possible myocardial infarction that's another thing that you have to be thinking about as well and they can also maybe develop arrhythmias so you have to watch out for arrhythmias as well so again signs of end organ damage from severe high blood pressure can also be signs of left ventricular hypertrophy which can lead to diastolic heart failure it can may be because a left bundle branch block it might even lead to ischemic heart disease because as the ventricle hypertrophy is it has an increased oxygen demand and maybe not enough supply and as you stretch out those ventricles are as you make the ventricles more hypertrophic and thickened they can alter the electrical pathways within the heart which can maybe lead to arrhythmias other things that can happen sometimes in patients you can affect their cardiovascular system not just their heart but their actual blood vessels and that pressure on the blood vessel walls may lead to tears with inside of the blood vessel and the one that you got to be very very careful of as the aorta so why don't you have to watch out for is called an aortic dissection and we know that high blood pressure is a very very common risk factor for patients with aortic dissection and so as the blood pressure is racing Racing racing high it can just basically tear through that endothelial lining and cause the blood to develop a second lumen where it travels on the tunica media as well as it travels into the normal lumen of the blood vessel and that's a problem okay because if that ruptures that's going to lead to significant internal bleeding okay the other thing is as the blood pressure also as people develop high blood pressure and a thorough scoliotic plaques it can cause dilation of the arteries and these dilations of the arteries particularly within the the abdominal aorta is very dangerous because this also has the risk of rupturing especially in people who smoke they have high blood pressure they have cardiovascular risk factors as well as just smoking and hypertension and this can lead to what's called a abdominal aortic aneurysm and the worrisome thing with this is this bad boy rupturing and causing massive internal bleeding hypovolemic shock and then possibly becoming refractory and not being able to save the patient so this is something else that you have to watch out for what else with high blood pressure guess what you do to the endothelial lining you damage it if there's endothelial injury what is that that FERC owes triad what does that mean there's an increased risk of clots so that's one thing but it also as you cause endothelial injury guess what that's also another risk factor for atherosclerosis as someone develops hypertension this can lead to atherosclerosis and these atherosclerosis are a big problem okay next thing is the kidneys it can really jack up our kidneys as well what can it do to the kidneys it can actually cause hyland arteriosclerosis which is basically proteinaceous deposit within the actual glomerular vessels and this hyaline arteriolosclerosis LaRosa's can lead to basically kidney damage and overtime with this increasing kidney damage this can lead to possibly increased risk of chronic kidney disease and therefore kidney failure so that's a big one that you got to watch out for so if someone starts having elevated bu n creatinine levels protein within their urine again elevated sodium levels electrolyte abnormalities that's another big one that you got to watch out for so again chronic kidney disease hypertension is actually the second most common cause of chronic kidney disease in the u.s. okay last one and probably one of the scary ones here is that with high blood pressure what it can actually do is it can lead to in Forks in small little vessels that are going to different parts of our brain particularly near the basal nuclei okay and near the basal nuclei as these infarct syncher it can lead to eight axia it can lead to hemiparesis which is weakness in muscles it can maybe lead to sensory deficits okay so these are some big big issues okay and this is actually something we have to watch out for in what's called lacunar in Forks okay so sometimes people can get what's called lacunar infarcts due to hypertension okay another one is that you can cause an interest cerebral bleed and this interest cerebral bleed could be from a small little aneurysm that actually is gonna form so sometimes you can have an interest cerebral bleed and this is called a shark hot bouchard aneurysm so a shark hot bouchard aneurysm and this is really a fancy way of saying a intra cranial bleed that's all it really is the other thing that you got to be careful of is you know you have vessels right again if you guys remember you get your vertebral x' alright and then you got your bats of basilar arteries that help to be able to come and form part of our actual posterior circulation here and then again you got your internal carotid arteries are also important here as well okay sometimes what can happen is these can actually form little aneurysms called berry aneurysms and these bad boys can also rupture and when they rupture they can actually accumulate in the subarachnoid space and this can lead to a sub arachnoid hemorrhage so that's another thing that you got to watch out for here as well hypertensive crisis is a blood pressure of what it depends upon which type of guidelines are using but for the most part a lot of them will say that any blood pressure greater than or equal to 180 systolic over 120 diastolic is considered to be a hypertensive crisis the next thing that you have to understand is there's two different types of crises and urgency which is that blood pressure okay so they have elevated blood pressure but no end organ damage okay if someone has an emergency they have an elevated blood pressure plus in organ damage I mean listener so in this video we talked about hypertension I hope it made sense I hope you guys did enjoy it if you guys did hit that like button comment down the comments section please subscribe also if you guys get a chance go down in the description box we have links to our 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Channel: Ninja Nerd

Views: 299,211

Keywords: Hypertension, high blood pressure, HTN, pathology of hypertension, pathophysiology of HTN, blood pressure, systolic blood pressure, diastolic blood pressure

Id: HcbS7n1nkS8

Length: 44min 15sec (2655 seconds)

Published: Fri Mar 20 2020