Block 2 PATH Exam -- Hypertension Lecture
Terms
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- Breakdown of hypertension cases
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Primary Hypertension -- 95%
Secondary Hypertension -- 5% - Benign Hypertension
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Diastolic 90 - 120, slow rise
Pts. are usually middle-aged or elderly
Common (95%)
Very slow course - Malignant Hypertension
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Diastolic > 120, rapid rise
Pts. are young or middle-aged
Uncommon (5%)
Very rapid course (months) - Glucocorticoid-Remediable Aldosteronism (GRA)
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Autosomal Dominant
Chromosome 8q
Chimeric gene causes ectopic aldosterone production
Under control of ACTH - APPARENT Mineralocorticoid Excess (AME)
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Autosomal recessive
Chromosome 16q
Inactivating mutation of beta-hydroxysteroid dehydrogenase
Increased levels of cortisol stimulate mineralocorticoid receptors - Liddle Syndrome
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Autosomal dominant
Chromosome 16p
Gain of function mutation causes sustained sodium channel activity
Independent of mineralocorticoids - Lifestyle risk factors for hypertension
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Stress
Obesity
Inactivity
Alcohol Intake
Smoking
High Sodium - Conn Syndrome
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Primary Hyperaldosteronism
Caused by adrenal cortical adenoma
Or, Idiopathic Bilateral Adrenal Hyperplasia - CV system complications of hypertension
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LVH
LAE
Aortic root dilatation
Eventual diastolic dysfunction
Acceleration of atherosclerosis - Renal complications due to hypertension
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Nephrosclerosis (most common)
Due to either hyperfiltration or ischemia
Small arteries show hyalinized walls