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A patient with high blood pressure
Published in Tim French, Terry Wardle, The Problem-Based Learning Workbook, 2022
Hypertension is usually symptomless (often called the ‘silent killer’), but it should be treated to reduce the risk of developing complications. The prevalence and risk of developing complications of hypertension increase with age. It is important to realise that hypertension is the major cardiovascular risk factor that is amenable to intervention and prevention.
Eclampsia and Pre-Eclampsia with Severe Features
Published in Sanjeewa Padumadasa, Malik Goonewardene, Obstetric Emergencies, 2021
Sanjeewa Padumadasa, Malik Goonewardene
The complications of hypertension in pregnancy that are related to blood pressure are cerebral haemorrhage, cardiac failure and pulmonary oedema, retinal haemorrhage, haemorrhage under the capsule of the liver and placental abruption. Therefore, it is essential to control the BP using a rapidly acting antihypertensive if the blood pressure is ≥160/110 mmHg. Excessive reduction of blood pressure could cause a reduction of uteroplacental blood flow, thereby compromising the fetus. This is especially true if the fetus is growth-restricted. Therefore, the systolic BP should not be reduced to <140 mmHg and the diastolic BP to <90 mmHg. The severity of dysfunction in the other organs and systems is not directly proportional to the severity of hypertension.
Atherosclerosis
Published in George Feuer, Felix A. de la Iglesia, Molecular Biochemistry of Human Disease, 2020
George Feuer, Felix A. de la Iglesia
Arteriosclerosis is usually associated with arterial hypertension.222,294 The causes of hypertension can be: (1) nonspecific renal failure, (2) renal neoplasm and ischemia, (3) hyperactive tumor of the adrenal cortex or medulla, (4) complicated pregnancy, and (5) obesity. Arteriosclerosis affects the kidney more than any other organ, but the most important complications of hypertension involve the heart. Hypertension promotes the development of coronary atherosclerosis and subsequent myocardial infarction by increased workload to the heart and increased peripheral resistance. In response to this increased output demand the heart undergoes hypertrophy, and it dilates when a critical level is reached. Eventually heart failure ensues, the most common cause of death in hypertensive patients. Reduced heart function decreases the renal blood flow and filtration potentiating the vicious circle. Patients with hypertension can be controlled by means of medication, and most complications of hypertensive cardiovascular disease are thus avoided. However, some of the drugs used can be toxic and cause severe side effects. Antihypertensive agents can be phenyl piperazine derivatives, or (3-adrenoceptor blockers, among others. Cardiotonic agents are commonly used in heart failure to increase the contractile force of the myocardium. It is not unusual to add agents to control the rhythm since electric disturbances are usually present.
The relationship between anemia and hyperuricemia and hypertension in Korean adults: the Korea National Health and Nutrition Examination Survey 2016–2018
Published in Current Medical Research and Opinion, 2023
Sang Muk Park, Mi Young Gi, Ju Ae Cha, Hyun Ho Sung, So Young Park, Cho Hee Park, Hyun Yoon
Chronic kidney disease is one of the most common complications of hypertension. In hypertensive patients, vasoconstriction is increased, vasodilator response is reduced, and the structure and function of the microcirculation are altered32, conditions that can all worsen kidney function. When UA crystals accumulate in the kidneys, renal function declines, which can lead to anemia due to decreased production of erythropoietin. Our results suggest that the increase in UA in chronic conditions, such as HTN, amplifies inflammation and adversely affects anemia33. There is a study similar to our findings. Eun et al. investigated the relationship between anemia and hyperuricemia in subjects with and without CKD19. In their adjusted model, anemia was positively associated with hyperuricemia in subjects with CKD (OR, 2.34; 95% CI, 1.20–4.56) but not in subjects without CKD (OR, 0.73; 95% CI, 0.50–1.10). They observed that the association between anemia and hyperuricemia was more pronounced in subjects with HTN or T2DM. It is well-recognized that anemia may occur as a complication of diabetic nephropathy or iron deficiency, and inappropriate erythropoietin responses are considered to be the underlying cause34. In our study of subjects with HTN, the prevalence of anemia was positively associated with hyperuricemia in the CKD subgroup (OR, 2.302; 95% CI, 1.467–3.611; p < .001) (Table 4) but not in the non-CKD subgroup (OR, 1.291; 95% CI, 0.932–1.788; p = 0.125) (Supplementary Table 2).
Study on ferroptosis pathway that operates in hypertensive brain damage
Published in Clinical and Experimental Hypertension, 2020
Jian Yang, Min Wang, Shu Wang, Guiping Li, Ying Gao
Cerebral vascular damage caused by hypertension, that is, hypertensive brain damage is one of the serious complications of hypertension (1), and its pathogenesis and pathological process have not yet been fully elucidated (2). The brain tissue is rich in polyunsaturated fatty acids (3) and lack of antioxidant enzyme (4), which is highly prone to free radicals causing damage to nerve cells. Therefore, in recent years, a large number of studies have proved that oxidative stress mediates pathologic changes in the brain and blood vessels (5) which contribute to the genesis of chronic hypertension.In other word, oxidative stress plays an important role in the occurrence and development of hypertensive brain damage (6,7). Ferroptosis is recently discovered as a newly type of cell death, induced by oxidative stress (8), characterized by the accumulation of iron- dependent lipid reactive oxygen species, which is closely related to brain injury and neurodegenerative diseases (9,10). Studies have confirmed that ferroptosis is associated with a variety of central nervous system diseases (11) such as Parkinson’s syndrome, epilepsy, stroke, but the relationship between brain damage caused by hypertension and ferroptosis mechanism has rarely been reported. In this study, we compared the expression of glutathione peroxidase 4(GPX4), the content of GSH, the iron content (12), and malondialdehyde (MDA) in the brain tissue between 24-week-old spontaneously hypertensive rats (SHR) and 24-week-old Wistar-Kyoto (WKY) rats. to probe the ferroptosis mechanism operates in hypertensive brain damage.
Endocrinopathies and cardiopathies in patients with Turner syndrome
Published in Climacteric, 2018
Z. A. Allybocus, C. Wang, Hr. Shi, Qh. Wu
Compared to the general population, the rate of cardiopathies is up to 30% and the risk of aortic dissection at a young age in patients with TS is increased. Associated complications include hypertension, ischemic heart disease, and stroke. Once diagnosis of TS is made, TTE monitoring of anatomical defects and functional discrepancies is performed65, usually every 6–12 months unless there is a sudden onset of symptoms such as chest pain and back discomfort. Pregnancy occurs spontaneously in 2–5% of TS patients66. With physiological changes in women’s body constitution during pregnancy, cardiac monitoring becomes a necessity throughout pregnancy and up to 8 days postpartum, as the risk of aortic dissection during pregnancy may be up to 2% and the risk of death during pregnancy is increased 100-fold67. Cardiac surgeries and interventional catheterization available for TS patients include aortic arch operations, patent ductus arteriosus ligation, pulmonary artery balloon dilation, balloon atrial septostomy, catheter closure of atrial septal defects, aortic valve balloon, coarctation balloon, and mitral valve balloon68.