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As individual nephrons are replaced by scar tissue

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Unformatted text preview: hypertensive nephrosclerosis Blood in urine at night Nocturia, Microalbuminuria, microscopic hematuria Urine dip stick- …uria pick up Proteinuria Reduced GFR Glomerular Filtration Rate Hemo/ peritoneo End Stage Renal Disease – requires dialysis This kidney bears the finely granular surface typical of people who have had high blood pressure for a long time. As individual nephrons are replaced by scar tissue, the contraction of the scar produces the "sandpaper kidney" effect. This medium-sized renal artery has marked fibrous thickening of its intima. This is both the result of the high blood pressure, and part of the vicious cycle of glomerular ischemia that perpetuates it. Blood Vessels: Peripheral Blood Vessels Arterial Disease Due to accelerated atherosclerosis affecting the extremity blood vessels Results in pain in legs, or thigh with walking Risk of amputation due vessel occlusion and subsequent gangrene Equivalent in risk to ischemic heart disease – associated with increased CVD mortality Blood Vessels: Blood Vessels Aortic Aneurysm & Dissection Aneurysm – AAADilation + risk rupture 3% of mild hypertensives; 11% of those with BP above 195mmHg & cerebrovasular disease or PVD High risk of rupture – dependent on size; high mortality Aortic dissection Break BV lumen + bleeding vessel walls Break in the wall of the aorta ⇒ bleeding within the vessel wall 80% of patients with dissection have hypertension Due to pulsatile wall stress and atherosclerosis May need surgical correction; high risk of fatality Goals of Therapy Goals Reduce CVD and renal morbidity and mortality. Treat to BP <140/90 mmHg or BP <130/80 mmHg in patients with diabetes or chronic kidney disease. Achieve SBP goal especially in persons >50 years of age. Systolic BP Benefits of Lowering BP Benefits Average Percent Reduction Stroke incidence 35–40% Myocardial Infarction 20–25% Heart failure 50% Population­Based Strategy Population­Based Strategy SBP Distributions After Intervention Before Intervention Reduction in BP Reduction in SBP mmHg % Reduction in Mortality Stroke CHD Total 2 –6 –4 –3 3 –8 –5 –4 5 –14 –9 –7 Benefits of Lowering BP Benefits In stage 1 HTN and additional CVD risk factors, achieving a sustained 12 mmHg reduction in SBP over 10 years will prevent 1 death for every 11 patients treated. Summary Summary Hypertension is largely asymptomatic Symptoms / signs often related to secondary causes or to target organ damage Hypertension may cause serious damage to the brain, eyes, heart, kidneys and blood vessels Treatment of hypertension will reduce target organ damage and save lives Goals of treatment ­ <140/90mmHg or <130/80mmHg in pts with DM or CKD...
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