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Arterial Hypertension – clinical features, diagnosis, differential diagnosis

Clinical features

General

  • Headache, fatigue
  • Vision problems
  • Chest pain, irregular heartbeat
  • Difficulty breathing

Target organ damage

  • Blood vessels
    • In larger arteries – thickened lamina, smooth muscle hypertrophy, deposition of fibrous tissue
      • Walls become less compliant
    • In smaller arteries – hyaline arteriosclerosis, lumen narrows, ↑risk of aneurysms
    • Activation of RAAS due to decreased renal blood flow
    • HTN is a major risk for aortic aneurysm and dissection
  • CNS
    • Stroke, Transient ischaemic attack , subarachnoid haemorrhage (SAH)
    • Papilloedema – due to ↑intracranial pressure
  • Retina

                   Cotton wool exudates– due to retinal infarction

  • Heart
    • ↑incidence of coronary artery disease
    • HTN causes a pressure load on the heart – causing LV hypertrophy + 4th heart sound
    • Atrial fib – due to diastolic dysfunction caused by LVH or CAD
  • Kidneys
    • Damage to renal vasculature – Hypertensive renal disease
    • High intraglomerular pressure – impairs filtration
      • Results in increased protein filtration – proteinuria
    • Nephrosclerosis – leading to glomerular ischemia and hyaline deposits
    • Progresses to renal failure

Malignant hypertension

  • BP >180/120 with end organ damage
  • Characterised by accelerated microvascular damage with necrosis of walls of small arteries and arterioles
  • Intravascular thrombosis
  • Diagnosed by – High BP, retinopathy, renal dysfunction

Diagnosis

Differential diagnosis

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