Complications

• Arterial hypertension is the most common risk factor for cardiovascular disease

• It leads to changes in the vascular endothelium, particularly of the small vessels, and can therefore affect any organ system.

• Left ventricular hypertrophy, hypertrophic cardiomyopathy, dilated cardiomyopathy

• Congestive heart failure

• Coronary artery disease and myocardial infarction

• Atrial fibrillation

• Aortic aneurysm

• Aortic dissection

• Carotid artery stenosis

• Peripheral artery disease

• Atherosclerosis

• Stroke , TIA

• Subcortical leukoencephalopathy

• Cognitive changes such as memory loss

• Hypertensive nephrosclerosis: a renal vascular injury secondary to long-standing arterial hypertension

  • Pathophysiology: chronic hypertension → hypertrophy of medial and intimal layers → narrowing of afferent arterioles → ↓ glomerular blood flow → glomerular and tubular ischemia → arteriolonephrosclerosis and fibrosis (focal segmental glomerulosclerosis) → end-stage renal disease

  • Clinical findings

    • Initially microalbuminuria and microhematuria

    • ↑ BUN, Cr, and uric acid levels

    • Nephrosclerosis with proteinuria (usually < 1 g/day) and progressive renal failure occur with disease progression.

  • Diagnostics: renal biopsy shows vascular, glomerular, and tubulointerstitial changes [55]

    • Arterial and arteriolar medial hypertrophy, intimal thickening, and hyalinosis

    • Global glomerulosclerosis (more common) or focal segmental glomerulosclerosis

    • Tubulointerstitial fibrosis

  • Treatment: ACE-inhibitors (first-line), ARBs

• Chronic kidney disease

Hypertensive retinopathy

• Arteriosclerotic and hypertension-related changes of the retinal vessels

• Initial reactive vasoconstriction (vasospasm), followed by sclerosis with breakdown of blood-retinal barrier and subsequent hemorrhage and exudation

• Fundoscopic examination

  • Cotton wool spots

  • Retinal hemorrhages (i.e., flame-shaped hemorrhages)

  • Microaneurysms

  • Macular star (results from exudation into the macula)

  • Hard exudates

  • Arteriovenous nicking: a tapering of a retinal venule at the point where a retinal arteriole crosses the retinal venule

    • Hourglass shape on fundoscopic examination

    • Associated with advanced hypertensive retinopathy.

  • Elschnig spots: multiple, round, brown-black spots with a bright ring that are scattered throughout the retina

  • Marked swelling and prominence of the optic disk with indistinct borders due to papilledema and optic atrophy (end-stage disease)

• The presence of papilledema in a hypertensive patient may indicate a hypertensive crisis and warrants urgent lowering of blood pressure