Internal Diseases · MU Sofia

Theory · 23. Arterial hypertension

Covers the definition of arterial hypertension and its blood pressure categories, set out in a table, then primary and secondary forms with their causes. It explains the pathophysiology through cardiac output and peripheral resistance, the renin-angiotensin and sympathetic theories, and the symptoms and examination findings. A table of secondary types, a hypertensive crisis section, and lists of laboratory and instrumental investigations close the note.

Inside: 14 sections · 4 labelled pictures · 3 tables · 12 flashcards · 5 min

Topic 21 of 88 in the MU Sofia syllabus for Internal Diseases (Dental Medicine, Year 4). The free AceMed note covers it in 14 sections, about 494 words (5 min of reading), with 12 flashcards.

In this note

  1. Arterial Hypertension
  2. Definition
  3. Blood Pressure Categories
  4. Classification
  5. Primary Hypertension
  6. Pathophysiology
  7. Symptoms of Hypertension
  8. Physical Examination Findings
  9. Secondary Hypertension
  10. Types of Secondary Hypertension
  11. Hypertensive Crisis
  12. Symptoms
  13. Laboratory Tests
  14. Instrumental Tests

Definition

Arterial hypertension is a long-term condition where blood pressure in the arteries is persistently elevated above 140/90 mmHg. It can lead to serious complications like coronary artery disease, stroke, heart failure, peripheral vascular disease, and vision loss.

Blood pressure depends on:

  • Cardiac output (CO) × Peripheral resistance (PR).

Classification

  • Primary hypertension (essential hypertension): no clear cause, most common type (about 95%).
  • Secondary hypertension: caused by an identifiable disease or condition, less common (about 5%).

Primary Hypertension

Etiology (Causes)

  • Family predisposition.
  • Atherosclerosis.
  • Hyperlipidemia (can be essential or secondary to diabetes, hypothyroidism).
  • Obesity and lack of exercise.
  • High salt intake.
  • Stress, smoking, excess alcohol consumption.
  • Hyperactivity of the sympathetic nervous system (SNS).
  • High renin levels, causing sodium and water retention: ↑ Renin → ↑ Angiotensin II → ↑ vasoconstriction, thirst, ADH and aldosterone → ↑ Na⁺ reabsorption → ↑ blood volume → ↑ BP.
  • Old age (vessels stiffen over time).

Pathophysiology

  • Arterial pressure is determined by cardiac output (CO) and peripheral resistance (PR).
  • CO depends on stroke volume (SV) × heart rate (HR).
  • Stroke volume relates to heart contractility and vascular compartment size.
  • Peripheral resistance comes from functional and anatomical changes in small arteries and arterioles.

Disease course:

  • Early: ↑ CO, normal TPR.
  • Later: Normal CO, ↑ TPR.

Theories explaining hypertension:

  1. 1. Overactive RAAS → vasoconstriction + water retention → high BP.
  2. 2. Overactive SNS → increased stress response.
  3. 3. Polygenic factors → multiple gene involvement.

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