Again, let’s talk a little bit about the
pathogenesis. There are a number of factors
involved in the pathogenesis. For example,
one can have elevated levels of hormones in
the blood that cause the hypertension and
one can also just have a genetic tendency
as we talked about before.
How does the hypertension manifest itself
In this slide, you see all of the forms of
events that can lead to the diagnosis of hypertension
even when the patient is feeling perfectly
well before one of these events happened.
Again, in the US we often talk about hypertension
as the silent killer because, for many years,
patients with quite severe hypertension may
have no symptoms at all.
Eventually, one starts to have effects on
the heart and the blood vessels from hypertension.
One can see cardiac arrhythmias – abnormalities
in the electrical activity of the heart. One
can see a myocardial infarction – a heart
attack – because hypertension increases
the rate of atherosclerosis. The heart my
actually fail and the patients may be fatigued
and short of breath and light headed. There
may be a stroke as we talked about. It could
be due to hemorrhage, as in President Roosevelt,
or it could be due to atherosclerosis which
has developed in part because of the hypertension.
Patients with hypertension often have a cognitive
dysfunction – that is brain dysfunction:
dementia. They may be forgetful and there
may be other evidences of poor brain function.
Again, that factor is increased in people
with untreated hypertension.
Finally, the kidneys may be damaged by high
blood pressure with eventual kidney failure
and the need for dialysis. And, of course,
all of this adds up to a shortened life expectancy
for people with hypertension unless they are