Complications of hypertension explained

Complications of hypertension are clinical outcomes that result from persistent elevation of blood pressure.[1] Hypertension is a risk factor for all clinical manifestations of atherosclerosis since it is a risk factor for atherosclerosis itself.[2] [3] [4] [5] [6] [7] It is an independent predisposing factor for heart failure,[8] [9] coronary artery disease,[10] [11] stroke,[1] kidney disease,[12] [13] [14] and peripheral arterial disease.[15] [16] It is the most important risk factor for cardiovascular morbidity and mortality, in industrialized countries.[17]

Complications affecting the heart

See main article: Left ventricular hypertrophy, Hypertensive cardiomyopathy and Myocardial infarction. Hypertensive heart disease is the result of structural and functional adaptations[18] leading to left ventricular hypertrophy,[19] [20] [21] diastolic dysfunction,[18] [20] CHF (Congestive Heart Failure), abnormalities of blood flow due to atherosclerotic coronary artery disease[18] and microvascular disease,[10] [19] and cardiac arrhythmias.[19] Individuals with left ventricular hypertrophy are at increased risk for, stroke,[22] CHF,[22] and sudden death.[22] Aggressive control of hypertension can regress or reverse left ventricular hypertrophy and reduce the risk of cardiovascular disease.[23] [24] [25] [26] left ventricular hypertrophy are seen in 25% of the hypertensive patients and can easily be diagnosed by using echocardiography.[27] Underlying mechanisms of hypertensive left ventricular hypertrophy are of 2 types: firstly, mechanical (mainly leading to myocyte hypertrophy) and secondly, neuro-hormonal(mainly resulting in a fibroblastic proliferation).[27]

Abnormalities of diastolic function, ranging from asymptomatic heart disease[28] [29] [30] to overt heart failure,[31] [32] are common in hypertensive patients. Patients with diastolic heart failure have a preserved ejection fraction, which is a measure of systolic function.[33] [34] Diastolic dysfunction is an early consequence of hypertension-related heart disease and is exacerbated by left ventricular hypertrophy[20] [34] and ischemia.

Complications affecting the brain

See main article: Hypertensive encephalopathy.

Hypertension is an important risk factor for brain infarction and hemorrhage.[1] [10] [35] [36] [37] [38] [39] [40] Approximately 85% of strokes are due to infarction and the remainder are due to hemorrhage, either intracerebral hemorrhage or subarachnoid hemorrhage.[41] The incidence of stroke rises progressively with increasing blood pressure levels, particularly systolic blood pressure in individuals >65 years. Treatment of hypertension convincingly decreases the incidence of both ischemic and hemorrhagic strokes.[41]

Hypertension is also associated with impaired cognition in an aging population.[42] [43] [44] [45] Hypertension-related cognitive impairment and dementia may be a consequence of a single infarct due to occlusion of a "strategic" larger vessel[46] [47] or multiple lacunar infarcts due to occlusive small vessel disease resulting in subcortical white matter ischemia.[43] [45] [48] Several clinical trials suggest that antihypertensive therapy has a beneficial effect on cognitive function, although this remains an active area of investigation.[49] [50] [51]

Cerebral blood flow remains unchanged over a wide range of arterial pressures (mean arterial pressure of 50–150 mmHg) through a process termed autoregulation of blood flow.[52] Signs and symptoms of hypertensive encephalopathy may include severe headache, nausea and vomiting (often of a projectile nature), focal neurologic signs, and alterations in mental status. Untreated, hypertensive encephalopathy may progress to stupor, coma, seizures, and death within hours.[53] [54] [55] [56] It is important to distinguish hypertensive encephalopathy from other neurologic syndromes that may be associated with hypertension, e.g., cerebral ischemia, hemorrhagic or thrombotic stroke, seizure disorder, mass lesions, pseudotumor cerebri, delirium tremens, meningitis, acute intermittent porphyria, traumatic or chemical injury to the brain, and uremic encephalopathy.[41]

Complications affecting the eye

See main article: Hypertensive retinopathy. Hypertensive retinopathy is a condition characterized by a spectrum of retinal vascular signs in people with elevated blood pressure.[57] It was first described by Liebreich in 1859.[58] The retinal circulation undergoes a series of pathophysiological changes in response to elevated blood pressure.[59] In the initial, vasoconstrictive stage, there is vasospasm and an increase in retinal arteriolar tone owing to local autoregulatory mechanisms. This stage is seen clinically as a generalized narrowing of the retinal arterioles. Persistently elevated blood pressure leads to intimal thickening, hyperplasia of the media wall, and hyaline degeneration in the subsequent, sclerotic, stage. This stage corresponds to more severe generalized and focal areas of arteriolar narrowing, changes in the arteriolar and venular junctions, and alterations in the arteriolar light reflex (i.e., widening and accentuation of the central light reflex, or "copper wiring").[60]

This is followed by an exudative stage, in which there is disruption of the blood–retina barrier, necrosis of the smooth muscles and endothelial cells, exudation of blood and lipids, and retinal ischemia. These changes are manifested in the retina as microaneurysms, hemorrhages, hard exudates, and cotton-wool spots. Swelling of the optic disk may occur at this time and usually indicates severely elevated blood pressure (i.e., malignant hypertension). Because better methods for the control of blood pressure are now available in the general population, malignant hypertension is rarely seen. In contrast, other retinal vascular complications of hypertension, such as macroaneurysms and branch-vein occlusions, are not uncommon in patients with chronically elevated blood pressure. These stages of hypertensive retinopathy however, may not be sequential.[59] [61] For example, signs of retinopathy that reflect the exudative stage, such as retinal hemorrhage or microaneurysm, may be seen in eyes that do not have features of the sclerotic stage,[59]

Complications affecting the kidneys

See main article: Hypertensive nephropathy. Hypertension is a risk factor for chronic kidney disease and end-stage kidney disease (ESKD).[62] [63] [64] [65] [66] [67] [68] Kidney risk appears to be more closely related to systolic than to diastolic blood pressure,[69] [70] and black men are at greater risk than white men for developing ESRD at every level of blood pressure.[71] [72] [73] [74] [75]

The atherosclerotic, hypertension-related vascular lesions in the kidney primarily affect the preglomerular arterioles,[69] [76] [77] resulting in ischemic changes in the glomeruli and postglomerular structures.[41] Glomerular injury may also be a consequence of direct damage to the glomerular capillaries due to glomerular hyperperfusion. Glomerular pathology progresses to glomerulosclerosis,[78] [79] and eventually the kidney tubules may also become ischemic and gradually atrophic. The kidney lesion associated with malignant hypertension consists of fibrinoid necrosis of the afferent arterioles,[80] [81] [82] [83] [84] [85] [86] sometimes extending into the glomerulus, and may result in focal necrosis of the glomerular tuft.[82] [87] [88]

Clinically, macroalbuminuria (a random urine albumin/creatinine ratio > 300 mg/g) or microalbuminuria (a random urine albumin/creatinine ratio 30–300 mg/g) are early markers of kidney injury. These are also risk factors for kidney disease progression and for cardiovascular disease.[41]

Complications associated to diabetes and hypertension

Diabetes has several complications of which one is hypertension or high blood pressure. Data indicate that at least 60-80 percent of individuals whom develop diabetes will eventually develop high blood pressure. The high blood pressure is gradual at early stages and may take at least 10–15 years to fully develop. Besides diabetes, other factors that may also increase high blood pressure include obesity, insulin resistance and high cholesterol levels. In general, fewer than 25 percent of diabetics have good control of their blood pressure. The presence of high blood pressure in diabetes is associated with a 4 fold increase in death chiefly from heart disease and strokes.[89] It has also been shown in recent epidemiological studies that variability of blood pressure, independent of mean blood pressure level, contributes to microvascular and macrovascular complications[90] in those with diabetes, including heart failure.[91] These variability associations may be especially deleterious in persons with either particularly high or particularly low blood pressures.[92]

The chief reason why people with diabetes develop high blood pressure is hardening of the arteries. Diabetes tends to speed up the process of atherosclerosis. The other fact about diabetes is that it affects both large and small blood vessels in the body. Over time, blood vessels become clogged with fatty depots, become non-compliant and lose their elasticity. The process of atherosclerosis is a lot faster in diabetic individuals whom do not have good control of their blood sugars. The high blood pressure eventually leads to heart failure, strokes, heart attacks, blindness, kidney failure, loss of libido and poor circulation of blood in the legs. When the blood supply to the feet is compromised, the chances of infections and amputations also increases. All diabetics should know that even mild elevations in blood pressure can be detrimental to health. Studies have shown that diabetics with even a slight elevation in blood pressure have 2-3 times the risk of heart disease compared to individuals without diabetes.[93]

Blood pressure readings do vary but experts recommend that blood pressure should not range above 140/80. Secondly, high blood pressure is a silent disease and thus it is vital for all diabetics to regularly check their blood pressure or have it checked at a doctor's office on a regular basis. The American Diabetes Association recommends that all diabetics get their blood pressure measured by a health care professional at least 2-5 times a year.[94]

Treatment for diabetic patients with hypertension

Once blood pressure is found to be high in diabetics, there are ways to treat it:

Medications like the Angiotensin-converting enzyme inhibitors (ACEI) are widely used to control blood pressure in diabetics. These medications not only control blood pressure but also delay or prevent the development of kidney disease in diabetes. Many studies have shown that ACEI should be the drugs of first choice in diabetics with high blood pressure. Other medications used to treat high blood pressure include water pills. Sometimes, a combination of medications is used to treat high blood pressure. All diabetics should quit smoking. The combination of diabetes and smoking usually leads to amputations of the toes and feet.Measure your blood sugars regularly, and make sure that they are well balanced as the majority of complications of diabetes can be prevented by ensuring such blood sugars stay within normal limits.[95] It is also recommended to eat a healthy diet and avoid sugary foods and limit the intake of salt. Also, ensure that your cholesterol levels are under control. Exercise is a must for all diabetics. Walking twice a day for 30 minutes can be a fair substitute for those not engaged in intense gym activities. Losing weight is also beneficial as this has been shown to improve blood sugar control, increase insulin sensitivity and reduce blood pressure.[96]

Notes and References

  1. White WB . Defining the problem of treating the patient with hypertension and arthritis pain . . 122 . 5 Suppl . S3–9 . May 2009 . 19393824 . 10.1016/j.amjmed.2009.03.002 .
  2. O’Mahoney . P. R. A. . Wong . D. T. . Ray . J. G. . 2008 . Retinal Vein Occlusion and Traditional Risk Factors for Atherosclerosis . JAMA Ophthalmology . 126 . 5 . 692–699 . 18474782 . 10.1001/archopht.126.5.692. free.
  3. Insull W . The pathology of atherosclerosis: plaque development and plaque responses to medical treatment . . 122 . 1 Suppl . S3–S14 . January 2009 . 19110086 . 10.1016/j.amjmed.2008.10.013 .
  4. Liapis CD, Avgerinos ED, Kadoglou NP, Kakisis JD . What a vascular surgeon should know and do about atherosclerotic risk factors . . 49 . 5 . 1348–54 . May 2009 . 19394559 . 10.1016/j.jvs.2008.12.046 . free .
  5. Riccioni G . The effect of antihypertensive drugs on carotid intima media thickness: an up-to-date review . . 16 . 8 . 988–96 . 2009 . 19275607 . 10.2174/092986709787581923 . 2009-06-20 . https://archive.today/20130112181214/http://www.bentham-direct.org/pages/content.php?CMC/2009/00000016/00000008/0006C.SGM . 2013-01-12 . dead .
  6. Safar ME, Jankowski P . Central blood pressure and hypertension: role in cardiovascular risk assessment . . 116 . 4 . 273–82 . February 2009 . 19138169 . 10.1042/CS20080072 .
  7. Werner CM, Böhm M . The therapeutic role of RAS blockade in chronic heart failure . . 2 . 3 . 167–77 . June 2008 . 19124420 . 10.1177/1753944708091777 . 12972801 . free .
  8. Gaddam KK, Verma A, Thompson M, Amin R, Ventura H . Hypertension and cardiac failure in its various forms . . 93 . 3 . 665–80 . May 2009 . 19427498 . 10.1016/j.mcna.2009.02.005 . 2009-06-20.
  9. Reisin E, Jack AV . Obesity and hypertension: mechanisms, cardio-renal consequences, and therapeutic approaches . . 93 . 3 . 733–51 . May 2009 . 19427502 . 10.1016/j.mcna.2009.02.010 . 2009-06-20.
  10. Agabiti-Rosei E . From macro- to microcirculation: benefits in hypertension and diabetes . . 26 . 3 . S15–9 . September 2008 . 19363848 . 10.1097/01.hjh.0000334602.71005.52.
  11. Murphy BP, Stanton T, Dunn FG . Hypertension and myocardial ischemia . . 93 . 3 . 681–95 . May 2009 . 19427499 . 10.1016/j.mcna.2009.02.003 . 2009-06-20.
  12. Tylicki L, Rutkowski B . [Hypertensive nephropathy: pathogenesis, diagnosis and treatment] . pl . . 14 . 80 . 168–73 . February 2003 . 12728683 .
  13. Truong LD, Shen SS, Park MH, Krishnan B . Diagnosing nonneoplastic lesions in nephrectomy specimens . . 133 . 2 . 189–200 . February 2009 . 19195963 . 10.5858/133.2.189 . 2009-06-20 . 2020-03-28 . https://web.archive.org/web/20200328032928/http://journals.allenpress.com/jrnlserv/?request=get-abstract&issn=0003-9985&volume=133&page=189 . dead .
  14. Tracy RE, White S . A method for quantifying adrenocortical nodular hyperplasia at autopsy: some use of the method in illuminating hypertension and atherosclerosis . . 6 . 1 . 20–9 . February 2002 . 11842376 . 10.1053/adpa.2002.30606.
  15. Aronow WS . Hypertension and the older diabetic . . 24 . 3 . 489–501, vi–vii . August 2008 . 18672184 . 10.1016/j.cger.2008.03.001 . 2009-06-20.
  16. Gardner AW, Afaq A . . 28 . 6 . 349–57 . 2008 . 19008688 . 10.1097/HCR.0b013e31818c3b96 . 2743684. Management of Lower Extremity Peripheral Arterial Disease .
  17. Novo S, Lunetta M, Evola S, Novo G . Role of ARBs in the blood hypertension therapy and prevention of cardiovascular events . . 10 . 1 . 20–5 . January 2009 . 19149532 . 10.2174/138945009787122897 . 2009-06-20 . https://archive.today/20130112095900/http://www.bentham-direct.org/pages/content.php?CDT/2009/00000010/00000001/0003J.SGM . 2013-01-12 . dead .
  18. Steinmetz M, Nickenig G . [Cardiac sequelae of hypertension] . de . . 50 . 4 . 397–409 . April 2009 . 19343394 . 10.1007/s00108-008-2289-3. 7660279 .
  19. Hennersdorf MG, Strauer BE . [Hypertension and heart] . de . . 101 . 27–30 . March 2006 . Suppl 1 . 16802514 .
  20. Hennersdorf MG, Strauer BE . [The heart in hypertension] . de . . 48 . 3 . 236–45 . March 2007 . 17260148 . 10.1007/s00108-006-1762-0. 22498249 .
  21. Motz W . [Right ventricle in arterial hypertension] . de . . 45 . 10 . 1108–16 . October 2004 . 15351931 . 10.1007/s00108-004-1273-9. 25919141 .
  22. Wachtell K, Devereux RB, Lyle PA, Okin PM, Gerdts E . The left atrium, atrial fibrillation, and the risk of stroke in hypertensive patients with left ventricular hypertrophy . . 2 . 6 . 507–13 . December 2008 . 19124445 . 10.1177/1753944708093846 . 9411507 .
  23. Petrović . Dejan . Stojimirović . Biljana . Hipertrofija leve komore kod bolesnlka koji se leče redovnim hemodijalizama . Left ventricular hypertrophy in patients treated with regular hemodialyses . sr . Medicinski Pregled . 2008 . 61 . 7–8 . 369–374 . 10.2298/MPNS0808369P . 19097374 . free .
  24. Cuspidi C, Sala C, Zanchetti A . Management of hypertension in patients with left ventricular hypertrophy . . 9 . 6 . 498–505 . December 2007 . 18367014 . 10.1007/s11906-007-0091-6. 44337763 .
  25. Simko F . Statins: a perspective for left ventricular hypertrophy treatment . . 37 . 9 . 681–91 . September 2007 . 17696957 . 10.1111/j.1365-2362.2007.01837.x . 34378084 . free .
  26. Wachtell K, Devereux RB, Lyle AP . The effect of angiotensin receptor blockers for preventing atrial fibrillation . . 9 . 4 . 278–83 . August 2007 . 17686377 . 10.1007/s11906-007-0051-1. 24230854 .
  27. Herpin D . [Impact of arterial hypertension on the heart] . fr . . 49 . 5 . 491–4 . March 1999 . 10358398 .
  28. Parekh N, Maisel AS . Utility of B-natriuretic peptide in the evaluation of left ventricular diastolic function and diastolic heart failure . . 24 . 2 . 155–60 . March 2009 . 19532102 . 10.1097/HCO.0b013e328320d82a .
  29. Biria M, Howard PA, Vacek J . Do statins have a role in the management of diastolic dysfunction? . . 8 . 5 . 297–303 . 2008 . 18828641 . 10.2165/00129784-200808050-00002. 38191136 .
  30. Caserta MA, Milan A, Naso D . [Left ventricular diastolic function and dysfunction: a single cardiac target for various systemic diseases] . it . . 8 . 5 . 279–98 . May 2007 . 17650687 . etal.
  31. Verma A, Solomon SD . Diastolic dysfunction as a link between hypertension and heart failure . . 93 . 3 . 647–64 . May 2009 . 19427497 . 10.1016/j.mcna.2009.02.013 . 2009-06-22.
  32. Ellis CR, Di Salvo T . Myocarditis: basic and clinical aspects . . 15 . 4 . 170–7 . 2007 . 17575480 . 10.1097/CRD.0b013e31806450c4 . 20513704 .
  33. Okoshi K, Guimarães JF, Di Muzio BP, Fernandes AA, Okoshi MP . [Diabetic cardiomyopathy] . pt . . 51 . 2 . 160–7 . March 2007 . 17505622 . 10.1590/s0004-27302007000200004. free . 11449/11269 . free .
  34. Fukuta H, Little WC . Diagnosis of diastolic heart failure . . 9 . 3 . 224–8 . May 2007 . 17470335 . 10.1007/BF02938354. 656249 .
  35. Schrader J . [Stroke and hypertension] . de . . 50 . 4 . 423–32 . April 2009 . 19308341 . 10.1007/s00108-008-2291-9. 38815274 .
  36. Zeng C, Villar VA, Yu P, Zhou L, Jose PA . Reactive oxygen species and dopamine receptor function in essential hypertension . . 31 . 2 . 156–78 . April 2009 . 19330604 . 10.1080/10641960802621283 . 3722595 .
  37. Varon J . Diagnosis and management of labile blood pressure during acute cerebrovascular accidents and other hypertensive crises . . 25 . 8 . 949–59 . October 2007 . 17920983 . 10.1016/j.ajem.2007.02.032 .
  38. Sare GM, Geeganage C, Bath PM . High blood pressure in acute ischaemic stroke--broadening therapeutic horizons . . 27 . 156–61 . 2009 . Suppl 1 . 19342846 . 10.1159/000200454 . 5400230 . 2009-06-20.
  39. Palm F, Urbanek C, Grau A . Infection, its treatment and the risk for stroke . . 7 . 2 . 146–52 . April 2009 . 19355997 . 10.2174/157016109787455707 . 2009-06-20 . https://archive.today/20130414125117/http://www.bentham-direct.org/pages/content.php?CVP/2009/00000007/00000002/004AD.SGM . 2013-04-14 . dead .
  40. Tanahashi N . [Roles of angiotensin II receptor blockers in stroke prevention] . ja . . 67 . 4 . 742–9 . April 2009 . 19348237 .
  41. Book: Loscalzo, Joseph . Fauci, Anthony S. . Braunwald, Eugene . Dennis L. Kasper . Hauser, Stephen L . Longo, Dan L. . Harrison's principles of internal medicine . McGraw-Hill Medical . 2008 . 978-0-07-147691-1 .
  42. Iadecola C, Park L, Capone C . Threats to the Mind: Aging, Amyloid, and Hypertension . . 40 . 3 Suppl . S40–4 . March 2009 . 19064785 . 10.1161/STROKEAHA.108.533638 . https://archive.today/20130223073829/http://stroke.ahajournals.org/cgi/pmidlookup?view=long&pmid=19064785 . dead . 2013-02-23 . 2009-06-22 . 2704500 .
  43. Book: Erkinjuntti T, Gauthier S . The concept of vascular cognitive impairment . 24 . 79–85 . 2009 . 19182465 . 10.1159/000197886 . Frontiers of Neurology and Neuroscience . 978-3-8055-9015-0. Dementia in Clinical Practice .
  44. Birns J, Kalra L . Cognitive function and hypertension . . 23 . 2 . 86–96 . February 2009 . 18650838 . 10.1038/jhh.2008.80. 11574645 . free .
  45. Moretti R, Torre P, Antonello RM, Manganaro D, Vilotti C, Pizzolato G . Risk factors for vascular dementia: Hypotension as a key point . . 4 . 2 . 395–402 . 2008 . 18561514 . 2496988 . 10.2147/VHRM.S2434 . free .
  46. Solans-Laqué R, Bosch-Gil JA, Molina-Catenario CA, Ortega-Aznar A, Alvarez-Sabin J, Vilardell-Tarres M . Stroke and multi-infarct dementia as presenting symptoms of giant cell arteritis: report of 7 cases and review of the literature . . 87 . 6 . 335–44 . November 2008 . 19011505 . 10.1097/MD.0b013e3181908e96 . free .
  47. Kuźma. Elżbieta. Lourida. Ilianna. Moore. Sarah F.. Levine. Deborah A.. Ukoumunne. Obioha C.. Llewellyn. David J.. August 2018. Stroke and dementia risk: A systematic review and meta-analysis. Alzheimer's & Dementia. 14. en. 11. 1416–1426. 10.1016/j.jalz.2018.06.3061. 30177276. 6231970. 2027.42/152961. 1552-5260.
  48. Pantoni L, Poggesi A, Inzitari D . Cognitive decline and dementia related to cerebrovascular diseases: some evidence and concepts . . 27 . 191–6 . 2009 . Suppl 1 . 19342851 . 10.1159/000200459 . 3403376 . 2009-06-23.
  49. Book: Dementia in Clinical Practice. Zekry D. 2009. 978-3-8055-9015-0. Frontiers of Neurology and Neuroscience. 24. 95–106. Is it possible to treat vascular dementia?. 10.1159/000197888. 19182467. https://archive-ouverte.unige.ch/unige:34022.
  50. Viswanathan A, Rocca WA, Tzourio C . Vascular risk factors and dementia: How to move forward? . . 72 . 4 . 368–74 . January 2009 . 19171835 . 10.1212/01.wnl.0000341271.90478.8e . 2677504.
  51. Sorrentino G, Migliaccio R, Bonavita V . Treatment of vascular dementia: the route of prevention . . 60 . 5 . 217–23 . 2008 . 18756085 . 10.1159/000151696 . 6389257 . 2009-06-23.
  52. Book: Hall, John E. . Guyton, Arthur C. . Textbook of medical physiology . Elsevier Saunders . St. Louis, Mo . 2006 . 762 . 978-0-7216-0240-0 .
  53. Müller-Wiefel DE . [The hypertensive crisis in childhood] . de . . 100 . 16 . 547–55 . August 1988 . 3055687 .
  54. Isles CG . Management of hypertensive crises . . 40 . 1 . 23–5 . February 1995 . 7604239 . 10.1177/003693309504000110. 24448490 .
  55. Refai D, Botros JA, Strom RG, Derdeyn CP, Sharma A, Zipfel GJ . Spontaneous isolated convexity subarachnoid hemorrhage: presentation, radiological findings, differential diagnosis, and clinical course . . 109 . 6 . 1034–41 . December 2008 . 19035716 . 10.3171/JNS.2008.109.12.1034 .
  56. O'Hara McCoy H . Posterior reversible encephalopathy syndrome: an emerging clinical entity in adult, pediatric, and obstetric critical care . . 20 . 2 . 100–6 . February 2008 . 18271765 . 10.1111/j.1745-7599.2007.00292.x . 208287631 .
  57. Walsh JB . Hypertensive retinopathy. Description, classification, and prognosis . . 89 . 10 . 1127–31 . October 1982 . 7155523 . 10.1016/s0161-6420(82)34664-3.
  58. Liebreich R. Ophthalmoskopischer Befund bei Morbus Brightii. Albrecht von Graefes Arch Ophthalmol 1859; 5: 265–268.
  59. Tso MO, Jampol LM . Pathophysiology of hypertensive retinopathy . . 89 . 10 . 1132–45 . October 1982 . 7155524 . 10.1016/s0161-6420(82)34663-1.
  60. Wong TY, Mitchell P . Hypertensive retinopathy . . 351 . 22 . 2310–7 . November 2004 . 15564546 . 10.1056/NEJMra032865 .
  61. Pache M, Kube T, Wolf S, Kutschbach P . Do angiographic data support a detailed classification of hypertensive fundus changes? . . 16 . 6 . 405–10 . June 2002 . 12037695 . 10.1038/sj.jhh.1001402. 28083513 .
  62. Krzesinski JM, Cohen EP . Hypertension and the kidney . . 62 . 1 . 5–14 . 2007 . 17451140 . 10.1179/acb.2007.002. 40916501 .
  63. Monhart V . [Diabetes mellitus, hypertension and kidney] . cs . . 54 . 5 . 499–504, 507 . May 2008 . 18630636 .
  64. Hohenstein K, Watschinger B . [Hypertension and the kidney] . de . . 158 . 13–14 . 359–64 . 2008 . 18677585 . 10.1007/s10354-008-0558-3. 195686488 .
  65. Khosla N, Kalaitzidis R, Bakris GL . The kidney, hypertension, and remaining challenges . . 93 . 3 . 697–715, Table of Contents . May 2009 . 19427500 . 10.1016/j.mcna.2009.02.001 . 2009-06-23.
  66. Ponnuchamy B, Khalil RA . Cellular mediators of renal vascular dysfunction in hypertension . . 296 . 4 . R1001–18 . April 2009 . 19225145 . 10.1152/ajpregu.90960.2008 . 2698613.
  67. Niang A . [Arterial hypertension and the kidney] . fr . . 53 . 1 . 1–6 . 2008 . 19102111 .
  68. Palmer BF . Hypertension management in patients with chronic kidney disease . . 10 . 5 . 367–73 . October 2008 . 18775113 . 10.1007/s11906-008-0069-z. 24933057 .
  69. Marín R, Gorostidi M, Fernández-Vega F, Alvarez-Navascués R . Systemic and glomerular hypertension and progression of chronic renal disease: the dilemma of nephrosclerosis . . 68. 99 . S52–6 . December 2005 . 16336577 . 10.1111/j.1523-1755.2005.09910.x . free .
  70. Schmitz A . Microalbuminuria, blood pressure, metabolic control, and renal involvement: longitudinal studies in white non-insulin-dependent diabetic patients . . 10 . 9 Pt 2 . 189S–197S . September 1997 . 9324121 . 10.1016/S0895-7061(97)00152-0. free .
  71. Lindhorst J, Alexander N, Blignaut J, Rayner B . Differences in hypertension between blacks and whites: an overview . . 18 . 4 . 241–7 . 2007 . 17940670 . 4170224 .
  72. Swift PA, Macgregor GA . Genetic variation in the epithelial sodium channel: a risk factor for hypertension in people of African origin . . 11 . 1 . 76–86 . January 2004 . 14730541 . 10.1053/j.arrt.2003.10.011. free .
  73. Ergul A . Hypertension in black patients: an emerging role of the endothelin system in salt-sensitive hypertension . . 36 . 1 . 62–7 . July 2000 . 10904013 . 10.1161/01.hyp.36.1.62 . free .
  74. Ferrari P, Krozowski Z . Role of the 11beta-hydroxysteroid dehydrogenase type 2 in blood pressure regulation . . 57 . 4 . 1374–81 . April 2000 . 10760070 . 10.1046/j.1523-1755.2000.00978.x. free .
  75. Campese VM . The kidney in the hypertensive black . . 1 . 2 . 145–51 . May 1996 . 9395558 . 10.1080/13557858.1996.9961781.
  76. Bidani AK, Griffin KA . Long-term renal consequences of hypertension for normal and diseased kidneys . . 11 . 1 . 73–80 . January 2002 . 11753090 . 10.1097/00041552-200201000-00011. 23305725 .
  77. Johnson RJ, Rodriguez-Iturbe B, Kang DH, Feig DI, Herrera-Acosta J . A unifying pathway for essential hypertension . . 18 . 3 . 431–40 . March 2005 . 15797666 . 10.1016/j.amjhyper.2004.08.035. free .
  78. Kwoh C, Shannon MB, Miner JH, Shaw A . Pathogenesis of nonimmune glomerulopathies . . 1 . 349–74 . 2006 . 18039119 . 10.1146/annurev.pathol.1.110304.100119 .
  79. Stoian M, Radulian G, Chiţac D, Simion E, Stoica V . A clinical approach in regression of glomerulosclerosis . . 45 . 2 . 215–8 . 2007 . 18333378 .
  80. Ono H, Ono Y . Nephrosclerosis and hypertension . . 81 . 6 . 1273–88 . November 1997 . 9356598 . 10.1016/S0025-7125(05)70582-4.
  81. Muirhead EE, Pitcock JA . Histopathology of severe renal vascular damage in blacks . . 12 . Suppl 4 . IV58–65 . December 1989 . 2620472 . 10.1002/clc.4960121312. 41855935 .
  82. Dustan HP, Curtis JJ, Luke RG, Rostand SG . Systemic hypertension and the kidney in black patients . . 60 . 17 . 73I–77I . December 1987 . 3687809 . 10.1016/0002-9149(87)90464-4.
  83. Schwartz GL, Strong CG . Renal parenchymal involvement in essential hypertension . . 71 . 5 . 843–58 . September 1987 . 3306206 . 10.1016/S0025-7125(16)30812-4.
  84. Cimprich RE, Ziemba LJ, Kutz SA, Robertson JL, Cockrell B . Experimentally induced malignant hypertension in beagle dogs . . 14 . 2 . 183–7 . 1986 . 3764316 . 10.1177/019262338601400206. 25800184 . free .
  85. Queiroz FP, Rojo-Ortega JM, Genest J . Metaischemic (post-Goldblatt) hypertensive vascular disease in rats . . 2 . 6 . 765–70 . 1980 . 7461792 . 10.1161/01.hyp.2.6.765 . 1587443 .
  86. Weller RO . Vascular pathology in hypertension . . 8 . 2 . 99–103 . May 1979 . 463685 . 10.1093/ageing/8.2.99.
  87. Sinclair RA, Antonovych TT, Mostofi FK . Renal proliferative arteriopathies and associated glomerular changes: a light and electron microscopic study . . 7 . 5 . 565–88 . September 1976 . 987010 . 10.1016/S0046-8177(76)80103-7.
  88. Linz W, Becker RH, Schölkens BA, Wiemer G, Keil M, Langer KH . Nephroprotection by long-term ACE inhibition with ramipril in spontaneously hypertensive stroke prone rats . . 54 . 6 . 2037–44 . December 1998 . 9853269 . 10.1046/j.1523-1755.1998.00208.x. free .
  89. http://www.mja.com.au/public/issues/misc/gilbert/gilbert.html Diabetes and Hypertension
  90. Chiriaco M, et al . Association between blood pressure variability, cardiovascular disease and mortality in type 2 diabetes: A systematic review and meta‐analysis . Diabetes, Obesity and Metabolism . 2019 . 21 . 12 . 2587–2598. 10.1111/dom.13828 . 31282073 . 195829708 .
  91. Nuyujukian DS, Koska J, Bahn G, Reaven PD, Zhou JJ . Blood Pressure Variability and Risk of Heart Failure in ACCORD and the VADT . Diabetes Care . 43 . 7 . 1471–1478 . July 2020 . 32327422 . 10.2337/dc19-2540 . 7305004 . 10150/641980 . free.
  92. Nuyujukian DS, Zhou JJ, Koska J, Reaven PD . Refining determinants of associations of visit-to-visit blood pressure variability with cardiovascular risk: results from the Action to Control Cardiovascular Risk in Diabetes Trial . Journal of Hypertension . 2021 . 39 . 11 . 2173–2182 . 34232160 . 10.1097/hjh.0000000000002931. 8500916 .
  93. http://diabetes.about.com/lw/Health-Medicine/Conditions-and-diseases/Diabetes-and-Hypertension.htm Diabetes associated to Hypertension
  94. Medical Journal of Australia. "Hypertension and Diabetes overview" 2010-02-09.
  95. http://www.diabeteshypertension.net/ Diabetes Hypertension Guidelines: Treatment And Symptoms
  96. American Academy of Family Physicians. "Controlling Hypertension in Patients with Diabetes" 2010-02-09.

This article is licensed under the GNU Free Documentation License. It uses material from the Wikipedia article "Complications of hypertension".

Except where otherwise indicated, Everything.Explained.Today is © Copyright 2009-2024, A B Cryer, All Rights Reserved. Cookie policy.