Hypertension: Pathogenesis and Symptoms

00:00 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.

00:23 How does the hypertension manifest itself in patients? 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.

00:40 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.

00:51 Eventually, one starts to have effects on the heart and the blood vessels from hypertension.

01:00 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.

01:30 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.

01:42 Again, that factor is increased in people with untreated hypertension.

01:46 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 treated effectively.