Epidemiology

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Etiology

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Pathophysiology

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Clinical features

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Diagnostics

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Treatment

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• Direct arteriolar vasodilators
  • Mechanism
    • Increase the release of cGMP → relaxation of smooth muscle → vasodilation → ↓ afterload
  • Agents
    • Hydralazine
      • Hydralazine is a treatment option in pregnant patients.
    • Minoxidil

Warning

In patients with long-standing hypertension, a chronic autoregulatory shift in the blood pressure–flow relationship occurs, affording less perfusion (flow) at any given pressure. Therefore, excessively rapid correction of blood pressure toward normal may induce relative ischemia.

Complications

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Eyes

• 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
      • 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