Target organ damage a result of hypertension.

Associated Clinical Manifestations Of Hypertension
Organ	Clinical Manifestation
Heart	Angina (chest pain due to decreased blood supply to heart) Myocardial Infarction (Heart Attack) Heart Failure. (deranged pumping action of heart) Left Ventricular Hypertrophy. (Enlargement of Heart)
Brain	Stroke (Paralysis and unconsciousness) Aneurysms (weakening and ballooning of blood vessels)
Kidney	Chronic Renal failure (Kidney Failure requiring dialysis)
Vascular System	Aortic aneurysm (weakening and ballooning of major artery-Aorta) Intermittent claudication (pain lower limbs, due to damaged blood vessels with failure to deliver adequate oxygen)

       

What is 'Target Organ Damage'

• Hypertension when of long standing duration and untreated , leads to progressive and sustained damage to blood vessels of various organs in different parts of body. 

• Damage to these organs is referred to as 'Target Organ Damage'

Examples of 'Target Organ Damage'

1. Stroke

2. Angina

3. Heart Attacks

4. Kidney Failure

5. Eye damage (Retinopathy). 

                  Heart attack                                 Stroke                                Retinopathy     

               (narrowing of arteries of heart)                          (narrowing of brain arteries)                                   (Eye damage). 

'Target Organ Damage' due to uncontrolled Hypertension

Stroke

• Cerebrovascular accident (CVA), also called stroke.

• An embolus (blood clot) or bleeding in the brain. 

• This results in lack of oxygen to the brain tissues that are normally supplied by the vessels. The after effects of a Cerebrovascular accident depend on the location and extent of damage. 

• Paralysis, weakness, speech defect, inability to understand language, or death may occur. 

• Symptoms usually diminish somewhat after the first few days as brain swelling subsides. 

• Physical therapy and speech therapy may restore much lost function.

Angina 

• A cramping chest pain and choking feeling caused by lack of oxygen to the heart muscle (angina pectoris).

Myocardial infarction (MI), heart attack

• A blockage of a heart artery.

•  It is caused by a kind of hardening of the arteries (Atherosclerosis) or a blood clot. This results in a dead tissue area in the heart muscle.

•  Myocardial infarction often begins with a crushing, viselike chest pain that may move to the left arm, neck, or upper abdomen. It sometimes seems like indigestion or a gallbladder attack. The patient becomes ashen, clammy, short of breath, faint, anxious. The patient may feel that death is near. 

• Typical signs are rapid heartbeat, a barely felt pulse, low blood pressure, above normal temperature, and heartbeat irregularities. 

• Emergency treatment of MI may require cardiopulmonary resuscitation (CPR) before the patient is taken to an intensive cardiac care unit of a hospital. In sudden MI, oxygen, heart drugs, and anticoagulants are usually given. Sleeping pills and painkillers are also given. Iced drinks and cold foods are avoided. The patient is usually given a low-sodium, low-cholesterol diet. Stool softeners and laxatives may be used to prevent straining.

Drug intervention.

• The progressive damage, so caused by uncontrolled hypertension may be irreversible in many cases.

• Intervention with drug therapy, aiming at vigorous and tight control of high blood pressure, coupled with 'Life Style Modification' and controlling associated risk factors and diseases can halt /delay, and may even reverse the damage process in early stages. 

 Atherosclerosis 

(Vascular damage associated with Hypertension )

             Yellowish plaques of bad cholesterol                                         Deposits inside blood vessels 

                                    deposited on inside walls of artery causing  narrowing of lumen of artery.

Coronary angiogram showing narrowed blood vessel

(coronary artery) supplying blood / oxygen to heart.

What is Atherosclerosis.

• Arteriosclerosis, a common disorder of the arteries. 

• It is marked by thickening, loss of elasticity, and hardening of the walls.

• This results in less blood supply, especially to the brain and legs. 

• The condition often develops with aging. 

• It also often occurs with high blood pressure, kidney disease, hardening of the connective tissues (scleroderma), diabetes, and excess of lipids in the blood (hyperlipidemia). 

• Symptoms include leg cramps when walking (intermittent claudication), changes in skin temperature and color, altered pulses, headache, dizziness, and memory defects. 

• Drugs to widen the blood vessels and exercise to stimulate circulation may relieve symptoms of arteriosclerosis. 

Disease process:

• It may begin with injury to the artery or with an increase of muscle in vessel walls due to uncontrolled Hypertension.

• Yellowish plaques of bad cholesterol, fats, and other remains are deposited in the walls of large and medium-sized arteries. 

• The vessel walls become thick and hardened. 

• The vessel narrows and lessens circulation to vital organs and other areas normally supplied by the artery. 

• These plaques (atheromas) are major causes of heart disease, chest pain (angina pectoris), heart attacks, strokes  and other disorders of the circulation. 

Risk Factors involved in development of Atherosclerosis.

• Uncontrolled Hypertension.

• Excess saturated fats in the diet.( high calorie, fatty food, alcohol intake)

• Faulty carbohydrate processing. (as in Diabetes)

• Genetic defect . (as in Lipid abnormalities-Hyperlipidemia)

• Smoking.

• Atherosclerosis usually occurs with aging.

• Overweight.

• Sedentary life styles. ( lack of exercise ).

• Male Sex. (more common in males)

• Family history of premature cardiovascular diseases. (leading to deaths below age of 56 years)

• HDL Cholesterol ( good cholesterol ) < 35 mg/dl.

• LDL Cholesterol (one of the bad cholesterols) >130 mg/dl.

• Serum Triglycerides (one of the  bad lipid) > 250 mg/dl. 

Potential Complications  

Complications include

• Atherosclerotic disease.

• left ventricular failure.

• Cerebrovascular insufficiency with or without stroke.

• Retinal hemorrhage, and 

• Renal failure. 

• When the pathologic process is accelerated, malignant hypertension results, the blood pressure becomes extremely high, and nephrosclerosis (kidney damage), encephalopathy (brain involvement with loss of consciousness), and cardiac failure rapidly ensue.

Hypertensive crisis

• A sudden severe increase in blood pressure to a level exceeding 200/120, occurring most often in untreated hypertension and in patients who have stopped taking prescribed anti hypertensive medication.

Hypertensive encephalopathy

• A set of symptoms, including headache, convulsions (seizures), and coma, associated with a certain type of kidney disease with hypertension  (Glomerulonephritis).