第6章 心血管系统疾病_3高血压（课件）-高一《病理学·第4版》同步教学（科学出版社）

Cardiovascular system 心血管系统疾病 病理学 心血管系统疾病 the heart and the blood vessels disease Section 3 高血压病 Hypertension 病理学 心血管系统疾病 the heart and the blood vessels disease 舒张压持续高于90mmHg 或收缩压持续高于140mmHg 缺血性心脏病 IHD 心衰 Heart failure 主动脉夹层 Aortic dissection 中风 Stroke 肾衰 Renal failure 25％ 病理学 心血管系统疾病 the heart and the blood vessels disease Regardless of cause, longstanding high blood pressure is bad. Patients get: increased incidence of cerebrovascular accidents, especially hemorrhage ("hypertensive hemorrhage" -- though the relationship is questionable) some acceleration of atherosclerosis (with resultant coronary artery disease), and hypertensive heart disease high blood pressure from any cause eventually damages the kidney. (NOTE: Regardless of the original disease, most advanced renal disease patients seem to benefit from angiotensin converting enzyme inhibition). damage to the white matter of the brain ("Binswanger's", "white matter hyperintensities"), which is an under-recognized cause of dementia in older folks (Neurology 56: 921, 2001). Even non-impaired older folks with high blood pressure have these (Neurology 63: 1892, 2004). The vascular changes in the brain parallel the familiar hypertensive changes in the retina (Neurology 59: 1536, 2002). The brain damage seems synergistic with Alzheimer's if the two are both present (Neurology 64: 263, 2005). iatrogenic disease secondary to the noxious side effects of antihypertensive agents is widespread and serious. Diuretics cause hypokalemia that can be disabling or fatal. Many other drugs cause fatigue, depression, impotence ( Ann. Int. Med. 144: 613, 1991). Hypertension is one of the most important risk factors for cardiovascular and renal diseases. Currently, approximately 73 million adults in the United States and approximately 1 billion adults worldwide have hypertension, and the prevalence is increasing. (Heart disease stroke statistics: 2008 update at-a-glance. Dallas: American Heart Association, 200