Preventing sudden systemic hypertension is critical in the management especially in heart attacks and strokes. Although the specific goals for blood pressure management are highly individualized for each patient with an existing vascular disease condition, nevertheless the common goal is to maintain a systolic blood pressure of less than 150 mm Hg in order to prevent complications such as hematoma enlargement.
In systemic hypertension, blood pressure is continually elevated and antihypertensive therapy is usually prescribed, During the administration of antihypertensive, arterial hemodynamic monitoring is essentially important in order to identify any precipitous drop in blood pressure which if left untreated can result in brain ischemia. Since seizures cause elevation of blood pressure, antiseizure agents are often administered as prophylaxis in order to avert blood pressure related complications.
Pathophysiology of systemic hypertension
Although there is no precise cause that can be identified in most cases of systemic hypertension, it is understood that hypertension is a multi-factorial condition. Since hypertension is a sign that something in the body is malfunctioning, it is a generally accepted fact that hypertension is a precursor to some other form of disease conditions manifesting itself through an increase in systemic blood pressure. For hypertension to occur, there must be a change in one or more factors affecting peripheral resistance or cardiac output. In addition, there must also be a co-existing dysfunction of an organ system in the body, primarily the kidneys or the brain in regulating vascular pressure of the circulatory system.
Factors that implicate as causes of systemic hypertension
The following are factors that may be implicated as causes of systemic hypertension among patients:
- The increased activity of the renin-angiotensin-aldosterone system which results in the expansion of extracellular fluid volume and increased systemic vascular resistance.
- Decreased vasodilatation of the arterioles related to dysfunction of the vascular endothelium.
- Increased renal re-absorption of sodium, chloride and water related to genetic variation in the pathways by which the kidneys handle sodium.
- Resistance to insulin action, which may be a common factor that links hypertension, type II diabetes mellitus, hypertriglyceridemia, obesity and glucose intolerance.
- Increased sympathetic nervous system activity related to dysfunction of the autonomic nervous system.
Clinical manifestations of systemic hypertension
Physical examination may reveal no abnormalities other than an abnormally high blood pressure. Occasionally, retinal changes such as hemorrhages, exudates, arterial narrowing and cotton-wool spots can occur. In severe hypertension, papilledema (swelling of the optic disc) is an observable manifestation. People with hypertension may be asymptomatic and can remain so for many years. However, when specific signs and symptoms appear they usually indicate vascular damage, with specific manifestations related to organs served by the involved arterial blood vessels.
Coronary artery disease with angina or myocardial infarction is the most common and devastating consequence of
As a result of prolonged and unchecked hypertensive episodes, left ventricular hypertrophy usually develops as a resulting consequence of the increased resistance and subsequent workload on the left ventricle as it contracts against a higher systemic pressure. When the heart becomes overly stressed due to persistent systemic hypertension, heart failure usually follows leading to cardiac arrest and eventual death.