Ateriosclerosis and Hypertension

hardening of the arteries

characterized by the atheroma, involves large and medium arteries

medial calcification without luminal narrowing or intimal disruption

• two types
• 1. hyaline: thickening of BM, assoc. w/ hypertension and diabetes mellitus
• 2. hyperplastic: fibrocellular intimal thickening, assoc. w/ malignant hypertension and scleroderma

proliferative arteriosclerosis: concentric smooth muscle cell proliferation and collagen deposition of the intima of small and medium-sized muscular arteries.

• 1. atherosclerosis
• 2. monckeberg's medial calcific sclerosis
• 3. arteriolosclerosis
• 4. fibroelastic hyperplasia

• 1. cigarette smoking (pack a day increases death rate by 200%)
• 2. diabetes mellitus
• 3. hypertension
• 4. hypercholesterolemia (HDL inversely assoc. w/ atherosclerosis)
• 5. C-reactive protein

• 1. lack of exercise
• 2. obesity
• 3. type A personality (stress)
• 4. high carb intake
• 5. lipoprotein
• 6. chlamydia pneumonia infection
• 7. hyperhomocysteinemia

• 1. major arterial branch points
• 2. abdominal aorta
• 3. coronary arteries
• 4. popliteal arteries
• 5. carotid arteries
• 6. cerebral arteries

plaques contain collagen, lipid, myofibroblasts, macrophages, and neovascularization

composed of smooth muscle and collagen. develops over a central core of lipids and cholesterol

• 1. ulceration
• 2. fissure formation
• 3. thrombosis
• 4. embolization
• 5. calcification

term given to earliest stages of atheromas. can occur in infants and children in geographically prone areas. characterized by lipid-laden cells in the intima.

• 1. IHD
• 2. stroke
• 3. gangrene
• 4. nephrosclerosis
• 5. aneurysm

• Normal: BP < 140/90
• Mild: 140/90 - 159/104
• Moderate/Severe: BP > 160/106

most show no symptoms until organ damage has occured

headaches, fatigue, dizziness, palpitations

• 1. left ventricular hypertrophy (compensated)
• 2. LV hypertrophy + dilation and CHF (decompensated)
• 3. atherosclerosis leads to IHD, stroke, and ischemic injury in other organs
• 4. arteriosclerosis leads to retinal injury and kidney damage/nephrosclerosis (renal failure)

• 1. peripheral vascular resistence (vasoconstriction)
• 2. reduced sodium excretion-->salt/water retention-->increased plasma volume and cardiac output

hypertension caused by other diseases. the hypertension is under control when the disease is controlled.

a hypothesis explaining atherogenesis as initiating with some injury to the endothelial cells lining the artery walls, which causes endothelial dysfunction and leads to abnormal cellular interactions and initiation and progression of atherogenesis.