Effects of Hypertension

Patients experiencing sustained and untreated hypertension are subjected to potential life-threatening risk factors. Left untreated, premature death may result. Cardiac compensation for the excessive workload imposed by the increased systemic pressure is at first sustained by ventricular hypertrophy and thickening. The function of the heart chamber, however, eventually deteriorates leading to cavity dilation and heart failure symptoms.

High blood pressure is also an important risk factor for atherosclerosis, a condition in which arterial walls harden and thicken. This condition may be present as either ischemic heart disease (IHD) or cerebrovascular disease, and is responsible for the majority of deaths in the United States and most westernized societies. The risk increases progressively with increasing blood pressure. In the Framingham study, IHD incidence in middle-aged men with blood pressures exceeding 160/95 was more than five times that in normotensive men (blood pressure 140/90 or less). Hypertensive men and women are affected similarly, with diastolic pressure (the lower number) being more important. The risk for atherosclerosis may be diminished with therapeutic reduction of blood pressure. Hence, early diagnosis and intervention remain critical in reducing a patient's likelihood of these events.

Symptoms of hypertension are often silent although end organs such as neurons, eyes and kidneys may be severly affected. Central nervous system dysfunction may be signaled by occipital headaches, dizziness, lightheadedness, vertigo, tinnitus, dimmed vision and syncope. Retinal changes in hypertension observed with a fundiscope include focal spasm, progressive narrowing of arterioles, hemorrhages, exudates and papilledema. In the kidney, hypertension may cause arteriosclerotic lesions of the afferent and efferent artioles resulting in decreased glomerular filtration rate and tubular dysfunction.

Several factors should be considered in assessing the prognosis of a patient with hypertension. Factors indicating an adverse prognosis include Black race, youth, persistent diastolic pressure >115 mmHg, smoking, diabetes mellitus, hypercholesterolemia, obesity, and evidence of end organ damage.