Hm515 Week 1 Literature Review

• SOURCES USED for learning issue # 1: What are the long-term effects of untreated hypertension?

- Student Coursepack, HM515: Cardiovascular Domain, MSU-CHM, 2016
- Lilly et al, Pathophysiology of Heart Disease, 5th Ed., Lippincott Williams & Wilkins, 2011.
- Mitchell et al, Pocket Companion to Robbins and Cotran: Pathologic Basis of Disease, 8th Ed., Elsevier Saunders Inc., 2012.

Long-term hypertension can result in a variety of consequences. These consequences are the result of the heart having to adapt and work harder, i.e. against an increased afterload due to the increased systolic pressure. The heart adapts via hypertrophy of the smooth muscle. Chronic hypertension can also lead to a disruption of the endothelium, thus increasing the …show more content…

- Mitchell et al, Pocket Companion to Robbins and Cotran: Pathologic Basis of Disease, 8th Ed., Elsevier Saunders Inc., 2012.

As discussed in Dr. Fink’s lecture, high blood pressure can result in retinal damage. This retinal damage can present as hemorrhages, exudates, or with a component of papilledema (CP, 145). According to Lilly, this retinal damage produced by hypertension is termed hypertensive retinopathy. More often than not, the retinopathy can be seen on physical exam but is asymptomatic to the patient. However, the clinical presentation can help to further classify the nature of the patient’s hypertension.
An acute presentation of hypertension will present with the aforementioned hemorrhages and exudates due to the bursting of small vessels. When the degree of hypertension is of a high severity, blurry vision and papilledema can also develop due to optic nerve infarction or increased intracranial pressure, respectively. Meanwhile, a chronic presentation will look quite different. A chronic pattern of hypertension will not involve papilledema, but instead will include arterial vasoconstriction and sclerosis. The “copper wiring” that was present in our patient’s case this week arises from this sclerosis. The appearance occurs because of an increased reflection of light while performing the fundoscopic exam …show more content…

- Mitchell et al, Pocket Companion to Robbins and Cotran: Pathologic Basis of Disease, 8th Ed., Elsevier Saunders Inc., 2012.

As discussed by Dr. Fink, hypertension is a multifactorial phenomenon. The hereditability based on twin studies suggests levels as high as 30-60%, but a familial correlation may also originate from environmental factors or lifestyle habits. Specific genetic polymorphisms that may contribute include mutations in controllers of vascular smooth muscle tone and the regulators of blood volume (Mitchell, 262). It is important to note that the genetic contribution is most often polygenic in nature and not the result of a single gene mutation. This can complicate the overall picture and prevention/treatment