资源简介

(共34张PPT)
Cardiovascular system
心血管系统疾病
Section 3
高血压病 Hypertension
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％
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, 2008. (Accessed November 13,2008)
Studies comparing the effects of antihypertensive medications with those of placebo have shown consistently that lowering blood pressure is associated with major reductions in the incidence of coronary events, strokes, and congestive heart failure.
These benefits have been observed irrespective of age, sex, severity of the hypertension, presence or absence of associated risk factors or concomitant diseases, or class of antihypertensive drug used. (Turnbull F, Neal B, Algert C, et al. Effects of different blood pressure-lowering regimens on major cardiovascular events in individuals with and without diabetes mellitus: results of prospectively designed overviews of randomized trials. Arch Intern Med 2005;165:1410-9.)
原发性高血压（primary or essential hypertention）
……90-95%原因未明，血压升高为主的全身独立性疾病
继发性高血压（secondary or symptomatic hypertension）
如肾性高血压
良性高血压（benign hypertension）(with long life)
恶性高血压(malignant hypertension）
5％(death within 1-2ys, diastolic pressure > 120 mmHg)
良性高血压 Benign hypertension
年龄、性别、种族
进展缓慢 Slow, progressive, asymptomatic
多基因 Multiple genetic
多病因 Multiple etiology
Environmental stress
Personality variables
Hereditary factors
obesity
正常血压的调控
心输出量
总的外周阻力
血容量
Arterioles
激素
神经
自我调节
局部因素
Na稳态
Cardiac output
Distal tubular sodium falls
良性高血压病变发展分期
功能紊乱期
动脉病变期
细小动脉硬化、大动脉硬化
内脏病变期
细动脉玻璃样变性（细动脉硬化）
血管壁增厚呈均质性、粉染玻璃样，管壁原有结构消失，管腔狭窄
发生机理：
血浆蛋白漏至血管壁
血管平滑肌产生更多的细胞外基质
病 理
肾小球入球小动脉
视网膜中动脉
Section of kidney showing the effects of chronic hypertension on a small artery - the marked fibrosis and replacement of the muscle layer (elastic stain).
高血压心脏病变
左心室向心性肥大，左室壁厚度超过2.0cm，重量超过450g，心腔不扩大。
向心性肥大
concentric hypertrophy
离心性肥大
eccentric hypertrophy
失代偿
充血性心力衰竭
向心性肥大
concentric hypertrophy
离心性肥大
eccentric hypertrophy
心力衰竭的原因？
心肌肥大僵硬，充盈不足
心肌缺血
毛细血管供血不力
冠脉粥样硬化
正常心肌供血
肥大心肌供血
Cap
Cap
高血压肾脏病变
双肾体积缩小，表面弥漫细小颗粒，
称原发颗粒性固缩肾
镜下观：
肾细小动脉（入球小动脉）玻璃样变
由于肾缺血，肾小球和肾小管萎缩，纤维化
间质纤维化，伴淋巴细胞浸润
高血压脑病变
脑水肿
高血压脑病 encephalopathy
高血压危象 crisis
脑梗死，脑软化
脑出血 stroke
微小动脉瘤
血管周围出血灶
动静脉压迹
反光性增强
迂曲
恶性高血压
急进型高血压病
坏死性细动脉炎
增生性小动脉硬化
Fibrinoid necrosisin malignant hypertension
hyperplastic arteriolosclerosis in malignant hypertension
“Hyaline” = benign.
“HYPERPLASTIC” = MALIGNANT HTN. SYS>200 1) ONION SKIN 2) “FIBRINOID” NECR.

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