Pathophysiology of Hypertension

Yamaguchi, Ikuyo; Flynn, Joseph T.

doi:10.1007/978-3-642-27843-3_55-1

“…Obezite ilişkili HT patofizyolojisinde rol oynayan yağ dokusu, böbrekler, endotel ve santral sinir sistemi arasındaki kompleks etkileşimler Şekil 2'de gösterilmiştir (14,15). Bu kompleks mekanizmada yer alan başlıklara ayrı ayrı bakıldığında aşağıdaki konuların irdelenmesi gereklidir:…”

Section: çOcukluk çAğı Obezitesinde Hipertansiyon Mekanizmalarıunclassified

Mechanisms of Hypertension in Childhood Obesity

Akçaboy¹,

Buyan²

2016

Turkish J Pediatr Dis

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Dünya genelinde 1990 ile 2010 yılları arasında fazla kiloluluk ve obezite prevalansının %2.5 oranında arttığı raporlanmıştır (3).Hipertansiyon (HT) ise bütün dünyada prevalans ve insidansı giderek artmakta olan diğer önemli bir sağlık sorunudur. Hipertansiyon ile birlikte eşlik eden komorbiditeler artmakta ve bütün dünyada erken ölümlere ve kardiyovasküler ve serebrovasküler sistem hastalıklarına yol açmaktadır (4).Çocukluk yaş grubunda HT prevalansının bütün dünyada global olarak arttığı bildirilmekle birlikte bu oranı dünya genelinde GİRİŞGelişmekte olan ülkelerden alınan sosyoekonomik ve demografik veriler, halen devam eden beslenme yetersizliği ve malnütrisyon sorunlarına rağmen obezite sıklığında bir artışın olduğunu düşündürmektedir (1). Gelişmekte olan ülkelerde son on yılda obezite prevalansı %2.3'ten, %19.6'a kadar artmıştır. Orta Doğu, Çin ve Pasifik Adaları'nda üç kat artış bildirilmiştir. Obezite sadece yüksek sosyoekonomik sınıfın değil, düşük sosyoekonomik sınıfın da önemli sorunu haline gelmiştir (2). ÖzETHipertansiyon, çağımızın önemli mortalite ve morbidite yaratan sorunlarının başında gelmektedir. Obezite, genetik faktör-ler zemininde çevresel etki ile artmaktadır. Çocukluk çağında esansiyel hipertansiyon, obezitedeki global artış nedeniyle belirgin artış göstermektedir. Obezite ve hipertansiyonun birlikteliği ise çalışmalarda kanıtlanmıştır. Obez hastalardaki hipertansiyon nedenleri ise birden fazla faktöre bağlı olarak bulunmuştur. Obez hastalarda eşlik eden hiperinsülinemi ve insülin direncinin; hiperleptinineminin; böbrekte eşlik eden yapısal ve fonksiyonel değişikliklerin; inflamasyon ve oksidatif stresin; endotel disfonksiyonunun; santral sinir sistemi aktivasyonunun; eşlik edebilen obstrüktif uyku apnesinin; fruktoz içeren gıda tüketimindeki artışının; ürik asit yüksekliğinin ve nitrik oksit mekanizmasındaki değişikliklerin, hipertansiyon patofizyolojisinde önemli rol aldığı bilinmektedir. Patofizyolojide yer alan mekanizmalar hastaların tedavi ve izleminde önemli ipuçlarını oluşturmaktadır. Obez çocuklar, önlem alınmaz ise erişkin hayatlarında hipertansiyon, kardiyovasküler sistem hastalıkları ve serebrovasküler sistem hastalıkları ve bu durumların birlikte getirdiği morbidite ve mortalite riski ile karşı karşıya olacaklardır. Anahtar Sözcükler: Çocuk, Hipertansiyon, Obezite ABSTRAcTHypertension is one of the major and predisposing causes of morbidity and mortality of our age. Obesity is increasing due to the effect of environmental factors on a genetic basis. Essential hypertension is increasing day by day in childhood, a result of the prominent increase in childhood obesity. It is well known that obesity and hypertension are strongly related. The mechanism of hypertension in obesity has been found to be multifactorial. The major mechanisms involved in hypertension are hyperinsulinemia and insulin resistance; hyperleptinemia; functional and structural changes of the kidneys; inflammation and oxidative stress; endothelial dysfunction; overactivation of the central nervous system; obstru...

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“…Increased intracranial pressure created by this process causes further increase in the systemic HTN by stretching the receptors in the floor of the fourth ventricle. This causes a vicious cycle leading to more severe brain injury, seizure, coma and death (8)(9)(10)(11)(12).…”

Section: Pathophysiologymentioning

confidence: 99%

“…They frequently follow head and neck surgeries and pheochromocytomas. The diagnosis is based on finding high fasting blood metanephrine and normetanephrine and vanylmandelic acid (VMA) and homovanilic acid (HVA) in the 24-hour urine and the source of the tumor can be detected by metaiodobenzylguanidine (MIBG) isotope scan (8)(9)(10)(11)(12). Catecholamine-induced HTN can also be caused by Guillain Barre Syndrome (GBS), poliomyelitis and dysautonomia.…”

Section: -Catecholamine Induced Htnmentioning

confidence: 99%

“…We ourselves presented a case of hypertensive encephalopathy due to mercury poisoning (14). Malignant hypertension is rare in neonates and is mostly due to renal failure or congenital adrenal hyperplasia (CAH) (8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19). In infancy, two-thirds of the causes are due to coarctation of the aorta and polycystic kidney diseases (PKD).…”

Section: -Catecholamine Induced Htnmentioning

confidence: 99%

“…In this condition, there are some fundal changes, but no papilledema. When there is papilledema, the hypertension is called malignant (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12). In hypertensive encephalopathy with papilledema the patient has evidence of diffuse brain dysfunction such as severe headache, vomiting, blurred vision, seizure and coma.…”

Section: Introductionmentioning

confidence: 99%

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Hypertensive Encephalopathy

Encyclopedia of Pain

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ObjectiveHypertension is called the silent killer and vital organs such as the brain, eyes, kidneys and the heart are the targets. Seizure, central nervous system (CNS) hemorrhage, and cerebrovascular accident (CVA), blindness and heart attacks are the end points. The prevalence of hypertension in children is much less than adults, but evidence reveals that the source of hypertension in adulthood goes back to childhood. In 70-80% of cases hypertension is due to renal diseases. In children, hypertensive encephalopathy (HE) may be the first manifestation of renal diseases. Seizure is one of the most common manifestations of HE. In this article, definitions, etiology, pathophysiology and finally the acute and chronic managements of HE will be discussed. Keywords: Hypertension; Hypertensive encephalopathy; Children Introduction Hypertension (HTN) is the second most common cause of death after diabetes in adults worldwide. Some authors call it the silent killer and others believe that it is not so silent (1, 2). Between 1 and 5 percent of children and 15% of young adults suffer from hypertension while more than 60% of adults above the age of 65 years have hypertension. If the child's blood pressure (BP) is more than the 90 th percentile, the incidence of hypertension in adulthood rises 2-4 fold. Therefore, it is postulated that childhood diseases such as reflux nephropathy (RN) are the reason of hypertension in adulthood (3, 4). Based on the World Health Organization (WHO) reports, hypertension is the cause of 62% of cerebrovascular accidents (CVA) and 49% of ischemic heart diseases. For every 5 mmHg increase in diastolic BP, there is a 35% and 20% increase in the risk of CVA and coronary artery disease, respectively. In addition, hypertension is the cause of up to 50% of end stage renal diseases (ESRD) requiring dialysis and transplantation in adults. DefinitionsSince BP values differ with the child's age, sex, height, weight and environment, definitions are based on the percentile of related monograms (3-7). If the BP is between the 90th and 95th percentile, the child is pre-hypertensive. Blood pressures between 95th and 99th percentile +5 mmHg are stage 1 and more than 99th percentile +5 mmHg are stage 2 hypertension (8, 9).

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Hypertensive Encephalopathy

Akutsu¹,

Migishima²

SpringerReference

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ObjectiveHypertension is called the silent killer and vital organs such as the brain, eyes, kidneys and the heart are the targets. Seizure, central nervous system (CNS) hemorrhage, and cerebrovascular accident (CVA), blindness and heart attacks are the end points. The prevalence of hypertension in children is much less than adults, but evidence reveals that the source of hypertension in adulthood goes back to childhood. In 70-80% of cases hypertension is due to renal diseases. In children, hypertensive encephalopathy (HE) may be the first manifestation of renal diseases. Seizure is one of the most common manifestations of HE. In this article, definitions, etiology, pathophysiology and finally the acute and chronic managements of HE will be discussed. Keywords: Hypertension; Hypertensive encephalopathy; Children Introduction Hypertension (HTN) is the second most common cause of death after diabetes in adults worldwide. Some authors call it the silent killer and others believe that it is not so silent (1, 2). Between 1 and 5 percent of children and 15% of young adults suffer from hypertension while more than 60% of adults above the age of 65 years have hypertension. If the child's blood pressure (BP) is more than the 90 th percentile, the incidence of hypertension in adulthood rises 2-4 fold. Therefore, it is postulated that childhood diseases such as reflux nephropathy (RN) are the reason of hypertension in adulthood (3, 4). Based on the World Health Organization (WHO) reports, hypertension is the cause of 62% of cerebrovascular accidents (CVA) and 49% of ischemic heart diseases. For every 5 mmHg increase in diastolic BP, there is a 35% and 20% increase in the risk of CVA and coronary artery disease, respectively. In addition, hypertension is the cause of up to 50% of end stage renal diseases (ESRD) requiring dialysis and transplantation in adults. DefinitionsSince BP values differ with the child's age, sex, height, weight and environment, definitions are based on the percentile of related monograms (3-7). If the BP is between the 90th and 95th percentile, the child is pre-hypertensive. Blood pressures between 95th and 99th percentile +5 mmHg are stage 1 and more than 99th percentile +5 mmHg are stage 2 hypertension (8, 9).

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Pathophysiology of Hypertension

Cited by 3 publications

References 472 publications

Mechanisms of Hypertension in Childhood Obesity

Mechanisms of Hypertension in Childhood Obesity

Hypertensive Encephalopathy

Hypertensive Encephalopathy

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