Complications of hypertension

{{main|Left ventricular hypertrophy|Hypertensive cardiomyopathy|Myocardial infarction}}

Image:Heart left ventricular hypertrophy sa.jpg]]

Hypertensive heart disease is the result of structural and functional adaptations{{cite journal |vauthors=Steinmetz M, Nickenig G |title=[Cardiac sequelae of hypertension] |language=de |journal=Der Internist |volume=50 |issue=4 |pages=397–409 |date=April 2009 |pmid=19343394 |doi=10.1007/s00108-008-2289-3|s2cid=7660279 }} leading to left ventricular hypertrophy,{{cite journal |vauthors=Hennersdorf MG, Strauer BE |title=[Hypertension and heart] |language=de |journal=Medizinische Klinik |volume=101 |pages=27–30 |date=March 2006 |issue=Suppl 1 |pmid=16802514 }}{{cite journal |vauthors=Hennersdorf MG, Strauer BE |title=[The heart in hypertension] |language=de |journal=Der Internist |volume=48 |issue=3 |pages=236–45 |date=March 2007 |pmid=17260148 |doi=10.1007/s00108-006-1762-0|s2cid=22498249 }}{{cite journal |author=Motz W |title=[Right ventricle in arterial hypertension] |language=de |journal=Der Internist |volume=45 |issue=10 |pages=1108–16 |date=October 2004 |pmid=15351931 |doi=10.1007/s00108-004-1273-9|s2cid=25919141 }} diastolic dysfunction, CHF (Congestive Heart Failure), abnormalities of blood flow due to atherosclerotic coronary artery disease and microvascular disease, and cardiac arrhythmias. Individuals with left ventricular hypertrophy are at increased risk for, stroke,{{cite journal |vauthors=Wachtell K, Devereux RB, Lyle PA, Okin PM, Gerdts E |title=The left atrium, atrial fibrillation, and the risk of stroke in hypertensive patients with left ventricular hypertrophy |journal=Therapeutic Advances in Cardiovascular Disease |volume=2 |issue=6 |pages=507–13 |date=December 2008 |pmid=19124445 |doi=10.1177/1753944708093846 |s2cid=9411507 }} CHF, and sudden death. Aggressive control of hypertension can regress or reverse left ventricular hypertrophy and reduce the risk of cardiovascular disease.{{cite journal |last1=Petrović |first1=Dejan |last2=Stojimirović |first2=Biljana |title=Hipertrofija leve komore kod bolesnlka koji se leče redovnim hemodijalizama |trans-title=Left ventricular hypertrophy in patients treated with regular hemodialyses |language=sr |journal=Medicinski Pregled |date=2008 |volume=61 |issue=7–8 |pages=369–374 |doi=10.2298/MPNS0808369P |pmid=19097374 |doi-access=free }}

{{cite journal |vauthors=Cuspidi C, Sala C, Zanchetti A |title=Management of hypertension in patients with left ventricular hypertrophy |journal=Current Hypertension Reports |volume=9 |issue=6 |pages=498–505 |date=December 2007 |pmid=18367014 |doi= 10.1007/s11906-007-0091-6|s2cid=44337763 }}{{cite journal |author=Simko F |title=Statins: a perspective for left ventricular hypertrophy treatment |journal=European Journal of Clinical Investigation |volume=37 |issue=9 |pages=681–91 |date=September 2007 |pmid=17696957 |doi=10.1111/j.1365-2362.2007.01837.x |s2cid=34378084 |doi-access=free }}{{dead link|date=February 2019|bot=medic}}{{cbignore|bot=medic}}{{cite journal |vauthors=Wachtell K, Devereux RB, Lyle AP |title=The effect of angiotensin receptor blockers for preventing atrial fibrillation |journal=Current Hypertension Reports |volume=9 |issue=4 |pages=278–83 |date=August 2007 |pmid=17686377 |doi= 10.1007/s11906-007-0051-1|s2cid=24230854 }} left ventricular hypertrophy are seen in 25% of the hypertensive patients and can easily be diagnosed by using echocardiography.{{cite journal |author=Herpin D |title=[Impact of arterial hypertension on the heart] |language=fr |journal=La Revue du praticien |volume=49 |issue=5 |pages=491–4 |date=March 1999 |pmid=10358398 }} Underlying mechanisms of hypertensive left ventricular hypertrophy are of 2 types: firstly, mechanical (mainly leading to myocyte hypertrophy) and secondly, neuro-hormonal(mainly resulting in a fibroblastic proliferation).

Abnormalities of diastolic function, ranging from asymptomatic heart disease{{cite journal |vauthors=Parekh N, Maisel AS |title=Utility of B-natriuretic peptide in the evaluation of left ventricular diastolic function and diastolic heart failure |journal=Current Opinion in Cardiology |volume=24 |issue=2 |pages=155–60 |date=March 2009 |pmid=19532102 |doi=10.1097/HCO.0b013e328320d82a }}{{cite journal |vauthors=Biria M, Howard PA, Vacek J |title=Do statins have a role in the management of diastolic dysfunction? |journal=American Journal of Cardiovascular Drugs |volume=8 |issue=5 |pages=297–303 |year=2008 |pmid=18828641 |doi= 10.2165/00129784-200808050-00002|s2cid=38191136 }}{{cite journal |vauthors=Caserta MA, Milan A, Naso D |title=[Left ventricular diastolic function and dysfunction: a single cardiac target for various systemic diseases] |language=it |journal=Giornale Italiano di Cardiologia |volume=8 |issue=5 |pages=279–98 |date=May 2007 |pmid=17650687 |display-authors=etal}} to overt heart failure,{{cite journal |vauthors=Verma A, Solomon SD |title=Diastolic dysfunction as a link between hypertension and heart failure |journal=The Medical Clinics of North America |volume=93 |issue=3 |pages=647–64 |date=May 2009 |pmid=19427497 |doi=10.1016/j.mcna.2009.02.013 |url=http://journals.elsevierhealth.com/retrieve/pii/S0025-7125(09)00029-7|access-date=2009-06-22|url-access=subscription }}{{cite journal |vauthors=Ellis CR, Di Salvo T |title=Myocarditis: basic and clinical aspects |journal=Cardiology in Review |volume=15 |issue=4 |pages=170–7 |year=2007 |pmid=17575480 |doi=10.1097/CRD.0b013e31806450c4 |s2cid=20513704 }} are common in hypertensive patients. Patients with diastolic heart failure have a preserved ejection fraction, which is a measure of systolic function.{{cite journal |vauthors=Okoshi K, Guimarães JF, Di Muzio BP, Fernandes AA, Okoshi MP |title=[Diabetic cardiomyopathy] |language=pt |journal=Arquivos Brasileiros de Endocrinologia e Metabologia |volume=51 |issue=2 |pages=160–7 |date=March 2007 |pmid=17505622 |doi= 10.1590/s0004-27302007000200004|doi-access=free |hdl=11449/11269 |hdl-access=free }}{{cite journal |vauthors=Fukuta H, Little WC |title=Diagnosis of diastolic heart failure |journal=Current Cardiology Reports |volume=9 |issue=3 |pages=224–8 |date=May 2007 |pmid=17470335 |doi= 10.1007/BF02938354|s2cid=656249 }} Diastolic dysfunction is an early consequence of hypertension-related heart disease and is exacerbated by left ventricular hypertrophy and ischemia.

{{Main|Hypertensive encephalopathy|Cerebrovascular accident}}

Hypertension is an important risk factor for brain infarction and hemorrhage.{{cite journal |author=Schrader J |title=[Stroke and hypertension] |language=de |journal=Der Internist |volume=50 |issue=4 |pages=423–32 |date=April 2009 |pmid=19308341 |doi=10.1007/s00108-008-2291-9|s2cid=38815274 }}{{cite journal |vauthors=Zeng C, Villar VA, Yu P, Zhou L, Jose PA |title=Reactive oxygen species and dopamine receptor function in essential hypertension |journal=Clinical and Experimental Hypertension |volume=31 |issue=2 |pages=156–78 |date=April 2009 |pmid=19330604 |doi=10.1080/10641960802621283 |pmc=3722595 }}{{cite journal |author=Varon J |title=Diagnosis and management of labile blood pressure during acute cerebrovascular accidents and other hypertensive crises |journal=The American Journal of Emergency Medicine |volume=25 |issue=8 |pages=949–59 |date=October 2007 |pmid=17920983 |doi=10.1016/j.ajem.2007.02.032 }}{{cite journal |vauthors=Sare GM, Geeganage C, Bath PM |title=High blood pressure in acute ischaemic stroke--broadening therapeutic horizons |journal=Cerebrovascular Diseases |volume=27 |pages=156–61 |year=2009 |issue=Suppl 1 |pmid=19342846 |doi=10.1159/000200454 |s2cid=5400230 |url=https://www.karger.com/Article/PDF/000200454|access-date=2009-06-20|url-access=subscription }}{{cite journal |vauthors=Palm F, Urbanek C, Grau A |title=Infection, its treatment and the risk for stroke |journal=Current Vascular Pharmacology |volume=7 |issue=2 |pages=146–52 |date=April 2009 |pmid=19355997 |doi=10.2174/157016109787455707 |url=http://www.bentham-direct.org/pages/content.php?CVP/2009/00000007/00000002/004AD.SGM |access-date=2009-06-20 |archive-url=https://archive.today/20130414125117/http://www.bentham-direct.org/pages/content.php?CVP/2009/00000007/00000002/004AD.SGM |archive-date=2013-04-14 |url-status=usurped |url-access=subscription }}{{cite journal |author=Tanahashi N |title=[Roles of angiotensin II receptor blockers in stroke prevention] |language=ja |journal=Nippon Rinsho |volume=67 |issue=4 |pages=742–9 |date=April 2009 |pmid=19348237 }}{{citation overkill|date=November 2021}} Approximately 85% of strokes are due to infarction and the remainder are due to hemorrhage, either intracerebral hemorrhage or subarachnoid hemorrhage.{{cite book |author1=Loscalzo, Joseph |author2=Fauci, Anthony S. |author3=Braunwald, Eugene |author4=Dennis L. Kasper |author5=Hauser, Stephen L |author6=Longo, Dan L. |title=Harrison's principles of internal medicine |publisher=McGraw-Hill Medical |year=2008 |isbn=978-0-07-147691-1 }} The incidence of stroke rises progressively with increasing blood pressure levels, particularly systolic blood pressure in individuals >65 years. Treatment of hypertension convincingly decreases the incidence of both ischemic and hemorrhagic strokes.

Hypertension is also associated with impaired cognition in an aging population.{{cite journal |vauthors=Iadecola C, Park L, Capone C |title=Threats to the Mind: Aging, Amyloid, and Hypertension |journal=Stroke |volume=40 |issue=3 Suppl |pages=S40–4 |date=March 2009 |pmid=19064785 |doi=10.1161/STROKEAHA.108.533638 |url=http://stroke.ahajournals.org/cgi/pmidlookup?view=long&pmid=19064785 |archive-url=https://archive.today/20130223073829/http://stroke.ahajournals.org/cgi/pmidlookup?view=long&pmid=19064785 |url-status=dead |archive-date=2013-02-23 |access-date=2009-06-22 |pmc=2704500 }}{{cite book |vauthors=Erkinjuntti T, Gauthier S |chapter=The concept of vascular cognitive impairment |volume=24 |pages=79–85 |year=2009 |pmid=19182465 |doi=10.1159/000197886 |series=Frontiers of Neurology and Neuroscience |isbn=978-3-8055-9015-0|title=Dementia in Clinical Practice }}{{cite journal |vauthors=Birns J, Kalra L |title=Cognitive function and hypertension |journal=Journal of Human Hypertension |volume=23 |issue=2 |pages=86–96 |date=February 2009 |pmid=18650838 |doi=10.1038/jhh.2008.80|s2cid=11574645 |doi-access=free }}{{cite journal |vauthors=Moretti R, Torre P, Antonello RM, Manganaro D, Vilotti C, Pizzolato G |title=Risk factors for vascular dementia: Hypotension as a key point |journal=Vascular Health and Risk Management |volume=4 |issue=2 |pages=395–402 |year=2008 |pmid=18561514 |pmc=2496988 |doi= 10.2147/VHRM.S2434 |doi-access=free }} Hypertension-related cognitive impairment and dementia may be a consequence of a single infarct due to occlusion of a "strategic" larger vessel{{cite journal |vauthors=Solans-Laqué R, Bosch-Gil JA, Molina-Catenario CA, Ortega-Aznar A, Alvarez-Sabin J, Vilardell-Tarres M |title=Stroke and multi-infarct dementia as presenting symptoms of giant cell arteritis: report of 7 cases and review of the literature |journal=Medicine |volume=87 |issue=6 |pages=335–44 |date=November 2008 |pmid=19011505 |doi=10.1097/MD.0b013e3181908e96 |doi-access=free }}{{cite journal|last1=Kuźma|first1=Elżbieta|last2=Lourida|first2=Ilianna|last3=Moore|first3=Sarah F.|last4=Levine|first4=Deborah A.|last5=Ukoumunne|first5=Obioha C.|last6=Llewellyn|first6=David J.|date=August 2018|title=Stroke and dementia risk: A systematic review and meta-analysis|url=https://www.alzheimersanddementia.com/article/S1552-5260(18)33250-3/abstract|journal=Alzheimer's & Dementia|volume=14|language=en|issue=11|pages=1416–1426|doi=10.1016/j.jalz.2018.06.3061|pmid=30177276|pmc=6231970|hdl=2027.42/152961|issn=1552-5260}} or multiple lacunar infarcts due to occlusive small vessel disease resulting in subcortical white matter ischemia.{{cite journal |vauthors=Pantoni L, Poggesi A, Inzitari D |title=Cognitive decline and dementia related to cerebrovascular diseases: some evidence and concepts |journal=Cerebrovascular Diseases |volume=27 |pages=191–6 |year=2009 |issue=Suppl 1 |pmid=19342851 |doi=10.1159/000200459 |s2cid=3403376 |url=https://www.karger.com/Article/PDF/000200459|access-date=2009-06-23|url-access=subscription }} Several clinical trials suggest that antihypertensive therapy has a beneficial effect on cognitive function, although this remains an active area of investigation.{{cite book|title=Dementia in Clinical Practice|author=Zekry D|year=2009|isbn=978-3-8055-9015-0|series=Frontiers of Neurology and Neuroscience|volume=24|pages=95–106|chapter=Is it possible to treat vascular dementia?|doi=10.1159/000197888|pmid=19182467|chapter-url=https://archive-ouverte.unige.ch/unige:34022}}{{cite journal |vauthors=Viswanathan A, Rocca WA, Tzourio C |title=Vascular risk factors and dementia: How to move forward? |journal=Neurology |volume=72 |issue=4 |pages=368–74 |date=January 2009 |pmid=19171835 |doi=10.1212/01.wnl.0000341271.90478.8e |pmc=2677504}}{{cite journal |vauthors=Sorrentino G, Migliaccio R, Bonavita V |title=Treatment of vascular dementia: the route of prevention |journal=European Neurology |volume=60 |issue=5 |pages=217–23 |year=2008 |pmid=18756085 |doi=10.1159/000151696 |s2cid=6389257 |url=https://www.karger.com/Article/PDF/000151696|access-date=2009-06-23}}

Cerebral blood flow remains unchanged over a wide range of arterial pressures (mean arterial pressure of 50–150 mmHg) through a process termed autoregulation of blood flow.{{cite book |author1=Hall, John E. |author2=Guyton, Arthur C. |title=Textbook of medical physiology |publisher=Elsevier Saunders |location=St. Louis, Mo |year=2006 |pages=762 |isbn=978-0-7216-0240-0 }} Signs and symptoms of hypertensive encephalopathy may include severe headache, nausea and vomiting (often of a projectile nature), focal neurologic signs, and alterations in mental status. Untreated, hypertensive encephalopathy may progress to stupor, coma, seizures, and death within hours.{{cite journal |author=Müller-Wiefel DE |title=[The hypertensive crisis in childhood] |language=de |journal=Wiener Klinische Wochenschrift |volume=100 |issue=16 |pages=547–55 |date=August 1988 |pmid=3055687 }}{{cite journal |author=Isles CG |title=Management of hypertensive crises |journal=Scottish Medical Journal |volume=40 |issue=1 |pages=23–5 |date=February 1995 |pmid=7604239 |doi= 10.1177/003693309504000110|s2cid=24448490 }}{{cite journal |vauthors=Refai D, Botros JA, Strom RG, Derdeyn CP, Sharma A, Zipfel GJ |title=Spontaneous isolated convexity subarachnoid hemorrhage: presentation, radiological findings, differential diagnosis, and clinical course |journal=Journal of Neurosurgery |volume=109 |issue=6 |pages=1034–41 |date=December 2008 |pmid=19035716 |doi=10.3171/JNS.2008.109.12.1034 }}{{cite journal |author=O'Hara McCoy H |title=Posterior reversible encephalopathy syndrome: an emerging clinical entity in adult, pediatric, and obstetric critical care |journal=Journal of the American Academy of Nurse Practitioners |volume=20 |issue=2 |pages=100–6 |date=February 2008 |pmid=18271765 |doi=10.1111/j.1745-7599.2007.00292.x |s2cid=208287631 }}{{dead link|date=February 2019|bot=medic}}{{cbignore|bot=medic}} It is important to distinguish hypertensive encephalopathy from other neurologic syndromes that may be associated with hypertension, e.g., cerebral ischemia, hemorrhagic or thrombotic stroke, seizure disorder, mass lesions, pseudotumor cerebri, delirium tremens, meningitis, acute intermittent porphyria, traumatic or chemical injury to the brain, and uremic encephalopathy.

{{Main|Hypertensive retinopathy}}

Image:Hypertensiveretinopathy.jpg with AV nicking and mild vascular tortuosity]]

Hypertensive retinopathy is a condition characterized by a spectrum of retinal vascular signs in people with elevated blood pressure.{{cite journal |author=Walsh JB |title=Hypertensive retinopathy. Description, classification, and prognosis |journal=Ophthalmology |volume=89 |issue=10 |pages=1127–31 |date=October 1982 |pmid=7155523 |doi= 10.1016/s0161-6420(82)34664-3}} It was first described by Liebreich in 1859.Liebreich R. Ophthalmoskopischer Befund bei Morbus Brightii. Albrecht von Graefes Arch Ophthalmol 1859; 5: 265–268. The retinal circulation undergoes a series of pathophysiological changes in response to elevated blood pressure.{{cite journal |vauthors=Tso MO, Jampol LM |title=Pathophysiology of hypertensive retinopathy |journal=Ophthalmology |volume=89 |issue=10 |pages=1132–45 |date=October 1982 |pmid=7155524 |doi= 10.1016/s0161-6420(82)34663-1}} In the initial, vasoconstrictive stage, there is vasospasm and an increase in retinal arteriolar tone owing to local autoregulatory mechanisms. This stage is seen clinically as a generalized narrowing of the retinal arterioles. Persistently elevated blood pressure leads to intimal thickening, hyperplasia of the media wall, and hyaline degeneration in the subsequent, sclerotic, stage. This stage corresponds to more severe generalized and focal areas of arteriolar narrowing, changes in the arteriolar and venular junctions, and alterations in the arteriolar light reflex (i.e., widening and accentuation of the central light reflex, or "copper wiring").{{cite journal |vauthors=Wong TY, Mitchell P |title=Hypertensive retinopathy |journal=The New England Journal of Medicine |volume=351 |issue=22 |pages=2310–7 |date=November 2004 |pmid=15564546 |doi=10.1056/NEJMra032865 }}

This is followed by an exudative stage, in which there is disruption of the blood–retina barrier, necrosis of the smooth muscles and endothelial cells, exudation of blood and lipids, and retinal ischemia. These changes are manifested in the retina as microaneurysms, hemorrhages, hard exudates, and cotton-wool spots. Swelling of the optic disk may occur at this time and usually indicates severely elevated blood pressure (i.e., malignant hypertension). Because better methods for the control of blood pressure are now available in the general population, malignant hypertension is rarely seen. In contrast, other retinal vascular complications of hypertension, such as macroaneurysms and branch-vein occlusions, are not uncommon in patients with chronically elevated blood pressure. These stages of hypertensive retinopathy however, may not be sequential.{{cite journal |vauthors=Pache M, Kube T, Wolf S, Kutschbach P |title=Do angiographic data support a detailed classification of hypertensive fundus changes? |journal=Journal of Human Hypertension |volume=16 |issue=6 |pages=405–10 |date=June 2002 |pmid=12037695 |doi=10.1038/sj.jhh.1001402|s2cid=28083513 |doi-access= }} For example, signs of retinopathy that reflect the exudative stage, such as retinal hemorrhage or microaneurysm, may be seen in eyes that do not have features of the sclerotic stage,

{{Main|Hypertensive nephropathy}}

Hypertension is a risk factor for chronic kidney disease and end-stage kidney disease (ESKD).{{cite journal |vauthors=Krzesinski JM, Cohen EP |title=Hypertension and the kidney |journal=Acta Clinica Belgica |volume=62 |issue=1 |pages=5–14 |year=2007 |pmid=17451140 |doi= 10.1179/acb.2007.002|s2cid=40916501 }}{{cite journal |author=Monhart V |title=[Diabetes mellitus, hypertension and kidney] |language=cs |journal=Vnitr̆ní Lékar̆ství |volume=54 |issue=5 |pages=499–504, 507 |date=May 2008 |pmid=18630636 }}{{cite journal |vauthors=Hohenstein K, Watschinger B |title=[Hypertension and the kidney] |language=de |journal=Wiener Medizinische Wochenschrift |volume=158 |issue=13–14 |pages=359–64 |year=2008 |pmid=18677585 |doi=10.1007/s10354-008-0558-3|s2cid=195686488 }}{{cite journal |vauthors=Khosla N, Kalaitzidis R, Bakris GL |title=The kidney, hypertension, and remaining challenges |journal=The Medical Clinics of North America |volume=93 |issue=3 |pages=697–715, Table of Contents |date=May 2009 |pmid=19427500 |doi=10.1016/j.mcna.2009.02.001 |url=http://journals.elsevierhealth.com/retrieve/pii/S0025-7125(09)00016-9|access-date=2009-06-23|url-access=subscription }}{{cite journal |vauthors=Ponnuchamy B, Khalil RA |title=Cellular mediators of renal vascular dysfunction in hypertension |journal=American Journal of Physiology |volume=296 |issue=4 |pages=R1001–18 |date=April 2009 |pmid=19225145 |doi=10.1152/ajpregu.90960.2008 |pmc=2698613}}{{cite journal |author=Niang A |title=[Arterial hypertension and the kidney] |language=fr |journal=Dakar Médical |volume=53 |issue=1 |pages=1–6 |year=2008 |pmid=19102111 }}{{cite journal |author=Palmer BF |title=Hypertension management in patients with chronic kidney disease |journal=Current Hypertension Reports |volume=10 |issue=5 |pages=367–73 |date=October 2008 |pmid=18775113 |doi= 10.1007/s11906-008-0069-z|s2cid=24933057 }}{{citation overkill|date=March 2021}} Kidney risk appears to be more closely related to systolic than to diastolic blood pressure,{{cite journal |vauthors=Marín R, Gorostidi M, Fernández-Vega F, Alvarez-Navascués R |title=Systemic and glomerular hypertension and progression of chronic renal disease: the dilemma of nephrosclerosis |journal=Kidney International Supplements |volume= 68|issue=99 |pages=S52–6 |date=December 2005 |pmid=16336577 |doi=10.1111/j.1523-1755.2005.09910.x |doi-access=free }}{{cite journal |author=Schmitz A |title=Microalbuminuria, blood pressure, metabolic control, and renal involvement: longitudinal studies in white non-insulin-dependent diabetic patients |journal=American Journal of Hypertension |volume=10 |issue=9 Pt 2 |pages=189S–197S |date=September 1997 |pmid=9324121 |doi= 10.1016/S0895-7061(97)00152-0|doi-access=free }} and black men are at greater risk than white men for developing ESRD at every level of blood pressure.{{cite journal |vauthors=Lindhorst J, Alexander N, Blignaut J, Rayner B |title=Differences in hypertension between blacks and whites: an overview |journal=Cardiovascular Journal of Africa |volume=18 |issue=4 |pages=241–7 |year=2007 |pmid=17940670 |pmc=4170224 }}{{cite journal |vauthors=Swift PA, Macgregor GA |title=Genetic variation in the epithelial sodium channel: a risk factor for hypertension in people of African origin |journal=Advances in Renal Replacement Therapy |volume=11 |issue=1 |pages=76–86 |date=January 2004 |pmid=14730541 |doi= 10.1053/j.arrt.2003.10.011|doi-access=free }}{{cite journal |author=Ergul A |title=Hypertension in black patients: an emerging role of the endothelin system in salt-sensitive hypertension |journal=Hypertension |volume=36 |issue=1 |pages=62–7 |date=July 2000 |pmid=10904013 |doi=10.1161/01.hyp.36.1.62 |doi-access=free }}{{cite journal |vauthors=Ferrari P, Krozowski Z |title=Role of the 11beta-hydroxysteroid dehydrogenase type 2 in blood pressure regulation |journal=Kidney International |volume=57 |issue=4 |pages=1374–81 |date=April 2000 |pmid=10760070 |doi=10.1046/j.1523-1755.2000.00978.x|doi-access=free }}{{cite journal |author=Campese VM |title=The kidney in the hypertensive black |journal=Ethnicity & Health |volume=1 |issue=2 |pages=145–51 |date=May 1996 |pmid=9395558 |doi= 10.1080/13557858.1996.9961781}}

The atherosclerotic, hypertension-related vascular lesions in the kidney primarily affect the preglomerular arterioles,{{cite journal |vauthors=Bidani AK, Griffin KA |title=Long-term renal consequences of hypertension for normal and diseased kidneys |journal=Current Opinion in Nephrology and Hypertension |volume=11 |issue=1 |pages=73–80 |date=January 2002 |pmid=11753090 |doi= 10.1097/00041552-200201000-00011|s2cid=23305725 }}{{cite journal |vauthors=Johnson RJ, Rodriguez-Iturbe B, Kang DH, Feig DI, Herrera-Acosta J |title=A unifying pathway for essential hypertension |journal=American Journal of Hypertension |volume=18 |issue=3 |pages=431–40 |date=March 2005 |pmid=15797666 |doi=10.1016/j.amjhyper.2004.08.035|doi-access=free }} resulting in ischemic changes in the glomeruli and postglomerular structures. Glomerular injury may also be a consequence of direct damage to the glomerular capillaries due to glomerular hyperperfusion. Glomerular pathology progresses to glomerulosclerosis,{{cite journal |vauthors=Kwoh C, Shannon MB, Miner JH, Shaw A |title=Pathogenesis of nonimmune glomerulopathies |journal=Annual Review of Pathology |volume=1 |pages=349–74 |year=2006 |pmid=18039119 |doi=10.1146/annurev.pathol.1.110304.100119 }}{{cite journal |vauthors=Stoian M, Radulian G, Chiţac D, Simion E, Stoica V |title=A clinical approach in regression of glomerulosclerosis |journal=Romanian Journal of Internal Medicine |volume=45 |issue=2 |pages=215–8 |year=2007 |pmid=18333378 }} and eventually the kidney tubules may also become ischemic and gradually atrophic. The kidney lesion associated with malignant hypertension consists of fibrinoid necrosis of the afferent arterioles,{{cite journal |vauthors=Ono H, Ono Y |title=Nephrosclerosis and hypertension |journal=The Medical Clinics of North America |volume=81 |issue=6 |pages=1273–88 |date=November 1997 |pmid=9356598 |doi= 10.1016/S0025-7125(05)70582-4}}{{cite journal |vauthors=Muirhead EE, Pitcock JA |title=Histopathology of severe renal vascular damage in blacks |journal=Clinical Cardiology |volume=12 |issue=Suppl 4 |pages=IV58–65 |date=December 1989 |pmid=2620472 |doi= 10.1002/clc.4960121312|s2cid=41855935 }}{{cite journal |vauthors=Dustan HP, Curtis JJ, Luke RG, Rostand SG |title=Systemic hypertension and the kidney in black patients |journal=The American Journal of Cardiology |volume=60 |issue=17 |pages=73I–77I |date=December 1987 |pmid=3687809 |doi= 10.1016/0002-9149(87)90464-4}}{{cite journal |vauthors=Schwartz GL, Strong CG |title=Renal parenchymal involvement in essential hypertension |journal=The Medical Clinics of North America |volume=71 |issue=5 |pages=843–58 |date=September 1987 |pmid=3306206 |doi= 10.1016/S0025-7125(16)30812-4}}{{cite journal |vauthors=Cimprich RE, Ziemba LJ, Kutz SA, Robertson JL, Cockrell B |title=Experimentally induced malignant hypertension in beagle dogs |journal=Toxicologic Pathology |volume=14 |issue=2 |pages=183–7 |year=1986 |pmid=3764316 |doi= 10.1177/019262338601400206|s2cid=25800184 |doi-access=free }}{{cite journal |vauthors=Queiroz FP, Rojo-Ortega JM, Genest J |title=Metaischemic (post-Goldblatt) hypertensive vascular disease in rats |journal=Hypertension |volume=2 |issue=6 |pages=765–70 |year=1980 |pmid=7461792 |doi=10.1161/01.hyp.2.6.765 |s2cid=1587443 |doi-access= }}{{cite journal |author=Weller RO |title=Vascular pathology in hypertension |journal=Age and Ageing |volume=8 |issue=2 |pages=99–103 |date=May 1979 |pmid=463685 |doi= 10.1093/ageing/8.2.99}}{{citation overkill|date=March 2021}} sometimes extending into the glomerulus, and may result in focal necrosis of the glomerular tuft.{{cite journal |vauthors=Sinclair RA, Antonovych TT, Mostofi FK |title=Renal proliferative arteriopathies and associated glomerular changes: a light and electron microscopic study |journal=Human Pathology |volume=7 |issue=5 |pages=565–88 |date=September 1976 |pmid=987010 |doi= 10.1016/S0046-8177(76)80103-7}}{{cite journal |vauthors=Linz W, Becker RH, Schölkens BA, Wiemer G, Keil M, Langer KH |title=Nephroprotection by long-term ACE inhibition with ramipril in spontaneously hypertensive stroke prone rats |journal=Kidney International |volume=54 |issue=6 |pages=2037–44 |date=December 1998 |pmid=9853269 |doi=10.1046/j.1523-1755.1998.00208.x|doi-access=free }}

Clinically, macroalbuminuria (a random urine albumin/creatinine ratio > 300 mg/g) or microalbuminuria (a random urine albumin/creatinine ratio 30–300 mg/g) are early markers of kidney injury. These are also risk factors for kidney disease progression and for cardiovascular disease.

Diabetes has several complications of which one is hypertension or high blood pressure. Data indicate that at least 60-80 percent of individuals whom develop diabetes will eventually develop high blood pressure. The high blood pressure is gradual at early stages and may take at least 10–15 years to fully develop. Besides diabetes, other factors that may also increase high blood pressure include obesity, insulin resistance and high cholesterol levels. In general, fewer than 25 percent of diabetics have good control of their blood pressure. The presence of high blood pressure in diabetes is associated with a 4 fold increase in death chiefly from heart disease and strokes.[http://www.mja.com.au/public/issues/misc/gilbert/gilbert.html Diabetes and Hypertension] {{Webarchive|url=https://web.archive.org/web/20090417130003/http://www.mja.com.au/public/issues/misc/gilbert/gilbert.html |date=2009-04-17 }} Medical Journal of Australia. 2010-02-09 It has also been shown in recent epidemiological studies that variability of blood pressure, independent of mean blood pressure level, contributes to microvascular and macrovascular complications{{cite journal | vauthors = Chiriaco M, et al | title = Association between blood pressure variability, cardiovascular disease and mortality in type 2 diabetes: A systematic review and meta‐analysis | journal = Diabetes, Obesity and Metabolism | year = 2019 | volume = 21 | issue = 12 | pages = 2587–2598| doi = 10.1111/dom.13828 | pmid = 31282073 | s2cid = 195829708 }} in those with diabetes, including heart failure.{{cite journal | vauthors = Nuyujukian DS, Koska J, Bahn G, Reaven PD, Zhou JJ | title = Blood Pressure Variability and Risk of Heart Failure in ACCORD and the VADT | journal = Diabetes Care | volume = 43 | issue = 7 | pages = 1471–1478 | date = July 2020 | pmid = 32327422 | doi = 10.2337/dc19-2540 | pmc = 7305004 | hdl = 10150/641980 | hdl-access = free}} These variability associations may be especially deleterious in persons with either particularly high or particularly low blood pressures.{{cite journal | vauthors = Nuyujukian DS, Zhou JJ, Koska J, Reaven PD | title = Refining determinants of associations of visit-to-visit blood pressure variability with cardiovascular risk: results from the Action to Control Cardiovascular Risk in Diabetes Trial | journal = Journal of Hypertension | date = 2021 | volume = 39 | issue = 11 | pages = 2173–2182 | pmid=34232160 |doi = 10.1097/hjh.0000000000002931| pmc=8500916 }}

The chief reason why people with diabetes develop high blood pressure is hardening of the arteries. Diabetes tends to speed up the process of atherosclerosis. The other fact about diabetes is that it affects both large and small blood vessels in the body. Over time, blood vessels become clogged with fatty depots, become non-compliant and lose their elasticity. The process of atherosclerosis is a lot faster in diabetic individuals whom do not have good control of their blood sugars. The high blood pressure eventually leads to heart failure, strokes, heart attacks, blindness, kidney failure, loss of libido and poor circulation of blood in the legs. When the blood supply to the feet is compromised, the chances of infections and amputations also increases. All diabetics should know that even mild elevations in blood pressure can be detrimental to health. Studies have shown that diabetics with even a slight elevation in blood pressure have 2-3 times the risk of heart disease compared to individuals without diabetes.[http://diabetes.about.com/lw/Health-Medicine/Conditions-and-diseases/Diabetes-and-Hypertension.htm Diabetes associated to Hypertension] {{Webarchive|url=https://web.archive.org/web/20150907171742/http://diabetes.about.com/lw/Health-Medicine/Conditions-and-diseases/Diabetes-and-Hypertension.htm |date=2015-09-07 }} About health portal. 2010-02-09

Blood pressure readings do vary but experts recommend that blood pressure should not range above 140/80. Secondly, high blood pressure is a silent disease and thus it is vital for all diabetics to regularly check their blood pressure or have it checked at a doctor's office on a regular basis. The American Diabetes Association recommends that all diabetics get their blood pressure measured by a health care professional at least 2-5 times a year.Medical Journal of Australia. [http://www.mja.com.au/public/issues/misc/gilbert/gilbert.html "Hypertension and Diabetes overview"] {{Webarchive|url=https://web.archive.org/web/20090417130003/http://www.mja.com.au/public/issues/misc/gilbert/gilbert.html |date=2009-04-17 }} 2010-02-09.

Once blood pressure is found to be high in diabetics, there are ways to treat it:

Medications like the Angiotensin-converting enzyme inhibitors (ACEI) are widely used to control blood pressure in diabetics. These medications not only control blood pressure but also delay or prevent the development of kidney disease in diabetes. Many studies have shown that ACEI should be the drugs of first choice in diabetics with high blood pressure.{{Citation needed|reason=relevant studies must be cited to make this claim|date=September 2015}} Other medications used to treat high blood pressure include water pills. Sometimes, a combination of medications is used to treat high blood pressure. All diabetics should quit smoking. The combination of diabetes and smoking usually leads to amputations of the toes and feet.

Measure your blood sugars regularly, and make sure that they are well balanced as the majority of complications of diabetes can be prevented by ensuring such blood sugars stay within normal limits.[http://www.diabeteshypertension.net/ Diabetes Hypertension Guidelines: Treatment And Symptoms] {{webarchive|url=https://web.archive.org/web/20100209040057/http://www.diabeteshypertension.net/ |date=2010-02-09 }} 2010-02-09

It is also recommended to eat a healthy diet and avoid sugary foods and limit the intake of salt. Also, ensure that your cholesterol levels are under control. Exercise is a must for all diabetics. Walking twice a day for 30 minutes can be a fair substitute for those not engaged in intense gym activities. Losing weight is also beneficial as this has been shown to improve blood sugar control, increase insulin sensitivity and reduce blood pressure.American Academy of Family Physicians. [http://www.aafp.org/afp/2002/1001/p1209.html "Controlling Hypertension in Patients with Diabetes"] 2010-02-09.

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{{Vascular diseases}}

Category:Hypertension

Category:Cardiovascular diseases