Target Organ Damage or Why Should we Treat Hypertension?

1

Which organs are most affected by elevated blood pressure?

• Heart

• Brain

• Kidneys

• Eyes

2

How does hypertension effect target organs?

Elevated blood pressure over many years can cause damage to several organs due to the direct effects of blood pressure on the vasculature of those organs as well as the effects of neurohormonal dysregulation. Sudden severe elevations in blood pressure can cause acute effects on these organs, including microangiopathy and organ failure.

3

What are the effects of hypertension on the heart and vasculature?

Chronically elevated blood pressure results in a number of pathophysiological changes to cardiac structure and function that ultimately result in cardiovascular disease ( Table 7.1 ). Elevated blood pressure leads to increased peak and end-systolic stress in the walls of the left ventricle, ultimately resulting in concentric left ventricular hypertrophy (LVH). Additionally, the renin-angiotensin aldosterone system and sympathetic nervous system are concurrently activated and further contribute to ventricular remodeling. Over several decades, changes in the structure and function of the heart due to elevated blood pressure can result in chronic heart failure and increased risk of nonvalvular arrhythmias. Additionally, elevated blood pressure accelerates the development of vascular diseases (in the coronary vessels and throughout the body) due to medial hypertrophy and intimal thickening from repetitive barotrauma and increased rate of development of atherogenic plaques.

Sudden elevations in blood pressure, particularly among individuals who do not have chronically elevated blood pressure, can acutely result in target organ effects including myocardial infarction, cardiogenic pulmonary edema, and aortic dissection.