Complications of hypertension

Hypertension can damage both large and small arteries, leading to disease in the tissues and organs supplied by these damaged blood vessels. The tissues and organs most often affected by hypertension are the brain, heart, kidneys, and eyes. Controlling blood pressure can help prevent or slow the progression of many of the complications of hypertension.

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Hypertension accelerates atherosclerosis--the buildup of deposits called plaques within the walls of large arteries. If the plaques partially obstruct blood flow in an artery that leads to the brain (for example, the carotid artery), the result could be a transient ischemic attack (a ministroke in which symptoms usually subside within five to 20 minutes). If a blood clot forms in a plaque-containing artery, it could completely block blood flow and cause an ischemic stroke. Hypertension can also weaken arteries, resulting in a sac-like bulge (aneurysm) in the artery's wall. Rupture of an aneurysm in an artery supplying blood to the brain can result in a hemorrhagic stroke. Hypertension is also associated with lesions in the brain that can impair mental functions such as memory.

Atherosclerosis in the coronary arteries, which carry blood to the heart, can lead to a type of chest pain called angina when blood flow to the heart is insufficient. Complete blockage of a coronary artery by a blood clot results in a heart attack.

In people with hypertension, the heart works harder to pump against the higher pressures in the arteries. This excess workload thickens and increases the size of the heart's left ventricle. Called left ventricular hypertrophy, this condition affects 30 percent of people with hypertension and increases the risk of angina, heart attack, heart failure, and cardiac arrest.

Hypertension can damage the kidneys in two ways: by promoting atherosclerotic narrowing of the main arteries supplying the kidneys and by damaging the small arteries within the kidneys. Both can lead to progressive loss of kidney function and, eventually, kidney failure.

Persistent elevation of blood pressure can damage the tiny arteries that supply blood to the retina (the light-sensitive layer of nerve tissue that lines the back of the eye), resulting in a condition called hypertensive retinopathy. In the early stages of this disorder, the arteries in the retina thicken and narrow. Eventually, these vessels may develop blockages or begin to leak blood and fluid into the surrounding tissue. In very severe cases, the optic nerve (the nerve that carries visual impulses to the brain) may swell and cause vision loss. Hypertensive retinopathy typically evolves gradually, and many years may pass before people notice any changes in their vision.