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Pathophysiology Arterial hypertension Arterial hypertension, simply stated, is a high blood pressure.

It is defined as a persistent elevation of the systolic blood pressure (SBP) at a level of 140 mm Hg or higher and diastolic blood pressure (DBP) at a level of 90 mm Hg or higher. Cigarette smoking, heavy alcohol consumption, and some illicit drug use all are risk factors for hypertension. The nicotine in cigarette smoke and drugs such as cocaine cause an immediate rise in blood pressure that is dose dependent; however, habitual use of these substances has been implicated in an increased incidence of hypertension over time. Four control systems play a major role in maintaining blood pressure: (1) the arterial baroreceptor and chemoreceptors system; (2) regulation of body fluid volume; (3) the renin-angiotensin system; and (4) vascular autoregulation Arterial baroreceptors and chemoreceptors work reflexively to control blood pressure Acute coronary syndrome events such as a heart attack are still the most common results of hypertension. Hypertension is also related to increased severity of disease, aortic aneurysms, and heart failure. Nearly all people with heart failure have antecedent hypertension. If hypertension is left untreated, nearly half of hypertensive clients will die of heart disease, on third will die of stroke, and the remaining 10% to 15% will die of renal failure. Acute coronary syndrome Acute coronary syndromes (ACS) represent a spectrum of clinical conditions that are associated with acute myocardial ischemia. Clinical conditions included in ACS are unstable angina, variant angina, nonST-segment elevation myocardial infarction (MI), and ST-segment elevation MI. Evaluation of chest pain related to these disorders is a major cause of emergency department visits and hospitalizations in the United States. The term ACS is used prospectively to diagnose patients with chest pain who need to be triaged for treatment of unstable angina or acute MI. Early identification of ACS and intervention to improve myocardial perfusion reduces the risk of sudden cardiac death and acute MI in these patients. Most patients who experience ACS have atherosclerotic changes in the coronary arteries. The presence of atherosclerotic plaques narrows the lumen of the arteries and contributes to thrombus formation that diminishes blood flow to the myocardium. This imbalance between myocardial oxygen demand and supply is the primary cause of the clinical manifestation in ACS. Other causes of ACS include coronary artery spasm and arterial inflammation. Noncardiac conditions that increase myocardial oxygen demand can precipitate ACS in patients with preexisting coronary artery disease (CAD). These conditions include fever, tachycardia, and hyperthyroidism. Decreased myocardial oxygen supply can occur in noncardiac conditions such as hypotensive states, hypoxemia, and anemia. Reference: Black, J M, Hawks, J. (2009) Medical-Surgical Nursing Clinical management for Positive Outcomes. Missouri: Sounders Elsevier