 Let's move on and discuss some more cardiac pathology. Specifically, let's discuss hypertension. Hypertension is defined as a systolic blood pressure that is greater than or equal to 130 mmHg and or a diastolic blood pressure greater than or equal to 90 mmHg. It doesn't have to be both. You can have a blood pressure that is 135 over 85 and that is diagnostic of hypertension. You can also have a blood pressure of 120 over 95 and that is also diagnostic of hypertension. These can be mutually exclusive. Some risk factors associated with hypertension include an increase in age. So the older you get, the more chance that you have of having hypertension. Diabetes is obviously a risk factor. Diabetes mellitus is a risk factor. If you live a sedentary lifestyle where you're not getting a lot of activity and exercise, that is also a risk factor for hypertension. Furthermore, an increase in salt intake is a risk for hypertension. Alcoholics or those that drink a whole lot of ethanol will also have an increased risk of hypertension. And then we have people that are smokers and those that have a family history of hypertension. Furthermore, there are some other risk factors that you can't control. Those are being individuals' race. So African-Americans, Caucasians, and Asians all have an increased risk of developing hypertension at some point in their life. Most cases of hypertension are due to an increase in the cardiac output or in the total peripheral resistance. There are also some less common causes of hypertension. Some of these may be related to renal issues. So specifically as you see in this picture here, what you're seeing is what's called the string of beads appearance. And this is the renal artery that has what is known as fibromuscular dysplasia. This is often seen in women of childbearing age. Furthermore, we can have primary hyperaldosteronism that can also predispose us to hypertension. When hypertension gets to a point where it is too high, we call that a hypertensive urgency or a hypertensive emergency. These two are distinguished by one specific thing that we'll discuss. Specifically, hypertensive urgencies have a severe hypertension that has a systolic blood pressure of greater than or equal to 180 millimeters of mercury or a diastolic blood pressure greater than or equal to 120 millimeters of mercury. Once again, as with hypertension, these two do not require both to be present in order for a diagnosis of hypertensive urgency to be made. Someone with a blood pressure of 190 over 100 would be considered to have a hypertensive emergency due to that systolic blood pressure of greater than or equal to 180. Likewise, someone with a blood pressure of 160 over 125 would be considered to be in a hypertensive emergency due to that diastolic blood pressure greater than or equal to 120. We move further into a hypertensive emergency when we have the same hypertension levels of greater than or equal to 180 systolic or greater than or equal to 120 diastolic, but we also add in end organ damage. What is end organ damage? End organ damage is anytime that we see downstream effects of this hypertension. So specifically in this picture, we are seeing a hemorrhagic stroke due to the hypertension. We can also see things like encephalopathy, retinal hemorrhages and exudates, papillodema in the eyes. There's also possibilities of myocardial infarction and heart failure. You can see aortic dissection, which we'll discuss later. Any injuries and eclampsia or microangiopathic hemolytic anemias are all possible as end organ damage associated with hypertensive emergencies. There are many complications that are associated with hypertension, many of which are listed in this diagram. Starting with the brain, we can have an increased incidence of stroke with hypertension. There's also a risk of hypertensive encephalopathy, where we will see confusion, headache and convulsions associated with that. In the eyes, we can see hypertensive retinopathy that will be visible on fundoscopic examination. With the heart, one of the main risks that we can have is heart attack due to a decrease in blood pressure to the heart because of that extra pressure. All of this can lead to left ventricular failure or heart failure, such as a hypertensive cardiomyopathy. We can also see atrial fibrillation and other issues like aortic dissection or aortic aneurysms. And related to the kidneys, we can see a hypertensive nephropathy, which leads to a chronic renal failure.