Arterial hypertension may be divided into stages. In the first stage

the arteries are healthy, but the tone, owing to contraction of the

muscular walls, is too great. This condition or stage has been

termed "chronic arterial hypertension." This condition may be due to

irritants circulating in the blood, to nervous tension, to incipient

chronic interstitial nephritis, or may be the first stage of

sclerosis of the arteries. If from any cause this hypertension

persists, the muscular coats of the arteries will become more or

less hypertrophied, and sooner or later degenerative changes begin

in the intima, and finally fibrosis occurs in the external coat of

the arteries; in other words, arteriosclerosis is in evidence. If

the patient lives with this arteriosclerosis, a later stage of the

arterial disease may occur which has been termed atheroma, with

thickening, and possibly calcareous deposits in some parts of the

walls of the vessels, while in other parts the coats become thinner

and insufficient. At this stage the heart, which has already shown

some trouble, becomes unable to force the blood properly against

this enormous resistance of inelastic vessels and the blood pressure

begins to fail as the left ventricle weakens.

Edema, failing heart, perhaps aneurysms, peripheral obstruction, or

hemorrhages are the final conditions in this chronic disease of


Riesman [Footnote: Riesman: Pennsylvania Med. Jour., December, 1911,

p. 193.] divides hypertension into four classes hypertension without

apparent nephritis or arterial disease; hypertension with

arteriosclerosis; hypertension with nephritis, and hypertension with

both arteriosclerosis and nephritis. These classes are given here in

the order of the seriousness of the prognosis.

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