Syphilis, a bacterial infection, does not directly or immediately cause high blood pressure. However, if left untreated, it can lead to long-term damage to the cardiovascular system, which may indirectly contribute to or worsen high blood pressure over time. This happens through specific changes in the heart and major blood vessels.
Syphilis and the Heart
Untreated syphilis can progress to its later stages, known as tertiary syphilis, often years or decades after initial infection. At this stage, the infection can affect the cardiovascular system, a condition referred to as cardiovascular syphilis.
Cardiovascular syphilis can involve various parts of the heart. It may lead to inflammation of the aorta, the body’s main artery, and can also affect heart valves, such as the aortic valve, potentially causing insufficiency. Heart muscle can also be impacted, though less common.
How Syphilis Affects Blood Vessels
Syphilis primarily impacts blood vessels through syphilitic aortitis, an inflammation of the aorta. This inflammation begins in the outer layer of the aortic wall, including the small vessels supplying the aorta, known as the vasa vasorum. As syphilitic aortitis progresses, the walls of these vasa vasorum thicken, restricting blood flow to the outer two-thirds of the aortic wall.
This reduced blood supply causes a lack of oxygen and nutrients, leading to the deterioration of elastic fibers and the death of smooth muscle cells within the aortic wall. The weakening of the aortic wall can then result in the formation of an aortic aneurysm, a bulge or ballooning in the artery. These aneurysms commonly affect the ascending aorta, the section closest to the heart.
The Link to High Blood Pressure
Damage to the aorta, particularly through syphilitic aortitis and aneurysm formation, can indirectly influence blood pressure. When elastic fibers in the aortic wall are damaged and replaced by scar tissue, the aorta loses its natural flexibility. This loss of elasticity, known as arterial stiffness, means the aorta cannot expand and recoil as effectively with each heartbeat.
A stiffened aorta increases resistance to blood flow, forcing the heart to work harder to pump blood. This increased workload and heightened circulatory resistance can contribute to or worsen existing high blood pressure. While a syphilitic aneurysm might not directly cause acute high blood pressure, its presence can lead to complications, such as compression of surrounding structures like the pulmonary artery, which can result in pulmonary hypertension.
Recognizing and Addressing Cardiovascular Syphilis
Early diagnosis and treatment of syphilis are important to prevent cardiovascular complications. Cardiovascular syphilis often manifests years to decades after the initial infection, making timely intervention challenging. Diagnosis involves a combination of serological tests, such as VDRL or RPR tests, and imaging studies like CT angiography or MRI to assess the extent of cardiovascular damage.
Treatment for cardiovascular syphilis primarily involves antibiotic therapy, with penicillin G benzathine being the recommended medication. If an aortic aneurysm has formed, surgical repair may also be necessary in conjunction with antibiotic treatment to reduce the risk of further complications. Seeking prompt medical evaluation upon suspicion of syphilis can help prevent severe and irreversible cardiovascular damage.