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Year 1: Cardiovascular System > 15. Hypertension > Flashcards

15. Hypertension Flashcards

1
Q

What is abnormal blood pressure?

A

140/90 mmHg

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2
Q

Describe the way systolic blood pressure changes with age

A

Rises in a linear way

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3
Q

Describe the way diastolic blood pressure changes with age

A

It plateaus and declines in old age

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4
Q

Describe the difference in blood pressure with increasing age

A

It the gap between systolic and diastolic BP increases

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5
Q

What is the relationship between BP and risk of stroke?

A

Exponential

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6
Q

What is the relationship between BP and myocaridal infarction?

A

Exponential

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7
Q

Define primary hypertension

A

There is no identifiable cause

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8
Q

Define secondary hypertension

A

There is an identifiable cause

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9
Q

What is the proportion of primary and secondary hypertension?

A 
Primary = 90-95%
Secondary = <5%
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10
Q

List the causes of secondary hypertension

A

Renal disease
Tumours secreting aldosterone (Conn’s syndrome)
Tumours secreting catecholamines
Oral contraceptive pill
Pre-eclampsia/pregnancy associated hypertension
Rare genetic diseases (e.g Liddle’s syndrome)

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11
Q

What is the most common cause of secondary hypertension?

A

Renal disease

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12
Q

What are two types of genetic causes of primary hypertension?

A 
Monogenic (rare) 
Complex Polygenic (common)
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13
Q

List the environmental causes of primary hypertension

A 
o Dietary Salt
o Obesity/Overweight/Lack of Exercise
o Alcohol 
o Pre-natal Environment (underweight babies have a higher risk of cardiovascular disease and diabetes) 
o Pregnancy (pre-eclampsia)
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14
Q

What is Liddle’s syndrome?

A

Monogenic - mutation in amiloride-sensitive tubular epithelial Na channel

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15
Q

What is Apparent mineralocorticoid excess?

A

Monogenic - mutation in 11beta-hydroxysteroid dehydrogenase

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16
Q

What is typically established hypertension associated with?

A
  • Increased TPR
  • Reduced arterial compliance (higher pulse pressure) - distensibility of larger arteries is reduced
  • Normal cardiac output
  • Normal blood volume/extracellular volume
  • Central shift in blood volume - secondary to reduced venous compliance
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17
Q

What are the causes of an increased TPR in hypertension?

A

1) Active narrowing of arteries - vasocontriction
2) Structural narrowing of Arteries - vasocontriction is accompanied by remodelling of arteries. The lumen gets smaller
3) Loss of capillaries - rarefaction

18
Q

Define rarefaction

A

Reduction in capillary density which means that resistance increased

19
Q

Define isolated systolic hypertension

A

Systolic BP > 140 and a Diastolic BP < 90. Characterised by the divergence of the SBP and DBP

20
Q

What is isolated systolic hypertension caused by?

A

Increased stiffness of the arteries so that the pulse wave is reflected and amplified by the time it reaches the brachial artery

21
Q

How do you treat isolated systolic hypertension?

A

You can’t treat it with drugs since it would just decrease DBP further

22
Q

What are the possible causes of primary hypertension?

A

Kidney
Sympathetic nervous system
Endocrine/Paracrine factors

23
Q

Discuss the effects of the kidney on hypertension

A

Impaired renal function or blood flow is the commonest cause of hypertension. Renal sodium excretion and salt intake issues greatly affect BP

24
Q

List the major risks attributable to increased BP?

A
  • Coronary heart disease
  • Stroke
  • Peripheral vascular disease/atheromatous disease
  • Heart failure
  • Atrial fibrillation
  • Dementia/cognitive impairment
  • Retinopathy
25
Q

What structural changes in the heart are caused by hypertension?

A

Hypertrophy of the left ventricle and change in ventricular volume (remodelling)

26
Q

Define heart failure

A

The inability of the heart to adequately pump blood at normal filling pressure

27
Q

By how much does hypertension increase the risk of CHF?

A

2-3 folds

28
Q

How many cases of CHF does hypertension account for?

A

25%

29
Q

What is the majority of hypertension in the elderly attributed to?

A

Ageing

30
Q

What is hypertension associated with in terms of arteries?

A

Hypertrophy, acceleration of atherosclerosis, dilation of the large arteries (aneurysm) which can lead to thrombosis or haemorrhage

31
Q

Describe Charcot-Bouchard aneurysms

A

Aneurysms of the brain vasculature which occur in small blood vessels - they are commonly associated with chronic hypertension and are a common cause of cerebral haemorrhage

32
Q

List the features caused by hypertension seen in the retina

A

o Thickening of the wall of small arteries
o Arteriolar narrowing
o Vasospasm
o Impaired perfusion
o Increased leakage into surrounding tissue (exudates)

33
Q

In the microvasculature what is hypertension associated with?

A

Reduction in capillary density

Elevated capillary pressure

34
Q

What does reduction in capillary density cause?

A

Impaired perfusion and an increase in peripheral vascular resistance

35
Q

What does elevated capillary pressure cause?

A

Damage and leakage

36
Q

What is a manifestation of renal dysfunction?

A

Loss of albumin in the urine (microalbuminuria and macroalbuminuria)

37
Q

What is lost in renal dysfunction?

A

The kidney gradually loses nephrons and their function deteriorates

38
Q

What is micoalbuminuria a sign of?

A

Renal dysfunction = glomerular damage

39
Q

How does hypertension affect the GFR (glomerular filtration rate)

A

Decreases the GFR with rate

40
Q

In terms of albumin, the higher your BP the more…

A

Albumin you will leak

Year 1: Cardiovascular System (21 decks)

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