2- hypertension

Question 1

what is ABMP?

Answer 1

ambulatory blood pressure monitoring = it’s when you wear a cuff on your arm & a small box on a belt around your waist

• at least 2 measurements per hour during persons usual waking hours

Question 2

what is HBPM?

Answer 2

home blood pressure monitoring
- 2 consecutive seated measurements, 1 minute apart
- BP recorded twice a day for a least 4 days (preferably 7 days)
- measurements on 1st day discarded

Question 3

what is essential hypertension?

Answer 3

essential (primary) hypertension

occurs when you have abnormally high blood pressure that’s not the result of a medical condition

(very common)

Question 4

what are the different stages of hypertension and the numbers?

Answer 4

Stage 1 = 140/90 or higher (clinic). 135/85 (home)

Stage 2 = 160/100 or higher (clinic). 150/95 or higher (home)

severe = 180 or higher (clinic systolic). 110 or higher (clinic diastolic)

Question 5

what should you test with hypertension?

Answer 5

• test urine for presence of protein
• take blood to measure glucose, electrolytes, creatinine (kidney function), estimated glomerular filtration rate & cholesterol
• examine fundi for hypertensive retinopathy
• arrange a 12 lead ECG

Question 6

what is the main driver of absolute risk for hypertension?

Answer 6

age

Question 7

what can you use to work out cardiovascular risk for scotland?

Answer 7

assign score

Question 8

what are consequences of chronic hypertension?

Answer 8

end (vital) organ damage:

• left ventricular hypertrophy
• creatinine raised
• albuminuria/microalbuminuria
• retinopathy

Question 9

what is left ventricular hypertrophy?

Answer 9

enlargement & thickening of LV (response to increased workload)

Question 10

what does creatinine raised suggest?

Answer 10

creatinine is a waste product produced by muscle metabolism, elevated levels suggest ineffective filtering & excreting by kidneys

Question 11

what is albuminuria/microalbuminuria?

Answer 11

= early sign of kidney damage

• albumin is a protein normally present in the blood but when it appears in urine, it indicates kidneys may be leaking

Question 12

what is retinopathy?

Answer 12

refers to damage or disease of retina, in context of hypertension retinopathy results from high blood pressure damaging the small blood vessels in the retina

Question 13

what is examination of fundus?

Answer 13

= fundus is interior surface of the eye opposite the lens

• examining the fundus is when you assess the back part of the eye during an eye examination. crucial for detecting various eye conditions including hypertensive retinopathy which is damage to retina due to high blood pressure

Question 14

what are polygenic risk scores (PRSs)?

Answer 14

the sum of the risk conferred by multiple disease associated SNVs across the genome

Question 15

what are common causes of hypertension?

Answer 15

• renal disease
• obstructive sleep apnoea
• aldosteronism
• reno-vascular disease

Question 16

what is secondary hypertension?

Answer 16

high blood pressure that is caused by an identifiable and often treatable underlying medical condition

Question 17

what is benign & malignant hypertension?

Answer 17

benign = old term describing high blood pressure without severe or acute symptoms

malignant = severe & potentially life threatening form of high blood pressure

Question 18

what are uncommon causes of hypertension?

Answer 18

• cushing’s
• pheochromocytoma
• hyperparathyroidism
• aortic coarctation
• intracranial tumor

Question 19

what is conns syndrome?

Answer 19

adenoma that secretes aldosterone that sucks in sodium and pushes out potassium →hypokolaemia

• 60% of hypertensive patients have inappropriate secretion of aldosterone

Question 20

what is renal disease? and how does it cause hypertension?

Answer 20

diseases affecting kidneys →can lead to imbalance of fluid & electrolytes contributing to elevated blood pressure

Question 21

what is obstructive sleep apnoea? and how does it cause hypertension?

Answer 21

sleep disorder characterized by repetitive episodes of complete/partial blockage of upper airway during sleep. drop in O2 levels and disrupted sleep patterns can lead to increased sympathetic nervous activity to elevated blood pressure

Question 22

what is aldosteronism? and how does it cause hypertension?

Answer 22

condition where there is overproduction of aldosterone and elevated aldosterone can lead to increased sodium retention & potassium loss →higher blood volume & blood pressure

Question 23

what is reno-vascular disease? and how does it lead to hypertension?

Answer 23

involves narrowing or blockage of renal arteries usually due to atherosclerosis →reduced blood flow to kidneys triggers RAAS →increased blood pressure

Question 24

what is cushings syndrome and how does it lead to hypertension?

Answer 24

hormonal disorder caused by prolonged exposure to high levels of cortisol (hormone produced by adrenal glands), elevated cortisol →increased sodium retention & fluid volume →higher blood pressure

Question 25

what is pheochromocytoma and how does it lead to hypertension?

Answer 25

rare tumor that develops in adrenal glands →overproduction of adrenaline & noradrenaline (catecholamines), excessive production of catecholamines →sudden & severe increase in blood pressure as stimulate heart & narrow blood vessels

Question 26

what is hyperparathyroidism and how does it lead to hypertension?

Answer 26

condition where parathyroid glands produce too much parathyroid hormone (PTH) leading to disruptions in calcium & phosphorus balance →elevated levels of PTH may contribute to increased blood pressure (not fully understood)

Question 27

what is aortic coarctation and how does it lead to hypertension?

Answer 27

congenital narrowing of aorta →increased pressure in vessels & reduced pressure beyond it

Question 28

what is intracranial tumor and how does it lead to hypertension?

Answer 28

tumor located in skull →lead to hypertension by increasing pressure within the skull, this affects blood flow & regulation in the brain →elevated blood pressure