34 Hypertension

Question 1

Systemic hypertension is defined as having a systolic pressure of ____ mmHg or above, &/or diastolic
pressure of ___ mmHg or above; varies with age

Answer 1

130;80

Question 2

For systemic hypertension
A. Most of them have known causes

B. Secondary hypertension means hypertension with known causes

C. Cushing’s disease and pheochromocytoma may cause hypertension

D. Pulmonary hypertension is defined as having pulmonary artery pressure of above 20 mmHg

Answer 2

C and D only

A: 90% with unknown causes = primary hypertension

B: have variety of causes

Question 3

An example of secondary hypertension is related to renal disease.

e.g. glomerulonephritis, tubulo-interstitial nephritis, hydronephrosis, renal
tumours or cysts, diabetic nephropathy

How does it relate to hypertension?

Answer 3

Although damage in some nephrons prompt others to restore filtration initially,

With fewer healthy nephrons are available to maintain renal
function → chronic renal failure

decrease in glomerular filtration activates RAAS, Ang II level elevated> potent vasoconstrictor > increase in MAP , increase CO

Question 4

Another example of secondary hypertension is renovascular hypertension. How does it occur?

Answer 4

Renal artery stenosis,

decreased renal perfusion, triggering renin relaase and activation of RAAS

Question 5

3rd example of secondary hypertension: adrenal conditions.

Give 3 examples of adrenal conditions that will cause hypertension.

Answer 5

1. Phaeochromocytoma
   - increase release of catacholamines, increased a1 mediated vasoconstriction and b1 heart rate increase, increase in MAP
2. Adrenal cortical adenoma (Primary aldosteronism)
   - non-malignant tumour in adrenal cortex that secretes high level of aldosterone
   - increased in Na+ retention, increase in plasma volume and increase in MAP
3. Cushing’s disease
   - increased cortisol from elevated ACTH (adrenocorticotropic hormone)
   - high level of cortisol ~ aldosterone, promote synthesis of angiotensinogen

Question 6

What is pre-eclampsia?

How does it affect blood pressure?

Answer 6

hypertension that occurs in pregnant women during the third trimester

increased sensitivity to AngII, therefore triggering RAAS to increase MAP

Question 7

Which of the following is/are not causes of primary hypertension?

A. Genetic
B. Familial history
C. Racial profile
D. Food intake 
E. Stress 
F. Lack vasodilatory production like bradykinin and PGI2 
G. increased responses to catecholamines

Answer 7

None