aetiology and pathophysiology of hypertension

Question 1

hypertension is

Answer 1

blood pressure at which the benefits of treatment with antihypertensive agents in reducing cardiovascular, cerebrovascular and peripheral vascular risk outweigh the risks of treatment

Question 2

when does a patient have hypertension

Answer 2

140/90mmHg

Question 3

how common is it and what are the risks

Answer 3

affects 30-40% of adult population, prevalence under 65% in persons older than 6p years, it is a risk for MI, HF, CVD, accounting for 41% of all CVD deaths

Question 4

framingham study shows

Answer 4

increasing blood pressure is associated with a progressive increase in the risk of stroke and cardiovascular disease, risk however rises exponentially and not linearly with pressure and age clearly plays a significant role also

Question 5

stage 1 hypertension

Answer 5

clinic blood pressure is 140/90mmHg or higher, ABPM daytime average 135/85 mmHg or higher

Question 6

stage 2 hypertension

Answer 6

clinic blood pressure is 160/100 mmHg or higher, ABPM daytime average 150/95mmHg or higher

Question 7

stage 3 hypertension or severe

Answer 7

clinical systolic blood pressure is 180/120mmHg

Question 8

cause of hypertension

Answer 8

in 80-90%of cases no cause can be found but it can be chronic renal disease, renal artery stenosis, endocrine disease, Cushing’s, primary hyperaldosteronism, phaechromocytoma, GRA

Question 9

risk factors of hypertension

Answer 9

cigarette smoking, diabetes mellitus, renal disease, male, hyperlipidaemia, previous MI or stroke, LVH, age, genetics, high sodium intake, alcohol, obese people, low birth weight,

Question 10

contributors to blood pressure are

Answer 10

cardiac output, stroke volume, heart rate, peripheral vascular resistance all can be manipulated by drug therapy

Question 11

sympathetic nervous system activation produces

Answer 11

increased vasoconstriction, increased peripheral resistance, increased cardiac output due to reflex tachycardia, increased stroke volume. stimulates renin release produces angiotensin II and aldosterone

Question 12

renin angiotensin aldosterone system

Answer 12

pivotal in long term BP control, responsible for maintenance of sodium balance, control of blood volume and control of blood pressure. stimulated by fall in Bpm fall in circulating volume and sodium depletion

Question 13

renin converts

Answer 13

angiotensin to angiotensin I and then angiotensin I is converted to angiotensin II by angiotensin converting enzyme (ACE)

Question 14

aetiology of hypertension is

Answer 14

polygenic- major genes, polygenes and polyfactorial- environment and individual and shared

Question 15

history of hypertension in families

Answer 15

closest correlation exists between sibs rather than parent and child, also environmental factors common to members of the family also have a role in the development of hypertension

Question 16

environmental factors that have an effect

Answer 16

mental and physical stress both increase BP, true stress responders who have very high BP when they attend their doctor but low normal pressures otherwise tend to be highly resistant to treatment