Aetiology, pathology and treatment of Hypertension

Question 1

What demographic are likely to have polypharmacy?

Answer 1

Older people

Over 75

Question 2

What are complications of hypertension to the brain?

Answer 2

Haemorrhage

Stroke

Cognitive decline

Question 3

What are the complications of hypertension to th eyes?

Answer 3

Retinopathy

Question 4

What are the complications of hypertension to the blood vessels?

Answer 4

Peripheral vascular disease

Question 5

Why is high BP bad for you?

Answer 5

Mechanical effect of sustained high BP directly affects arterial and capillary integrity

Esp. In heart, brain, kidneys and eyes

Regulatory dysfunction causing HTN may also have direct deleterious effects

E.g. direct catecholamines effect on heart

Question 6

Effect of hypertension on the kidneys?

Answer 6

Renal failure

Dialysis

Transplantation

Proteinuria

Question 7

Complication of hypertension on the heart?

Answer 7

LVH - left ventricle hypertrophy

CHD

CHF - congestive heart failure

MI

Question 8

Reninopathy?

Answer 8

Bleeding at the back of the eye

Question 9

What is the effect of 2mmHg rise in BP?

Answer 9

7% increase risk mortality from IHD

10% increase risk mortality from stroke

Question 10

What BP is a pt hypertensive?

Answer 10

140/90

Question 11

Normal BP?

Answer 11

<120/<80

Question 12

Elevated BP?

Answer 12

120-129/<80

Question 13

High normal BP?

Answer 13

130-139/80-89

Question 14

Stage 1 hypertension?

Answer 14

140/90 in clinic or higher

Question 15

Stage 2 hypertension?

Answer 15

160/100 mmHg or higher in clinic

ABPM daytime average 150/95 mmHg

Question 16

Severe hypertension?

Answer 16

Systolic bp 180/120 mmHg

Question 17

What is a more accurate way to measure BP?

Answer 17

ABPM Daytime average 135/85mmHg

Home monitor or given a monitor for a day

Question 18

What BP does smoking add?

Answer 18

20/10 mmHg

Question 18

What factors increase risk of hypertension?

Answer 18

Cigarettes
Diabetes
Renal disease
Male
Hyperlipidaemia
Previous MI or stroke
Left ventricular hypertrophy

Question 19

How much does diabetes increase chance of MI?

Answer 19

5-30 times increase MI

Question 20

Are men more likely to have hypertension?

Answer 20

Yes 2 x more likely

Question 21

What controls bp?

Answer 21

Sympathetic

Renin angiotensin aldosterone systems

Question 22

Cardiac output?

Answer 22

Stroke volume x hr

Question 23

Prime contributors to BP?

Answer 23

Cardiac output

Peripheral vascular resistance

Question 24

What are the effects of the peripheral nervous system?

Answer 24

Vasoconstriction Reflex tachycardia Increased cardiac output These all increase bp

Question 25

What stimulates Ras?

Answer 25

Fall in bp Fall in circulating volume Sodium depletion

Question 26

ACE inhibitor?

Answer 26

Ramipril

Question 27

What is a long term control of BP?

Answer 27

RAAS

Question 28

Describe the process of angiotensin II production

Answer 28

TheRAASisstimulatedby: – fall in BP – fall in circulating volume – sodium depletion * Anyoftheabovestimulatereninreleasefromthejuxtaglomerular apparatus which converts angiotensinogen to angiotensin I * AngiotensinIisconvertedtoangiotensinIIbyangiotensinconverting enzyme (ACE)

Question 29

Can hypertension be genetic?

Answer 29

Yes, GRA gene turned on by endogenous steroid

Question 30

Factors affecting hypertension?

Answer 30

Age Genetics and family history Environment Weight Alcohol intake Race Birth weight Sodium intake

Question 31

What are causes of secondary hypertension?

Answer 31

Chronic renal disease Renal artery stenosis Endocrine disease, Cushing, conn’s syndrome, GRA

Question 32

What is secondary hypertension?

Answer 32

5-10% of all hypertension has identifiable cause Removal of the cause does not guarantee that the normal hypertension or risk will Truro to normal Sustained hypertension produces end-organ damage to blood vessels, heart and kidney

Question 33

Drug induced secondary hypertension?

Answer 33

Nsaids Oral contraceptive Coricosteroids

Question 34

Endocrine system and hypertension?

Answer 34

Conn’s syndrome Cushing disease Hypo or hyperthyroidism Acromegaly

Question 35

Vascular cause of secondary hypertension?

Answer 35

Coarctation of the aorta

Question 36

How to identify true hypertension?

Answer 36

ABPM ambulatory BP monitoring Or HBPM home blood pressure monitoring

Question 37

How to assess risk of pt and hypertension?

Answer 37

Previous MI, stroke, IHD – Smoking – Diabetes mellitus – Hypercholesterolaemia – Family history – Physical Examination

Question 38

If it is difficult to assess risk of hypertension, wat do you use?

Answer 38

Assign risk calculator / Q risk

Question 39

What is teh target bp of a hypertensive pt?

Answer 39

<135/80-85 mmHg

Question 40

Why treat hypertension?

Answer 40

Reduce cerebrovascular disease by 40-50% Reduce MI by 16-30%

Question 41

Teatment for a young person with high renin?

Answer 41

ACE inhibitor/ARB

Question 42

Treatment for elderly with low renin?

Answer 42

Calcium channel blocker Thiazide - type diuretic

Question 43

Step 1 in tx if pt is under 55 years?

Answer 43

ACE1/ARB

Question 44

When do you not prescribe ACE1/ARB?

Answer 44

Afro-Caribbean Women of child baring age

Question 45

Step 2 of tx for hy[ertension?

Answer 45

Add thiazide-type diuretic sch as inapamide to CCB or ACE1/ARB

Question 46

Step 3 or tx plan for hypertension?

Answer 46

Add CCB, ACE1, diuretic together

Question 47

Contraindications of ACE inhibitors?

Answer 47

Renal artery stenosis Renal failure Hyperkalaemia