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Cardiovascular System > Aetiology & Pathology of Hypertension > Flashcards

Aetiology & Pathology of Hypertension Flashcards

1
Q

What does angiotensin II do?

A

Stimulates aldosterone and ADH release.
Causes vasoconstriction
Strimulates NA+ reabsorption

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2
Q

What does aldosterone do?

A

Increases Na+ reabsorption

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3
Q

What does ADH do?

A

Increases water permeability of the gut, reducing diuresis and increasing plasma volume

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4
Q

How many cases of hypertension are secondary?

A

Only 5-10%

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5
Q

How many deaths is Hypertension responsible for?

A

Around 1/5 of all deaths directly or indirectly

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6
Q

How much does mortality risk go up for 2mmHg rise in BP?

A

Mortality from IHD goes up by 7%
Mortality from stroke goes up 10%

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7
Q

Summarise some end-organ damage complications of hypertension?

A

Brain - Haemorrhage, Stroke, Cognitive Decline
Heart - LVH, CHD, CHF, MI
Vessels - Renal Failure,
Kidneys - Peripheral vascular disease
Eyes - Retinopathy

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8
Q

How does higher BP affect risk of stroke and coronary heart disease?

A

A rises BP causes stroke risk to rise exponentially, CHD risk rises more linearly

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9
Q

Whats the difference in the risk of ischaemic heart disease between the old and young?

A

The old have a much higher baseline risk
However the risk rises faster for younger people as BP increases

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10
Q

At what BP does hypertension start?

A

140/90, however a healthy BP is more like 120/80

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11
Q

What is ABPM?

A

Ambulatory Blood Pressure Monitor

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12
Q

What defines stage 1 hypertension?

A

A Clinical BP of 140/90 or above
An ABPM daytime average of 135/85 or higher

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13
Q

What makes you stage 2 hypertension?

A

A clinical BP of 160/100
An ABPM daytime average of 150/95

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14
Q

How fucked do you have to be to have severe (stage 3) hypertension?

A

A clinical systolic BP of 180 or Diastolic of 110

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15
Q

Where is the closest correlation in hypertension risk within a family?

A

Between siblings, particularly monozygotic twins

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16
Q

What environmental factors affect hypertension?

A

Diet
Oral Contraceptives
Exercise
Stress

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17
Q

How do genetics affect hypertension?

A

Major genes and polygenes increase BP
History of hypertension tends to run in families

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18
Q

How does race affect hypertension?

A

Afro-Carribeans are more at risk of hypertension in a western environment because they’re salt retainers and dont cope with the high salt western diet

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19
Q

How does stress lead to chronic hypertension?

A

Stress causes acute hypertension
If you spend a lot of time stressed the hypertension damages your vessels and kidneys leading to chronic hypertension

20
Q

What are the main dietary influences on hypertension?

A

Salt intake and alcohol

21
Q

How does alcohol affect hypertension?

A

Giving up alcohol reduces BP in a matter of weeks but only by a small amounnt (5/3mmHg ish)

22
Q

How does salt intake influence hypertensives?

A

reducing salt intake lowers the BP of hypertensives.
We should aim for 6g/day, 1.5g/day or even 0.5g/day

23
Q

How important is weight loss in controlling hypertension?

A

Weight loss is the best non-pharmacological way to reduce BP, an otherwise untreated obese hypertensive could drop 19/18mmHg by losing weight.

24
Q

How does birth weight affect development of hypertension later in life?

A

A low birth weight is strongly associated with the development of hypertension in later life.
Something to do with in-utero malnutrition.

25
Q

How many cases are secondary?

A

5-10%

26
Q

Why does removing the cause of secondary hypertension not always remove the hypertension?

A

Hypertension from a secondary cause can damage the vessels and kidneys so that when the secondary cause is removed the damage is already done and the hypertension remains

27
Q

Name 4 renal diseases that can cause hypertension?

A

Chronic Infection
FIbromuscular Dysplasia
Renal Artery Stenosis
Polycystic Kidney Disease

28
Q

Name 3 drug types that can cause hypertension?

A

NSAIDs
Oral Contraceptives
Corticosteroids

29
Q

How does pregnancy cause hypertension, how dangerous is it?

A

Pre-Eclampsia (2nd biggest cause of maternal death in UK)

30
Q

Name 5 endocrine diseases causing hypertension?

A

Conn’s Syndrome
Cushing’s Syndrome
Pheochromocytoma
Hypo and Hyper Thyroidism
Acromegaly
GRA

31
Q

What is fibromuscular dysplasia?

A

Hyperplasia of the arterial lining

32
Q

What is conn’s syndrome?

A

An adenoma or glandular enlargement causes the adrenals to overproduce aldosterone

33
Q

Cushing’s disease?

A

Over production of Cortisol

34
Q

What is pheochromocytoma and why don’t sufferers always have symptoms when they visit the doctor?

A

An adrenal gland tumour causing excess epinephrine/norepinephrine production

Its effects can be sporadic, hence why they arnt always noticeable when the patient visits the doctor.

35
Q

Name a single vascular cause of hypertension?

A

Coarctation of the Aorta

36
Q

How can we detect coarctation of the aorta during an examination?

A

Depending on the position on the aorta of the coarctation it will cause a delay in the flow down one or more of the branches/descending aorta.
So its often possible to feel a delay between the radial pulses or the radial and femoral.

37
Q

Name 6 categories secondary hypertension?

A

Endocrine
Renal
Vascular
Sleep Apnoea
Pregnancy
Drug Induced

38
Q

What is responsible for second to second control of BP?

A

The sympathetic Nervous System through vasoconstriction, tachycardia and altered contractility.

39
Q

What is the main system controlling long term BP?

A

The Renin-Angiotensin-Aldosterone System (RAAS)

40
Q

What stimulates the RAAS

A

Falls in BP
Falls in Blood Volume
Falls in Blood Na+

41
Q

Show the series of hormones/enzymes involved in the RAAS?

A

Renin converts Angiotensinogen -> Angiotensin I
Angiotensin Converting Enzyme converts Angiotensin I -> Angiotensin II

42
Q

What does angiotensin II do?

A

Stimulates ADH & Aldosterone release
Stimulates Na+ reabsorption
Causes Vasoconstriction

43
Q

What does aldosterone do?

A

Stimulates Na+ Reabsorption

44
Q

What does ADH do?

A

Increases thirst and the water permeability of the collecting duct

45
Q

How could angiotensin II actually contribute to hypertension?

A

Its a potent hypertrophic agent so it can cause myocyte and smooth muscle hypertrophy, this can make the vessels so large they cant relax properly and TPR is permanently high. Ergo hypertension

46
Q

What is GRA?

A

Glucocorticoid Remediable Aldosteronism

An autosomal Dominant inherited condition

Increases aldosterone secretion due to the aldosterone synthase enzyme becoming sensitive to ACTH for some reason.

Cardiovascular System (49 decks)

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