Aetiology & Pathology of Hypertension

Question 1

What does angiotensin II do?

Answer 1

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

Question 2

What does aldosterone do?

Answer 2

Increases Na+ reabsorption

Question 3

What does ADH do?

Answer 3

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

Question 4

How many cases of hypertension are secondary?

Answer 4

Only 5-10%

Question 5

How many deaths is Hypertension responsible for?

Answer 5

Around 1/5 of all deaths directly or indirectly

Question 6

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

Answer 6

Mortality from IHD goes up by 7%

Mortality from stroke goes up 10%

Question 7

Summarise some end-organ damage complications of hypertension?

Answer 7

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

Question 8

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

Answer 8

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

Question 9

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

Answer 9

The old have a much higher baseline risk

However the risk rises faster for younger people as BP increases

Question 10

At what BP does hypertension start?

Answer 10

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

Question 11

What is ABPM?

Answer 11

Ambulatory Blood Pressure Monitor

Question 12

What defines stage 1 hypertension?

Answer 12

A Clinical BP of 140/90 or above

An ABPM daytime average of 135/85 or higher

Question 13

What makes you stage 2 hypertension?

Answer 13

A clinical BP of 160/100

An ABPM daytime average of 150/95

Question 14

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

Answer 14

A clinical systolic BP of 180 or Diastolic of 110

Question 15

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

Answer 15

Between siblings, particularly monozygotic twins

Question 16

What environmental factors affect hypertension?

Answer 16

Diet
Oral Contraceptives
Exercise
Stress

Question 17

How do genetics affect hypertension?

Answer 17

Major genes and polygenes increase BP

History of hypertension tends to run in families

Question 18

How does race affect hypertension?

Answer 18

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

Question 19

How does stress lead to chronic hypertension?

Answer 19

Stress causes acute hypertension

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

Question 20

What are the main dietary influences on hypertension?

Answer 20

Salt intake and alcohol

Question 21

How does alcohol affect hypertension?

Answer 21

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

Question 22

How does salt intake influence hypertensives?

Answer 22

reducing salt intake lowers the BP of hypertensives.

We should aim for 6g/day, 1.5g/day or even 0.5g/day

Question 23

How important is weight loss in controlling hypertension?

Answer 23

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

Question 24

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

Answer 24

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

Question 25

How many cases are secondary?

Answer 25

5-10%

Question 26

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

Answer 26

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

Question 27

Name 4 renal diseases that can cause hypertension?

Answer 27

Chronic Infection FIbromuscular Dysplasia Renal Artery Stenosis Polycystic Kidney Disease

Question 28

Name 3 drug types that can cause hypertension?

Answer 28

NSAIDs Oral Contraceptives Corticosteroids

Question 29

How does pregnancy cause hypertension, how dangerous is it?

Answer 29

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

Question 30

Name 5 endocrine diseases causing hypertension?

Answer 30

``` Conn's Syndrome Cushing's Syndrome Pheochromocytoma Hypo and Hyper Thyroidism Acromegaly GRA ```

Question 31

What is fibromuscular dysplasia?

Answer 31

Hyperplasia of the arterial lining

Question 32

What is conn's syndrome?

Answer 32

An adenoma or glandular enlargement causes the adrenals to overproduce aldosterone

Question 33

Cushing's disease?

Answer 33

Over production of Cortisol

Question 34

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

Answer 34

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.

Question 35

Name a single vascular cause of hypertension?

Answer 35

Coarctation of the Aorta

Question 36

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

Answer 36

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.

Question 37

Name 6 categories secondary hypertension?

Answer 37

``` Endocrine Renal Vascular Sleep Apnoea Pregnancy Drug Induced ```

Question 38

What is responsible for second to second control of BP?

Answer 38

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

Question 39

What is the main system controlling long term BP?

Answer 39

The Renin-Angiotensin-Aldosterone System (RAAS)

Question 40

What stimulates the RAAS

Answer 40

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

Question 41

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

Answer 41

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

Question 42

What does angiotensin II do?

Answer 42

Stimulates ADH & Aldosterone release Stimulates Na+ reabsorption Causes Vasoconstriction

Question 43

What does aldosterone do?

Answer 43

Stimulates Na+ Reabsorption

Question 44

What does ADH do?

Answer 44

Increases thirst and the water permeability of the collecting duct

Question 45

How could angiotensin II actually contribute to hypertension?

Answer 45

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

Question 46

What is GRA?

Answer 46

Glucocorticoid Remediable Aldosteronism An autosomal Dominant inherited condition Increases aldosterone secretion due to the aldosterone synthase enzyme becoming sensitive to ACTH for some reason.