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Cardiology > Aetiology & Pathology of Hypertension > Flashcards

Aetiology & Pathology of Hypertension Flashcards

1
Q

Summarise 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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2
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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3
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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4
Q

At what BP does hypertension start?

A

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

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5
Q

What is ABPM?

A

Ambulatory Blood Pressure Monitor

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6
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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7
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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8
Q

What makes you stage 3 hypertension?

A

A clinical systolic BP of 180 or Diastolic of 110

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9
Q

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

A

Between siblings, particularly monozygotic twins

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10
Q

What environmental factors affect hypertension?

A

Diet
Oral Contraceptives
Exercise
Stress

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11
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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12
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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13
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

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14
Q

What are the main dietary influences on hypertension?

A

Salt intake and alcohol

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15
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)

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16
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

17
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.

18
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.

19
Q

How many cases are secondary?

A

5-10%

20
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

21
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.

22
Q

What is responsible for second to second control of BP?

A

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

23
Q

What is the main system controlling long term BP?

A

The Renin-Angiotensin-Aldosterone System (RAAS)

24
Q

What stimulates the RAAS

A

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

25
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

26
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.

27
Q

2 investigations to diagnose HBP

A

Ambulatory Blood Pressure Monitoring, automatically takes BP every 1/2 hour
Home Blood Pressure Monitoring, the patient has to take it themselves a few times a day

28
Q

What happens to BP at night?

A

It should always dip a little lower than daytime.

29
Q

What are the main risk factors that compound hypertension? [5]

A 
Any previous MI, Stroke or IHD
Smoking
Diabetes Mellitus
Hypercholesterolaemia
Family History of Heart Disease`
30
Q

How do we assess the level of end-organ damage caused by hypertension? [5]

A

ECG + ECHO —-> LVH
ACR —-> Proteinuria —> Renal Disease
Renal Ultrasound + eGFR —> Renal Disease
Fundoscopy > papilloedema

31
Q

What is an ACR test?

A

A urine albumin to creatine ratio

Cardiology (29 decks)

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