Aetiology & Pathology of Hypertension Flashcards
Summarise end-organ damage complications of hypertension?
Brain - Haemorrhage, Stroke, Cognitive Decline Heart - LVH, CHD, CHF, MI Vessels - Renal Failure, Kidneys - Peripheral vascular disease Eyes - Retinopathy
How does higher BP affect risk of stroke and coronary heart disease?
A rises BP causes stroke risk to rise exponentially, CHD risk rises more linearly
Whats the difference in the risk of ischaemic heart disease between the old and young?
The old have a much higher baseline risk
However the risk rises faster for younger people as BP increases
At what BP does hypertension start?
140/90, however a healthy BP is more like 120/80
What is ABPM?
Ambulatory Blood Pressure Monitor
What defines stage 1 hypertension?
A Clinical BP of 140/90 or above
An ABPM daytime average of 135/85 or higher
What makes you stage 2 hypertension?
A clinical BP of 160/100
An ABPM daytime average of 150/95
What makes you stage 3 hypertension?
A clinical systolic BP of 180 or Diastolic of 110
Where is the closest correlation in hypertension risk within a family?
Between siblings, particularly monozygotic twins
What environmental factors affect hypertension?
Diet
Oral Contraceptives
Exercise
Stress
How do genetics affect hypertension?
Major genes and polygenes increase BP
History of hypertension tends to run in families
How does race affect hypertension?
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
How does stress lead to chronic hypertension?
Stress causes acute hypertension
If you spend a lot of time stressed the hypertension damages your vessels and kidneys leading to chronic hypertension
What are the main dietary influences on hypertension?
Salt intake and alcohol
How does alcohol affect hypertension?
Giving up alcohol reduces BP in a matter of weeks but only by a small amounnt (5/3mmHg ish)
How does salt intake influence hypertensives?
Reducing salt intake lowers the BP of hypertensives.
We should aim for 6g/day, 1.5g/day or even 0.5g/day
How important is weight loss in controlling hypertension?
Weight loss is the best non-pharmacological way to reduce BP, an otherwise untreated obese hypertensive could drop 19/18mmHg by losing weight.
How does birth weight affect development of hypertension later in life?
A low birth weight is strongly associated with the development of hypertension in later life.
Something to do with in-utero malnutrition.
How many cases are secondary?
5-10%
Why does removing the cause of secondary hypertension not always remove the hypertension?
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
How can we detect coarctation of the aorta during an examination?
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.
What is responsible for second to second control of BP?
The sympathetic Nervous System through vasoconstriction, tachycardia and altered contractility.
What is the main system controlling long term BP?
The Renin-Angiotensin-Aldosterone System (RAAS)
What stimulates the RAAS
Falls in BP
Falls in Blood Volume
Falls in Blood Na+
