Aetiology, Pathophysiology and Treatment of Hypertension

Question 1

Give 3 possible complications in the brain caused by hypertension

Answer 1

• haemorrhage
• stroke
• cognitive decline

Question 2

Give 4 possible complications in the kidneys caused by hypertension

Answer 2

• renal failure
• dialysis
• transplantation
• proteinuria

Question 3

Give 4 possible complications in the heart caused by hypertension

Answer 3

• left ventricular hypertrophy
• coronary heart disease
• congestive heart failure
• myocardial infarction

Question 4

Give two other examples of end organ damage caused by hypertension other than the brain, heart and kidneys.

Answer 4

• retinopathy

- peripheral vascular disease

Question 5

What two forms of stress can cause wide fluctuations in blood pressure during the day?

Answer 5

Physical and mental stress

Question 6

According to the Framingham Study, increasing blood pressure is associated with a progressive increase in the risk of

Answer 6

stroke and cardiovascular disease

Question 7

Does the risk of stroke and cardiovascular disease rise exponentially or linearly with blood pressure?

Answer 7

Exponentially

Question 8

At what blood pressure is a patient hypertensive?

Answer 8

140/90 mmHg

Question 9

What is the optimum blood pressure?

Answer 9

120/80 mmHg

Question 10

What are the stages of hypertension?

Answer 10

• stage one hypertension
• stage two hypertension
• severe hypertension

Question 11

Are most cases of hypertension primary or secondary hypertension?

Answer 11

Primary hypertension

Question 12

What is primary hypertension?

Answer 12

Hypertension in which no cause can be found

Question 13

Give 3 examples of causes of secondary hypertension

Answer 13

• chronic renal disease
• renal artery stenosis
• endocrine diseases (e.g. Cushing’s, Conn’s syndrome, Phaeochromocytoma, GRA)

Question 14

Give 3 factors that increase the risk from hypertension

Answer 14

• cigarette smoking
• diabetes mellitus
• renal disease
• males
• hyperlipidaemia
• previous MI/stroke
• left ventricular hypertrophy

Question 15

What are the prime contributors to blood pressure?

Answer 15

• Cardiac output - SV, HR

- Peripheral vascular resistance

Question 16

What effects are produced by the sympathetic nervous system which increase blood pressure?

Answer 16

• vasoconstriction
• reflex tachycardia
• increased cardiac output

Question 17

The actions of the sympathetic system are rapid and account for second to second

Answer 17

blood pressure control

Question 18

The renin-angiotensin-aldosterone system (RAAS) is pivotal in long term BP control and is responsible for

Answer 18

• maintenance of sodium balance
• control of blood volume
• control of blood pressure

Question 19

Give 3 factors which stimulate the RAAS

Answer 19

• fall in blood pressure
• fall in circulating volume
• sodium depletion

Question 20

What component of the RAAS is a potent anti-natriuretic peptide and stimulator of aldosterone release from adrenal glands?

Answer 20

Angiotensin II

Question 21

What component of the RAAS is a potent anti-natriuretic and antidiuretic peptide?

Answer 21

Aldosterone

Question 22

What component of the RAAS stimulates myocyte and smooth muscle hypertrophy in the arterioles?

Answer 22

Angiotensin II

Question 23

Give two examples of poor prognostic indicators in patients with hypertension

Answer 23

Myocyte and smooth muscle hypertrophy

Question 24

What two systems are key targets in the treatment of hypertension?

Answer 24

• RAAS

- Sympathetic nervous system

Question 25

The aetiology of hypertension is

Answer 25

• polygenic

- polyfactorial

Question 26

A likely cause of hypertension is increased reactivity of resistance vessels and resultant increase in peripheral resistance as a result of

Answer 26

a hereditary defect of the smooth muscle lining arterioles

Question 27

What occurs when the kidneys are unable to excrete the appropriate amounts of sodium for any given blood pressure?

Answer 27

Sodium and fluid are retained and blood pressure increases

Question 28

As age increases, blood pressure tends to

Answer 28

increase

Question 29

Hypertension in the elderly should be treated

Answer 29

aggressively

Question 30

Treating both diastolic and systolic hypertension in the elderly significantly reduces the risk/occurrence of

Answer 30

stroke/MI

Question 31

Mental/physical stress can cause blood pressure to rise, however, if the stress occurred over long periods of time removing the stress will not necessarily

Answer 31

return blood pressure to normal values

Question 32

What effect will reducing salt intake have in hypertensives?

Answer 32

Blood pressure will decrease

Question 33

What effect will small amounts of alcohol have on blood pressure?

Answer 33

Decrease blood pressure

Question 34

What effect will large amounts of alcohol have on blood pressure?

Answer 34

Increase blood pressure

Question 35

What effect will weight loss in an obese patient have on their blood pressure?

Answer 35

Blood pressure will decrease

Question 36

What effect will significant weight loss have on blood pressure?

Answer 36

Significant decrease in blood pressure

Question 37

How does birth weight correlate with the likelihood of developing hypertension and heart disease?

Answer 37

The lower the birth weight the higher the likelihood of developing hypertension and heart disease

Question 38

Sustained hypertension produces end organ damage to

Answer 38

blood vessels, heart and kidneys

Question 39

Give 3 drug types that can cause drug induced secondary hypertension

Answer 39

• NSAIDs
• oral contraceptive pill
• corticosteroids

Question 40

What condition in pregnancy is characterised by high blood pressure?

Answer 40

Pre-eclampsia