Arterial/Systemic Hypertension (HBP) Flashcards
Hence at what BP level do we say there is hypertension?
• Geoffrey Rose defined hypertension as a BP level ___________________________________________________ .
above which investigation and treatment will do more good than harm
Definition of Hypertension Has evolved over years:
➢ JNC VII 2003, ESC-ESH 2018 and ISH 2020 : persistent elevation in clinic systolic BP ≥_____ mmHg and/or diastolic BP ≥ ____ mmHg following repeated measurement.
OR a 24-hr ABPM average of ≥ ____/____ mmHg or an HBPM average of ≥ ____/____ mmHg.
➢ ACC/AHA 2018: persistent systolic BP ≥ ____ mmHg and/or diastolic BP ≥ ____ mm Hg.
➢ JNC 8
140;90
130;80
135;85
130;80
Epidemiology of Hypertension
• 1 in ____ males and 1 in ____ females adults are affected globally
• Higher prevalence in LMIC e.g Nigeria
• Has lower age of onset and poorer prognosis in ______ race.
• In Nigeria:
-overall prevalence is 25.1 -32.8%
4; 5
black
Aetiology and types of
Hypertension
1. _________ hypertension (__________ hypertension)
2.__________ hypertension
Primary hypertension (essential hypertension)
2.Secondary hypertension
Aetiology and types of
Hypertension
1. Primary hypertension
•accounts for _____% of cases:
•___________ cause
• Genetic predisposition and interplay with environmental factors/risk factors
95; no definite
Primary hypertension
Examples of environmental/risk factors: A. ______________ : _____,_______,_____
B._________________
Non modifiable
- Aging
- Male gender
- Ethnicity/race
Modifiable
Secondary hypertension
-accounts for about ____% of cases
- specific cause can be identified and is usually a complication of other conditions:
5
Secondary hypertension
Kidney diseases
List 6
-Acute glomerulonephritis.
-Chronic nephritis.
- Polycystic disease.
- Diabetic nephropathy.
- Hydronephrosis.
- Renal artery stenosis.
Secondary hypertension
Endocrine disorders
List 6
-pheochromocytoma
-Cushing syndrome
-congenital adrenal hyperplasia -hyperthyroidism
-hyperparathyroidism
-obesity
Pregnancy can cause secondary hypertension
T/F
T
Mechanism of Hypertension
• normal BP is dependent on the balance between _______________ and ___________.
BP =_____ x ______.
cardiac output (CO) and peripheral vascular resistance (PVR)
CO ; PVR
The balance in CO and PVR is maintained by interplay of _______,_______,______, and ________ control systems.
• Derangement in any of these systems can affect cardiac and vascular homeostasis, therefore the
renal, neural, endocrine and vascular
Mechanism of Hypertension
Renal Mechanism:
• the kidney controls BP homeostasis by regulating the pressure via the _______ relationship and the activity of the ———————— system.
• Perturbation in the renal physiology induced by impaired ____________ , elevation of renal inflammation and oxidative stress burdens stimulate adaptive changes that could lead to increased BP, if sustained.
natriuresis
renin– angiotensin (RAS)
renal blood flow
Mechanism of Hypertension
Vascular mechanism:
•___________ and __________ vascular abnormalities either in the micro- or macro- circulation can lead to ______________ and increased _______________ . [increased vascular tone by sympathetic nervous system, humoral factors and local autoregulation can cause this]
Structural and functional
arterial stiffening
total peripheral resistance
Mechanism of Hypertension
Neural Mechanisms:
• _______________ activation can induce HBP by causing peripheral vasoconstriction, potentiating cardiac contraction, reducing _________, and modulating _________ and ________________. (Increased SNS activity is associated with obesity/weight gain, hyperinsulinaemia/altered glucose metabolism, and obstructive sleep apnoea)
Sympathetic
venous capacitance
renal sodium and water excretion