Arterial/Systemic Hypertension (HBP) Flashcards

1
Q

Hence at what BP level do we say there is hypertension?
• Geoffrey Rose defined hypertension as a BP level ___________________________________________________ .

A

above which investigation and treatment will do more good than harm

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2
Q

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

A

140;90

130;80

135;85

130;80

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3
Q

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%

A

4; 5

black

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4
Q

Aetiology and types of
Hypertension
1. _________ hypertension (__________ hypertension)
2.__________ hypertension

A

Primary hypertension (essential hypertension)
2.Secondary hypertension

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5
Q

Aetiology and types of
Hypertension
1. Primary hypertension
•accounts for _____% of cases:
•___________ cause
• Genetic predisposition and interplay with environmental factors/risk factors

A

95; no definite

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6
Q

Primary hypertension

Examples of environmental/risk factors: A. ______________ : _____,_______,_____
B._________________

A

Non modifiable
- Aging
- Male gender
- Ethnicity/race

Modifiable

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7
Q

Secondary hypertension
-accounts for about ____% of cases
- specific cause can be identified and is usually a complication of other conditions:

A

5

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8
Q

Secondary hypertension

Kidney diseases

List 6

A

-Acute glomerulonephritis.
-Chronic nephritis.
- Polycystic disease.
- Diabetic nephropathy.
- Hydronephrosis.
- Renal artery stenosis.

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9
Q

Secondary hypertension

Endocrine disorders

List 6

A

-pheochromocytoma
-Cushing syndrome
-congenital adrenal hyperplasia -hyperthyroidism
-hyperparathyroidism
-obesity

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10
Q

Pregnancy can cause secondary hypertension

T/F

A

T

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11
Q

Mechanism of Hypertension
• normal BP is dependent on the balance between _______________ and ___________.
BP =_____ x ______.

A

cardiac output (CO) and peripheral vascular resistance (PVR)

CO ; PVR

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12
Q

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

A

renal, neural, endocrine and vascular

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13
Q

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.

A

natriuresis

renin– angiotensin (RAS)

renal blood flow

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14
Q

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]

A

Structural and functional

arterial stiffening

total peripheral resistance

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15
Q

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)

A

Sympathetic

venous capacitance

renal sodium and water excretion

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16
Q

Mechanism of Hypertension
• Excess production of _____________ as in primary hyperaldosteronism
• Excess ______________ as in pheochromocytoma
•—————- hormone in thyrotoxicosis
•______________ in Cushing syndrome

A

mineralocorticoids

catecholamines

Thyroid

Glucocorticoids

17
Q

Mechanism of Hypertension
• Excess production of mineralocorticoids as in ___________________
• Excess catecholamines as in ________________
• Thyroid hormone in _____________
• Glucocorticoids in _________________

A

primary hyperaldosteronism

pheochromocytoma

thyrotoxicosis

Cushing syndrome

18
Q

Mechanism of Hypertension
Other mechanisms:
• Low birth weight (_____________________)
• Acute and chronic _______
• ___________

A

Barker’s hypothesis

Stress

Obesity

19
Q

Diagnosing Hypertension
• BP must be measured according to protocol.
• Measure in sitting, standing and lying positions.
• Use _________ at first visit and use the arm with ___________________ subsequently
• Elevated BP must be documented on at least _______ different occasions __________ apart.
• BP recording of ≥______/_____mmHg can be taken as hypertension.
• Screen for other CV risk factors – dysglycaemia, obesity, dyslipidaemia, (Hypertension as a

A

both arms ; higher measure

three; 1 to 4 weeks

180; 110

20
Q

Definition of common terms

• Severe hypertension – BP ≥ _____/____mmHg or ≥ _____/____mmHg

• Malignant hypertension- Markedly elevated BP > _____/____mmHg, with evidence of __________________________.

A

BP ≥ 180/110mmHg or ≥ 160/100mmHg

BP > 180/120mmHg ; acute progressive multi-organ damage.

21
Q

Accelerated hypertension –_______ significant (gradual or rapid?) increase over baseline BP that is associated with ______________

A

recent

rapid

target organ damage.