B.3 Hypertension

Question 1

What is blood pressure?

Answer 1

The force exerted by the heart through the arteries (driving force for blood to flow)

Question 2

What is systolic blood pressure?

Answer 2

The upper value as ventricles are contracting (pressure of arterials when ventricles contract)

Question 3

What is diastolic blood pressure?

Answer 3

The lower value as ventricles are not contracting but fill

pressure of arterioles when the ventricles are relaxed

Question 4

What is the mean arterial pressure equal to?

Answer 4

Diastolic +1/3 pulse pressure

Question 5

What is the pulse pressure?

Answer 5

The difference between systolic and diastolic pressure

Question 6

What is the standard physicological blood pressure for healthy people (and for young people)

Answer 6

Healthy people: 120/80mmHg

Healthy young people: 100/60 mmHg

Question 7

What is the blood pressure for prehypertensive patients?

Answer 7

120-139/80-89mmHg

Question 8

What is blood pressure equal to?

Answer 8

Cardiac output x TPR (total peripheral resistance)

Question 9

What is cardiac output?

Answer 9

The volume of blood pumped per unit time

Question 10

What is TPR?

Answer 10

Total peripheral resistance is the resistance to blood flow which is posed by the arterial circulation. (the resistance of the arteries to blood flow)

Question 11

How does sympathetic activity affect CO and TPR?

Answer 11

Acts on the heart to speed up the force of contraction

Increases TPR via vasoconstriction.

More minute to minute regulation

Question 12

Blood regulation induced by sympathetic activity is affected minute to minute. True or false?

Answer 12

True

Question 13

What organ regulates blood flow on a more long term level?

Answer 13

Kidney

Question 14

What is the traditional approach to measuring a patient’s blood pressure?

Answer 14

Sphygmomanometer with auscultation

Question 15

What part of the arm is the radial pressure and the brachial pressure found?

Answer 15

Radial artery: wrist

Brachial artery: Inside the elbow

Question 16

What happens to blood flow when the pressure in the cuff is less than the systolic pressure?

Answer 16

Blood will flow

Question 17

What happens to blood flow when the pressure in the cuff is greater than the systolic pressure?

Answer 17

Blood will not flow

Question 18

At what height should the Cluff be placed on the arm and why?

Answer 18

Height of heart so that arterial pressure is central pressure

Question 19

What happens if the cuff is placed above or below the required height?

Answer 19

The hydrostatic effect is experienced

Question 20

What will happen if the pressure in the cuff is between systolic and diastolic pressure?

Answer 20

Turbulent flow of blood

Question 21

When will you hear korotkoff sounds?

Answer 21

When the pressure in the cuff is equal to systolic pressure

when the cuff pressure is equal to diastolic pressure then sounds will disappear

Question 22

How many phases are there in korotkoff sounds and what are the sounds generated by?

Answer 22

5 phases generated by turbulent flow

Question 23

What is phase one, 4, and 5?

Answer 23

One: cuff= systolic then tapping
Four: muffling (just above diastole)
Five:
Cuff+ diastolic then sounds disappear

Question 24

What is white coat hypertension?

Answer 24

Hypertension induced by the stress of visiting the GP leading to false diagnosis (home monitoring and ambulatory devices used for a more realistic picture)

Question 25

What is essential (primary) hypertension?

Answer 25

Where the cause of hypertension is not known but may be multifactorial

(blood pressure associated with significant cardiovascular risk)

Question 26

What factors could be multifactorial for essential hypertension

Answer 26

Obesity
Insulin resistance 
Excessive alcohol consumption 
Genetics 
Environment 
Low birth weight 
Salt sensitivity 
age 
Ethnicity

Question 27

What is isolated systolic hypertension?

Answer 27

Increase in systolic BP with normal diastolic

Associated with age and aorta becomes stiffer (less recoil)

Question 28

What is the theory of the development of hypertension?

Answer 28

Raise in pressure:
- Fluid overload
- Increase RAAS
- Vasoconstriction 
Endothelial dysfunction

This leads to an adaptive change:
Remodeling of blood vessels
-Hypertrophy (more muscle) of small arteries to protect capillaries

This leads to an:

• Increased vascular resistance
• Increased reactivity of arteries
• Maintains high blood pressure

Question 29

What is secondary hypertension and what can it be due to?

Answer 29

Raised blood pressure due to another disease:

• renal disease
• renovascular disease
• conns syndrome
• cushioning syndrome
• hyperthyroidism
• phaeochromaocytoma
• pregnancy
• drugs

Question 30

What are the consquences of hypertention?

Answer 30

The risk of CVD doubles for every 20/100mmHg increase from 115/75mmHg

• Left ventricular hypertrophy (IHD)
• Increased risk of myocardial infarction
• Increased risk of stroke
• Development of renal impairment
• Development of chronic heart failure

Question 31

What are the goals of treatment for hypertension?

Answer 31

A reduction of blood pressure and when this involves drug treatment, this should be with as few side effects as possible.

• reduction in cardiovascular damage
  preservation of renal function
  limitation or reverse of left ventricular hypertrophy
  prevention of IDH
  reduction in mortality due to stroke and MIs.