Cardiovascular: Hypertension

Question 1

What are the readings for hypertension?

Answer 1

140/90 mmHg

140 - systolic
90 - diastolic

Question 2

What is normal blood pressure?

Answer 2

120/80 mmHg

Question 3

How is blood pressure measured?

Answer 3

Rest for 15 mins then take 3 readings whilst the patient is seated.

Question 4

What are the risk factors for hypertension?

Answer 4

Age 
Race 
Obesity 
Alcohol
Family history
stress 
Medication

Question 5

What medication increases the risk for hypertension?

Answer 5

Oral contraceptive
Corticosteroids
NSAIDS

Question 6

What are the consequences of hypertension?

Answer 6

Accelerated atherosclerosis;
leads to acute coronary syndromes
i.e. angina, MI or stroke etc.

Renal failure

Question 7

What causes hypertension?

Answer 7

High risk factors (e.g. alcohol consumption and obesity) paired with genetic predisposition.

Question 8

What are rare triggers for hypertension? i.e Why would an individual with low risk factors get hypertension?

Answer 8

Renal artery stenosis

Endocrine tumours

Question 9

Describe what occurs in renal artery stenosis that causes hypertension.

Answer 9

Narrowing of the renal artery usually by atherosclerosis (commonly occurs at junctions with turbulent blood flow) makes the kidney think that blood pressure has fallen.

To compensate for this, the kidney employs measures to increases salt and water retention to counteract the false fall in blood pressure.

This can lead to a reduction in size of the kidney.

Question 10

What are the signs and symptoms of hypertension?

Answer 10

Commonly none!

Headaches - when blood pressure is severely high.

Transiet ischaemic attacks/’mini strokes’ - caused by the accelerated atherosclerosis that comes alongside hypertension.

Question 11

When should there be further investigations in a patient with hypertension?

Answer 11

Young patient

Resistant hypertension - blood pressure remains high despite medication being taken and the risk factors being lowered.

Accelerated hypertension

Unusual history.

Question 12

How is hypertension treated?

Answer 12

Modifying risk factors - via lifestyle changes:
Reduce alcohol consumption
Dietary restrictions

Single daily drug dose - aids compliance as 1 drug is easy to remember to take.

Question 13

What drugs are used to treat hypertension?

Answer 13

Thiazide diuretics: e.g. bendroflumethiazide
Increase salt and water loss, reduce plasma volume. (reducing circulating volume and therefore BP)

ACE Inhibitors: e.g. Enalapril
Prevent vasoconstriction by inhibiting the conversion of angiotensin 1 to angiotensin 2.

Ca channel blockers: e.g. amlodipine
Relax smooth muscle = vasodilation.

Beta blockers: e.g. atenolol
Reduce force of contraction and excitability of heart muscle.