CBM - Chronic Disease

Question 1

Hypertension: a very basic introduction

Answer 1

• Hypertension is one of the most common medical conditions encountered in the developed world.
• Whilst there is a degree of normal variation in blood pressure according to the time of day and whether we are exerting ourselves hypertension describes a chronically raised blood pressure.
• The main relevance of hypertension lies in the fact that it is an important risk factor for the development of cardiovascular disease such as ischaemic heart disease and stroke.
• Unless the blood pressure is very high it is unusual for patients to experience any symptoms

Question 2

Hypertension: a very basic introduction

Answer 2

Normal blood pressure can vary widely according to age, gender and individual physiology.

• Most healthy people have a blood pressure between 90/60 mmHg and 140/90 mmHg.

NICE define hypertension as follows:

• a clinic reading persistently above >= 140/90 mmHg, or:
• a 24 hour blood pressure average reading >= 135/85 mmHg

Why do some patients have an elevated blood pressure? Patients with hypertension may be divided into two categories.

The vast majority (around 90-95%) have primary, or essential hypertension.

This is where there is no single disease causing the rise in blood pressure but rather a series of complex physiological changes which occur as we get older

Question 3

Secondary

Hypertension

Answer 3

• Patients with hypertension may be divided into two categories.
• The vast majority (around 90-95%) have primary, or essential hypertension.
• This is where there is no single disease causing the rise in blood pressure but rather a series of complex physiological changes which occur as we get older.
• Secondary hypertension may be caused by a wide variety of endocrine, renal and other causes.
• The table below lists some of the conditions that may cause secondary hypertension

Question 4

Hypertension

Signs and Symptoms

Answer 4

As mentioned earlier, hypertension does not typically cause symptoms unless it is very high, for example > 200/120 mmHg. If very raised patients may experience:

• Headaches
• visual disturbance
• seizures

Question 5

Hypertension

Management

Answer 5

It also also important when assessing a patient with newly diagnosed hypertension to ensure they do not have any end-organ damage:

• fundoscopy: to check for hypertensive retinopathy
• urine dipstick: to check for renal disease, either as a cause or consequence of hypertension
• ECG: to check for left ventricular hypertrophy or ischaemic heart disease

Question 6

Hypertension

Drugs

Answer 6

Question 7

Acute coronary syndrome: Ischaemic heart disease

Answer 7

Acute coronary syndrome (ACS) is an umbrella term covering a number of acute presentations of ischaemic heart disease.

It covers a number of presentations, including:

• ST elevation myocardial infarction (STEMI)
• non-ST elevation myocardial infarction (NSTEMI)
• unstable angina

ACS generally develops in patients who have ischaemic heart disease, either known or previously undetected. Ischaemic heart disease is a term synonymous with coronary heart disease and coronary artery disease. It describes the gradually build up of fatty plaques within the walls of the coronary arteries.

This leads to two main problems:

• Gradual narrowing, resulting in less blood and therefore oxygen reaching the myocardium at times of increased demand. This results in angina, i.e. chest pain due to insufficient oxygen reaching the myocardium during exertion
• The risk of sudden plaque rupture. The fatty plaques which have built up in the endothelium may rupture leading to sudden occlusion of the artery. This can result in no blood/oxygen reaching the area of myocardium