CVD - Hypertension

Question 1

What do I need to know about hypertension?

Answer 1

• Hypertension, above all, works silently. It is normally asymptomatic.
• Key tool of identification is the sphygmomanometer or blood pressure meter

Mechanisms of hypertension:
The relevant physiological mechanisms, damage or disruption to which cause hypertension, are:
* Cardiac output - might be elevated
* Peripheral resistance - increases
* Autonomic nervous system
* Renin-angiotensin system
They are all trying to normalise blood pressure but actually elevating it

Systolic and diastolic pressure:
* Systolic pressure – (top number) represents arterial pressure during systole (ventricular contraction)
* Diastolic pressure – (bottom number) represents arterial pressure during diastole (ventricular relaxation)
A normal blood pressure – 120/80”

Question 2

What is hypertension?

Answer 2

Primary (Essential) Hypertension
* Approximately 90% of all cases of hypertension are classed as essential hypertension
* There is no identifiable cause of the elevation in blood pressure
* Atherosclerosis may be a contributory risk factor

Secondary Hypertension
The remaining 10% of cases of hypertension can be linked to an underlying condition
Conditions and medications which can
contribute to hypertension include:
* Kidney disease
* Thyroid disorders
* Adrenal tumours
* Illegal drug use (amphetamines, cocaine)
* Oral contraceptive pill
* Congenital heart defects

Question 3

What are the signs and symptoms of hypertension? What are the potential complications?

Answer 3

Signs and symptoms
* Mostly silent, asymptomatic
* Occasionally headaches and
nosebleeds if hypertension severe

Complications – we have looked at the impacts on a diverse range of organs including kidneys,
brain and eyes.
* Left Ventricular Hyrotrophy (larger left heart), heart failure, angina, MI (mycaridal infarction/ heart attack), stroke
* Kidney failure
* Vascular dementia
* Retinopathy, and claudication (pain in legs etc)

Question 4

What likely causes hypertension?

Answer 4

Aetiology
* In cases of essential hypertension, potentially genetic factors combine with increased
sympathetic nervous system stimulation
* In secondary hypertension, development is linked to the structures involved in the underlying condition, for example renal artery stenosis

Risk factors
* Age
* Race
* Family history
* Sedentary lifestyle
* Smoking
* High salt, low potassium
* Alcohol
* Stress
* Pre-existing conditions
* Pregnancy

Question 5

What is the pathophysiology of hypertension?

Answer 5

Hypertension and its impact on other organs
Changes in cardiovascular structure and function
Damage to kidney vasculature
Reduction in blood flow to the brain
Damage to peripheral and ocular vasculature

Question 6

What are the key diagnostic tests for hypertension?

Answer 6

Diagnosis
* Perhaps the most straightforward diagnostic investigation in our clinical toolkit
* Taking the blood pressure and arriving at a consistent reading of 140/90 (additionally using
home blood pressure monitoring if it is suspected the patient is anxious in the clinic setting, ‘white coat hypertension’) permits a diagnosis of hypertension
* Investigations for target organ damage and assessment using a cardiovascular risk tool (QRISK is widely used – https://www.qrisk.org) are recommended

Question 7

What are the convential treatments for hypertension? How can herbs help?

Answer 7

Conventional treatment
* Lifestyle recommendations
* ACE inhibitors
* Angiotensin receptor blockers
* Calcium channel blockers
* Beta blockers
* Diuretics

What side effects might need to be
considered in a patient taking these
medications?

Question 8

How do you recognise hypotension?

Answer 8

There is no specific measure, as in hypertension, that is diagnostic of hypotension, rather it is a lower than normal reading for the individual patient combined with relevant signs and symptoms.

Signs and symptoms:

**Key elements of pathophysiology **
The combination of cardiac output and vascular resistance generates individual blood pressure, therefore factors impairing these elements may cause hypotension. These factors include:
* Hypovolaemia (reduced circulating blood volume, due to fluid loss or inadequate fluid intake
* Impairment of peripheral vasoconstriction
* Cardiac filling is obstructed and so output is reduced
* Cardiac output is reduced due to dysfunction of the pumping mechanism of the heart