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CVS > CVS 14 - Hypertension > Flashcards

CVS 14 - Hypertension Flashcards

1
Q

Above which blood pressure is it considered abnormal?

A

140/90 mmHg

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2
Q

Describe how blood pressure may change with age.

A
  1. Systolic BP rises in a linear fashion.
  2. Diastolic BP plateaus and declines into old age
  3. ^This causes gap between systolic and diastolic BP to increase.
  4. Exponential risk between BP and stroke risk
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3
Q

How is hypertension classified?

A
  1. Identifiable causes - Secondary Hypertension (<5%). e.g. renal disease, tumours secreting aldosterone, oral contraceptive, etc
  2. Unidentifiable - Primary / essential (90-95%)
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4
Q

What is the most common cause of secondary hypertension?

A

Renal disease

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5
Q

Explain how genetics and environmental influences can contribute to high BP.

A

Genetics -

  1. Monogenic (rare - < 1%) -
  2. Complex polygenic

Environment -

  1. Dietary salt
  2. Obesity/overweight
  3. Alcohol
  4. Pre-natal environment
  5. Pregnancy
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6
Q

Give 2 monogenic causes of hypertension.

A
  1. Liddles Syndrome - mutation in amiloride-sensitive tubular epithelial Na channel
  2. Apparent mineralocorticoid excess - mutation in 11B-hydroxysteroid dehydrogenase
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7
Q

5 things that hypertension can be associated with.

A
  1. Increased TPR
  2. Reduced arterial compliance (higher pulse pressure) - reduced distensibility of larger arteries.
  3. Normal CO
  4. Normal blood volume/extracellular volume
  5. Central shift in blood volume
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8
Q

What are the causes of increased TPR in hypertension?

A
  1. Active narrowing of arteries (vasoconstriction)
  2. Structural narrowing of arteries (vasoconstriction followed by remodelling of arteries). Lumen of arteries gets smaller.
  3. Loss of capillaries. Rarefaction = reduction in capillary density - resistance is increased.
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9
Q

What is isolated systolic hypertension?

A
  1. Systolic BP > 140, Diastolic BP < 90.
  2. Typically occurs in people over 60, as systolic and diastolic pressures diverge.
  3. Pulse wave is reflected - it bounces off the walls of the stiffened blood vessels. The wave is greater when it reaches the brachial artery.
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10
Q

What are 3 possible causes of primary hypertension

A
  1. Kidney
  2. Sympathetic Nervous System
  3. Endocrine/paracrine factors
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11
Q

How may the kidney be the cause of hypertension?

A

The kidney exerts a major role on BP by regulating Na/H2O/ECF volume

  1. Impaired renal function / blood flow is the commonest 2dary cause of hypertension (e.g. renal parenchymal disease)
  2. Most monogenic causes of hypertension affects renal Na excretion.
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12
Q

What consequential risks can hypertension cause

A
  1. CHD
  2. Stroke
  3. Peripheral Vascular Disease
  4. Heart failure
  5. Atrial fibrillation
  6. Dementia/cognitive impairment
  7. Retinopathy
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13
Q

Hypertension can cause structural changes in the heart. How?

A

LV wall may thicken (hypertrophy) and ventricular volume may change (remodelling)

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14
Q

Describe the relationship between hypertension and congestive heart failure?

A
  1. Heart Failure = inability to adequately pump out blood at normal filling pressures.
  2. Increases risk of CHF 2/3 fold
  3. Precedes heart failure in 90% of cases.
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15
Q

Hypertension is associated with large artery hypertrophy. What else is is associated with?

A

Accelerated atherosclerosis.

Can also cause an aneurysm, which may cause a thrombosis or haemorrhage is aneurysm ruptures.

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16
Q

What are Charcot-Bouchard Aneurysms?

A

Brain vasculature aneurysms occurring in small blood vessels. Commonly associated with chronic hypertension and a common cause of cerebral haemorrhage.

17
Q

What features of microvascular damage are present on the retina in hypertensive patients?

A
  1. Thickening of wall of small arteries.
  2. Arteriolar narrowing
  3. Vasospasm
  4. Impaired perfusion
  5. Increased leakage into surrounding tissue
18
Q

Hypertension is associated with reduced capillary density and elevated capillary pressure. What can these cause.

A

Reduced capillary density = impaired perfusion and increased in PVR

Elevated capillary pressure = damage and leakage

19
Q

Renal dysfunction is common from hypertension. How can it manifest?

A

Loss of albumin in the urine (microalbuminuria and macroalbuminuria).

Kidney loses nephrons and deteriorates in function.

20
Q

What is microalbuminuria a sign of?

A

Glomerular damage

21
Q

How does GFR change with age in hypertensive patients?

A

Decline in GFR

CVS (16 decks)

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