CVS: HTN

Question 1

Outline the pathophysiology of HTN

Answer 1

Isolated systolic HTN = stiffening of the large arteries

Accelerated phase HTN = rapid rise in BP leading to vascular damage

Secondary HTN

o Renal disease = incorrect fluid balance

o Endocrine disease = incorrect hormonal balance, effecting fluid balance

Question 2

Outline the aetiology of HTN

Answer 2

Arteriosclerosis

Renal disease = glomerulonephritis, pyelonephritis, polycystic kidneys, atheromatous renovascular disease

Endocrine disease = Cushing’s, conns

Coarctation

Steroid use

Pregnancy

Question 3

What are the signs and symptoms of HTN

Answer 3

Asymptomatic

Retinopathy

Signs of renal disease

Radiofemoral delay

Weak femoral pulses

Renal bruits

Palpable kidneys

Cushing’s syndrome

Proteinuria

Question 4

How would you investigate HTN

Answer 4

Bloods = fasting glucose, cholesterol (assess overall risk), U+Es, Ca

HCG = pregnancy

ECG = LVH, past MI

Urine analysis = proteinuria

Renal US, arteriogram

24h BP monitoring

Question 5

How would you manage HTN

Answer 5

• Weight loss and a low-fat diet
• Smoking cessation
• Reduce alcohol intake
• Reduce salt in diet
• Increase exercise

(Treat <80yrs with 140/90 with at least 1 organ involvement, treat ALL those with >160/100) A B C D =

ACEi = ramipril, lisinopril

• SE = cough, increased K, renal failure

Beta blocker = bisoprolol

• SE = bronchospasm, HF, cold peripheries

Ca channel blocker = amlodipine

• SE = flushes, fatigue, gum hyperplasia, ankle oedema

Diuretic = Bendroflumethiazide

Question 6

What are the complications of HTN

Answer 6

CKD

MI

Stroke

Aneurysm