Essential Hypertension Flashcards
Define essential HTN
BP >140/>90 with no secondary cause identified
2 factors that determine BP
- Sympathetic NS
- Renin-angiotension-aldosterone system
- Plasma volume (mediated mainly by the kidneys)
Pathogenesis of essential HTN
- Numerous genetic and environmental factors
- Mainly determined by the CVS and renal system
Risk factors for essential HTN
- Age (increases with age)
- Obesity
- Family history
- Race
- Reduced nephron number
- High sodium diet
- Excessive alcohol intake
- Physical inactivity
Influence of family history of HTN
- 2x more common in patient with 1 or 2 HTN parents
- Genetic factors account for approx. 30% of variation in BP
Effect of race on HTN
Black people
- More common, more severe, occurs earlier in life, greater organ damage
What can cause reduced nephron numbers
- Genetic factors
- Intrauterine development disturbances
- Premature birth
- Postnatal environment = infection and malnutrition
Epidemiology HTN
- 1 billion people worldwide
- Increasing prevalence - especially in developing countries
- M > F before 45 years old
- F > M after 65 years old
- Prevalence highest in black populations
Non-pharmalogical management of HTN
- Dietary salt restriction
- Potassium supplementation (no CKD)
- Weight loss
- Limit alcohol intake
Pharmalogical management of HTN
- Thiazide diuretic
- Long-acting calcium channel blocker
- ACE inhibitor
- Angiotensin 2 receptor blocker (ARB)
- Combination therapy
What is resistant HTN
BP that is not controlled to goal despite adherence to an appropriate regimen of 3 antihypertensive drugs of different classes (include a diuretic)
What is pseudoresistant HTN
Another problem, such as inaccurate measurement or poor adherence, is causing HTN that appears resistant
What classifies a hypertensive emergency
DBP >120 and evidence of acute end-organ damage
Complications of HTN
- LV hypertrophy
- Heart failure (both reduced EF and preserved EF)
- Ischaemic stroke
- Intracerebral haemorrhage
- Ischaemic heart disease
- Chronic kidney disease and end-stage kidney disease/failure
Medications that cause secondary HTN
- Oral contraceptives (esp. oestrogen containing drugs)
- Chronic NSAID use
- Antidepressants (TCA and SSRIs)
- Corticosteroids
- Decongestants (eg. phenylephrine and pseudoephedrine)
- Some weight loss drugs
