Essential or secondary hypertension

Question 1

Give the broad definition of hypertension:

Answer 1

the persistent evaluation of blood pressure in the systemic arterial circulation

Question 2

In which ethnic groups is hypertension most common?

Answer 2

black African and African Caribbean

Question 3

Why is it that women have a lower blood pressure at all ages until menopause?

Answer 3

female sex hormones protect against raised blood pressure

Question 4

What is systolic blood pressure?

Answer 4

the peak arterial pressure during cardiac contraction

Question 5

What is diastolic blood pressure?

Answer 5

the lowest arterial pressure during cardiac relaxation

Question 6

Describe how blood pressure should be taken in clinical practice (2):

Answer 6

1) take after 5 minutes of uninterrupted rest with the back supported and legs uncrossed
2) you should take 2 or more subsequent BP readings and calculate the mean or take the lowest of them

Question 7

What is an ambulatory measure of blood pressure?

Answer 7

portable device that measures BP across 24 hour periods often at 30 minute intervals, giving a broader average

Question 8

What is combined hypertension?

Answer 8

where both systolic and diastolic blood pressure are elevated

Question 9

What is isolated systolic hypertension:

Answer 9

where systolic blood pressure is elevated but diastolic blood pressure is decreased

Question 10

What is orthostatic hypertension?

Answer 10

a sustained fall in blood pressure within 3 minutes of assuming an upright position of more than 20mmHg systolic or 10mmHg diastolic

Question 11

What is primary hypertension?

Answer 11

raised blood pressure with no singular identifiable cause (90% of hypertension cases)

Question 12

What is secondary hypertension?

Answer 12

Elevated BP with a specific cause

Question 13

Give the equation for blood pressure:

Answer 13

BP=CO x TPR

Question 14

What is resistant hypertension?

Answer 14

uncontrolled blood pressure despite the use of at least three separate antihypertensives

Question 15

Give 4 lifestyle causes of hypertension:

Answer 15

1. High salt intake
2. Lack of exercise
3. Alcohol
4. recreational drug use

Question 16

Name 3 drugs that can cause hypertension:

Answer 16

1) oral contraceptive pill
2) NSAIDs
3) corticosteroids

Question 17

Name 4 causes of secondary hypertension using ROPE:

Answer 17

1) R: renal disease (increase in circulatory volume)
2) O: obesity
3) P: pregnancy
4) E: endocrine disorders

Question 18

Name and explain 4 endocrine causes of hypertension:

Answer 18

1. Hyperaldosteronism (increases salt and water retention)
2. Pheochromocytoma (increased adrenaline increases BP)
3. Cushing’s syndrome (cortisol increased blood glucose which increases the circulatory volume
4. Acromegaly - growth hormone increases blood glucose which increases circulatory volume

Question 19

What is pre-eclampsia?

Answer 19

pregnancy-induced hypertension with the presence of proteinuria

Question 20

what are 2 symptoms of pre-eclampsia?

Answer 20

1. Seizures
2. Pitting oedema

Question 21

Name 5 groups of anti-hypertensive drugs:

Answer 21

1) ACE inhibitors
2) angiotensin II receptor blockers
3) beta blockers
4) calcium channel blockers
5) diuretics

Question 22

Give an example of a thiazide diuretic:

Answer 22

indapamid

Question 23

Give an example of a potassium sparing diuretic:

Answer 23

Spironolactone

Question 24

How do beta blockers reduce BP?

Answer 24

They stimulate vasodilation through renin inhibition

Question 25

How do calcium channel blockers help reduce BP?

Answer 25

they stimulate peripheral vasodilation

Question 26

Give two examples of calcium channel blockers:

Answer 26

1. Amlodipine
2. verapamil

Question 27

How do ARBs and ACEi help to reduce BP?

Answer 27

they reduce angiotensin II mediated vasoconstriction

Question 28

Give an example of an angiotensin II receptor blocker:

Answer 28

losartan

Question 29

Define essential hypertension:

Answer 29

blood pressure of >140/90mmHg with no secondary cause identified

Question 30

What blood pressure reading is considered ‘severe’ hypertension?

Answer 30

180/110mmHg

Question 31

what is malignant hypertension?

Answer 31

Short onset hypertension with a systolic pressure over approx 180mmHg

Question 32

Name 5 symptoms of malignant hypertension?

Answer 32

1. Headache
2. Visual disturbances
3. Sweating
4. Palpitations
5. Symptoms of end organ damage

Question 33

Describe a histological finding associated with malignant hypertension:

Answer 33

fibrinoid necrosis in blood vessels

Question 34

Give 6 retinal signs of hypertension that may be seen during fundoscopy:

Answer 34

1) arteriolar narrowing
2) haemorrhages (blot, dot and flame)
3) microaneurysm
4) cotton wool spots (white patches)
5) hard exudate
6) papilledema (swelling of optic disc)

Question 35

Give a common cardiac manifestation of hypertension:

Answer 35

left ventricular hypertrophy

Question 36

How may left ventricular hypertrophy be identified upon palpation?

Answer 36

thrusting apex beat

Question 37

Give 2 investigations for hypertensive kidney disease:

Answer 37

1) GFR
2) dip stick albumin

Question 38

Give 5 lifestyle changes that can help reduce blood pressure:

Answer 38

1) regular cardiovascular exercise
2) increased intake of fruits and vegetables and reduced intake of saturated fat
3) reduced alcohol intake
4) weight reduction
5) reducing dietary salt intake

Question 39

Which anti-hypertensive drug are those 55+ or black African patients started on?

Answer 39

calcium channel blockers

Question 40

What anti-hypertensive drug are those younger than 55 started on?

Answer 40

ACEi or ARBs

Question 41

What is classified as hypertensive?

Answer 41

BP >140 systolic or >90 diastolic.

Question 42

What is mild hypertension?

Answer 42

Mild – >140 systolic or >90 diastolic

Question 43

What is moderate hypertension?

Answer 43

Moderate – >160 systolic or >100 diastolic

Question 44

What is severe hypertension?

Answer 44

180 systolic or >110 diastolic