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HTN Flashcards
In hypertension btw ischemic and hemorrhagic stroke which is more common?
Ischemic
What’s the optimal BP?
<115/75
In AHA Stage 1 is
Stage 2
130-139/ 80-89
>140/90
In Harrison’s what’s pre, stage 1and 2 hypT
Pre 120-139/80-89
Stage 1= 140-159/90-99
Stage 2 = >160/100
Automated office BP how do you use it to diagnose HTN?
Rest 5mins
Smoking and coffee = 30 min rest
Do in both hands
Take 3 readings. Discard the first then take the average of the second
If > 135/85 = HTN
Ambulatory BP monitoring
How do you diagnose with it?
Note. It’s a continues reading
Average>135/85 = HTN AWAKE
SLEEP > 120/75
Home BPMontarring
For 7 cinsequetive days
Discard first
Morning &evening
Average of 6days if > 135/85 = HTN
What’s the management of white coat hypertension
Life style modifications
Annual BP recordings to detect progression
What’s masked hypertension?
How do you manage?
Office BP is normal bt home is high
Lifestyle modification and anti hypertensive therapy
What’s the most common cause of 2* hypertension?
Renal parenchymal dxs
What’s the most common cause of congenital hypertension?
Coractation of aorta
In a sitting position the BP of the lower limb is always higher than the upper ( with the legs dangling) by only an increase in systole of 20
Upper L 120/80
Lower L 140/80
What conditions can cause different BP in both arms?
Takayasu Ateritis
Coractation of Aorta the predoctal variety
Supravalvular Aortic stenosis
Aortic disection
Isolated diastolic HTN can be found in? And why
Hypothyroidism
120/100
Due to myxedema
What’s the most common cause of isolated systolic HTN?
Old age due to calcification if the Arteries
Secondary HTN is common in what age groups?
<25 & >55
What’s are the risk factors for type 1 HTN
Primary ( 95% of HTN )
Cause in unknown
However, certain genetic & environmental factors
determine developement of HTN:
Family history - 70%
Ethnicity - Black
Socio- econ grp - Low
Dietary factors - High Na, Alcohol consumption
Diseases - DM, Obesity
Hormonal - Renin, & N.O. prostacycline Low ANP, High endothelein-1
Life style - Smoking, sedentary life
What’s are the stages in hypertensive retinopathy
Stage 1 Focal attenuation of arteries
Stage 2 1+ AV Nicking
Stage 3. 1+2+ Cotton wool spots
Stage 4, all + papillar edema
Which is the most common site of hemorrhagic stroke?
Which organ is the first affected by hypertension?
Putamen
Heart
Eye
Brain
Kidney
Aorta
What are the signs f long standing htn?
Locomotor brachialis
Thickening if the atries
Displacement of the special beat
Loud A2 (loud second heart sound)
Retinal changes
What are the complications of hypertension in the brain
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Brain:
- ICI (Ischemic Cerebral Infarction): This refers to a stroke caused by a blockage in the arteries supplying blood to the brain.
- ICH (Intracerebral Hemorrhage): This is bleeding within the brain due to ruptured blood vessels, often caused by high blood pressure.
- SAH (Subarachnoid Hemorrhage): Bleeding into the space between the brain and the surrounding membrane (subarachnoid space), which is often linked to aneurysms caused by hypertension.
- HE (Hypertensive Encephalopathy): A condition where extremely high blood pressure causes brain swelling and dysfunction, leading to confusion, seizures, or coma.
- MID (Multi-Infarct Dementia): This is a type of dementia caused by multiple small strokes (infarcts) in the brain, often a result of long-term hypertension.
- Lacunar Infarcts: These are small strokes in deep parts of the brain, typically caused by chronic hypertension leading to blockage in tiny arteries.
What are the complications of hypertension in the eye & heart
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Eyes:
- Various grades of retinopathy: Hypertension damages the blood vessels in the retina, leading to hypertensive retinopathy. This can range from mild changes like narrowing of blood vessels to severe problems such as bleeding or swelling in the retina, which can lead to vision loss.
-
Heart:
- LVH (Left Ventricular Hypertrophy): Hypertension forces the left side of the heart to work harder, leading to thickening of the heart muscle.
- LAE (Left Atrial Enlargement): The left atrium can also enlarge due to the increased workload caused by high blood pressure.
- HF (Heart Failure): Over time, the heart may weaken and fail to pump blood effectively, leading to heart failure.
- CAD (Coronary Artery Disease): Hypertension accelerates the buildup of plaque in the coronary arteries, leading to a higher risk of heart attacks.
- Arrhythmia: Hypertension can cause irregular heartbeats (arrhythmias) due to structural and electrical changes in the heart.
- Valvular Disease: High blood pressure can affect the heart valves, leading to dysfunction.
What are the complications of hypertension in the BV and kidneys
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Blood Vessels:
- PVD (Peripheral Vascular Disease): This is damage to the arteries that supply blood to the limbs, leading to pain, poor circulation, and increased risk of amputation.
- Aortic Dissection: High blood pressure can cause a tear in the aorta, the main artery of the body, which is a life-threatening emergency.
- Kidneys (Renal): Hypertension is a major cause of kidney damage, leading to chronic kidney disease and potentially kidney failure.
Risk Factor:
- The risk of complications starts to increase at a blood pressure of 115/70 mmHg, and the risk doubles with every 20/10 mmHg increase. This means that even slightly elevated blood pressure can significantly increase the risk of serious complications
How do you manage a hypertensive patient
Management of hypertension involves a stepwise approach to confirm the diagnosis, find underlying causes, and assess the overall risk to the patient. Here’s how it’s done:
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Management of HTN (1):
- Confirm HTN & determine its level: First, the diagnosis of high blood pressure must be confirmed with accurate measurements. The level of hypertension is then classified based on these readings.
- Identify secondary causes: Secondary hypertension occurs when high blood pressure is caused by another condition, such as kidney disease or hormonal disorders, so it’s important to identify if there’s an underlying cause.
- Find other cardiovascular (CV) risk factors: Other risk factors, like smoking, high cholesterol, or diabetes, should be identified as they can increase the likelihood of complications.
- Investigate: Conduct tests to understand the patient’s overall health and look for signs of complications.
- Determine presence of end-organ damage: Look for damage to organs such as the heart, kidneys, brain, and eyes, which are commonly affected by prolonged high blood pressure.
- Stratify the risk: Once all factors are considered, the risk of future complications (like heart attack or stroke) is assessed and categorized as low, moderate, or high.
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Management of HTN (2):
This is done through:- Full History: Taking a detailed medical history helps identify risk factors, previous illnesses, and family history of hypertension or heart disease.
- Thorough Physical Exam & Fundoscopy: A full physical examination, including checking the blood pressure, heart sounds, and conducting an eye exam (fundoscopy), helps detect signs of hypertension-related damage.
- Investigations: Laboratory tests (e.g., kidney function tests, lipid profiles) and imaging studies (e.g., echocardiogram, renal ultrasound) are done to assess the impact of hypertension and check for secondary causes.
What are the guideline BP threshold for the administration of treatment
With and without TOD
Threshold for Starting Treatment:
The decision to start antihypertensive treatment is based on the risk of complications:
-
Without Target Organ Damage (TOD) or risk factors:
- JNC-7, WHO-ISH, and European guidelines suggest starting treatment at 140/90 mmHg.
- British guidelines recommend starting at 160/90 mmHg.
-
With risk factors or TOD:
- All guidelines agree to start treatment at 140/90 mmHg.
-
With diabetes or chronic kidney disease (CKD):
- JNC-7 and WHO-ISH recommend starting at 130/80 mmHg.
- British guidelines suggest 140/90 mmHg.
- European guidelines recommend 130/85 mmHg.
What are the compelling indications and contraindications of diuretics
Drug Classes, Compelling Indications, and Contraindications:
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Diuretics:
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Compelling Indications (Indicated for use):
- CCF (Congestive Cardiac Failure)
- Elderly patients
-
Contraindications (Avoid use):
- Gout (diuretics can increase uric acid levels, worsening gout)
-
Compelling Indications (Indicated for use):
What are the compelling indications and contraindications of beta blockers
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β-blockers (Beta-blockers):
-
Compelling Indications:
- Angina (chest pain due to reduced blood flow to the heart)
- High Heart Rate
- Post Myocardial Infarction (M.I.) (after a heart attack)
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Contraindications:
- Asthma and COPD (Chronic Obstructive Pulmonary Disease) (beta-blockers can cause bronchoconstriction)
- Heart Block (a slow or blocked electrical signal in the heart)
-
Compelling Indications:
What are the compelling indications and contraindications of ACE Inhibitors and ARBs
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ACE Inhibitors/ARBs (Angiotensin-Converting Enzyme Inhibitors/Angiotensin Receptor Blockers):
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Compelling Indications:
- Congestive Cardiac Failure (CCF)
- Post M.I. (for heart recovery)
- Diabetic Nephropathy (kidney protection in diabetes)
- Left Ventricular Dysfunction
-
Contraindications:
- Pregnancy (ACE inhibitors/ARBs are teratogenic)
- High potassium levels (can worsen hyperkalemia)
- Renal Artery Stenosis (narrowing of the kidney arteries)
-
Compelling Indications:
What are the compelling indications and contraindications of Ca channel blockers & alpha blockers
-
Calcium Channel Blockers (CCB):
-
Compelling Indications:
- Angina
- Systolic Blood Pressure (SBP) control
- Elderly (especially in isolated systolic hypertension)
-
Contraindications:
- Heart Block (due to risk of exacerbating conduction issues)
-
Compelling Indications:
-
α-blockers (Alpha-blockers):
-
Compelling Indication:
- Prostatic Hypertrophy (enlarged prostate, which can cause urinary issues)
-
Compelling Indication:
What are other drugs that can be used in treating htn
- Renin Antagonists/Inhibitors (e.g., Aliskiren): These block the renin-angiotensin-aldosterone system, reducing blood pressure.
- Central Alpha-2 Blockers (e.g., Aldomet, Guanabenz, Guanadrel, and Clonidine): These work in the brain to lower blood pressure by reducing sympathetic nervous system activity.
- Peripheral Adrenergic Inhibitors (e.g., Reserpine, Guanethidine): These block nerve signals that cause blood vessel constriction.
- Vasodilators (e.g., Hydralazine): These relax blood vessels and reduce resistance, lowering blood pressure.
What should be the first choice of drug in htn
Choice of First Drug:
When choosing the first drug for a hypertensive patient, it must be done carefully since it may be taken for many years. Different guidelines offer recommendations: which are?
- WHO/ISH (2003): Recommends starting with a low-dose diuretic, unless contraindicated.
- EHS/ESC (2003): Suggests starting with any of the 5 major drug classes (Diuretics, Beta-blockers, ACE inhibitors, ARBs, Calcium Channel Blockers).
- BHS (British Hypertension Society): The choice is based on age and risk factors.
- British National Institute for Clinical Excellence (NICE): Recommends starting with thiazide diuretics.
- Canadian Hypertension Education Program (CHEP): Suggests using any class, but if combination therapy is required, it should include a thiazide diuretic.
Recommended Combination Therapy:
If hypertension is not controlled by a single drug, combination therapy is often required. Here are the WHO-recommended combinations:
The NHS (National Health Service) recommendations for combinations are similar, with the addition of options like:
Preferred Combinations (American Society of Hypertension - ASH):
- Diuretics + ACE Inhibitors (ACEI) or ARB (Angiotensin Receptor Blockers)
- Diuretics + β-blockers
- Calcium Channel Blockers (CCB) + ACEI
- CCB + β-blockers
The NHS (National Health Service) recommendations for combinations are similar, with the addition of options like:
- Diuretics + Central Acting Drugs
- Diuretics + Alpha-blockers
Preferred Combinations (American Society of Hypertension - ASH):
Preferred 2-drug combinations:
- ACE Inhibitors/Diuretics
- ARB/Diuretics
- ACEI/Calcium Channel Blockers (CCB)
What are the acceptable and unacceptable anti HTN drugs and why?
Acceptable combinations:
- β-blocker/Diuretics
- CCB/Diuretics
- Renin Inhibitor/Diuretics
Unacceptable combinations:
- ACE Inhibitors/ARBs (using both together can cause dangerous side effects)
- ARB/β-blocker (less effective)
- CCB (non-dihydropyridine)/β-blocker (increases the risk of heart block)
- Centrally Acting Agent/β-blocker (can cause significant side effects like bradycardia)
What are some special considerations when choosing an anti HTN drug
Special Considerations:
- Blacks: Often require more aggressive treatment and diuretics should be emphasized.
- Pregnant Women: Specific medications should be used (avoid ACE inhibitors/ARBs).
- Elderly: Often have Isolated Systolic Hypertension (ISH); Calcium Channel Blockers are preferred.
- Athletes: Should avoid drugs that cause drowsiness (like beta-blockers and some central agents).
- Diabetics: Should use ACE inhibitors or ARBs for kidney protection.
- Patients with CAD (Coronary Artery Disease), CCF (Congestive Cardiac Failure), CVD (Cerebrovascular Disease), or PVD (Peripheral Vascular Disease): Require specific tailored treatment based on their conditions.
- Hypertensive Pilots: Special consideration due to occupational needs.
- Resistant Hypertension: May need combination therapy or investigation for secondary causes.
What are the drugs to consider in a patient with chronic hypertension that pregnant
Add comment also
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Methyldopa:
- Comments: Methyldopa is preferred in treating chronic hypertension during pregnancy because of its long-term safety profile. It has been shown to be safe for both the mother and fetus, especially based on long-term follow-up studies. It is also commonly used in eclampsia cases, making it a reliable option for hypertensive crises in pregnancy.
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β-Blockers (Beta-blockers):
- Comments: These drugs are generally considered safe, but there have been reports of intrauterine growth retardation (restricted fetal growth) in some cases. This risk must be balanced with the benefit of controlling high blood pressure.
- Labetalol, a specific β-blocker, is becoming increasingly preferred over methyldopa because it has fewer side effects, making it a better tolerated option for pregnant women.
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Clonidine:
- Comments: Clonidine is not commonly used in pregnancy due to limited data on its safety for both mother and fetus. Thus, its use is reserved for specific cases when other treatments are not suitable.
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Calcium Channel Blockers (CCB):
- Comments: These drugs have limited data available, but current studies have not shown an increase in major teratogenicity (birth defects). This means they are not linked to significant harm when the fetus is exposed during pregnancy, making them an option for treating high blood pressure.
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Diuretics:
- Comments: Diuretics are not first-line treatments for hypertension in pregnancy. They are likely safe in low doses, but because they can affect blood volume and electrolyte balance, they are used cautiously in pregnant women. They are typically avoided unless necessary.
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ACE Inhibitors & ARBs:
- Comments: These drugs are strongly contraindicated in pregnancy. They are classified as Category C in the 1st trimester (meaning risk to the fetus cannot be ruled out) and Category D in the 2nd and 3rd trimesters (there is evidence of fetal risk). Exposure to these drugs during pregnancy has been associated with major teratogenicity, including fetal toxicity and death. Therefore, they should be avoided in all pregnant women.
The prevalence of hypertension is increasing, and genetics play a significant role. Pregnant women with chronic hypertension should have their SBP (Systolic Blood Pressure) kept below 140 mmHg and DBP (Diastolic Blood Pressure) below 90 mmHg to reduce the risk of complications.
Other cardiovascular risk factors should also be identified and treated appropriately. Combination drug therapy may be used to control blood pressure, but the chosen medications must be safe for both the mother and fetus. Failure to manage hypertension during pregnancy can lead to severe complications such as cerebrovascular accidents (stroke), acute myocardial infarction (heart attack), and chronic renal failure.
Discuss the pathophysiology of hypertension and its classification.
- What are the key clinical features and complications of untreated hypertension?
- Explain the diagnostic workup for a patient presenting with suspected hypertension.
- Describe the pharmacological management of hypertension, including drug classes and their mechanisms.
- Discuss the management of hypertension in special populations, including pregnancy.
- Describe the pathophysiology of essential hypertension.
Essential (primary) hypertension is the most common form of hypertension, and its pathophysiology involves multiple interconnected factors:
- Genetic predisposition: Family history plays a major role. Variations in genes related to blood pressure regulation (such as those controlling RAAS components) make certain individuals more susceptible.
- Renin-Angiotensin-Aldosterone System (RAAS): RAAS is crucial for blood pressure regulation. Angiotensin II, a potent vasoconstrictor, increases systemic vascular resistance and aldosterone release, which enhances sodium and water retention, raising blood volume and pressure.
- Sympathetic Nervous System (SNS): Overactivity of the SNS leads to vasoconstriction and increased cardiac output, contributing to chronic hypertension. This occurs because of abnormal signals from the brainstem, which causes over-stimulation of peripheral sympathetic nerves.
- Endothelial dysfunction: The endothelium (inner lining of blood vessels) normally produces vasodilators like nitric oxide (NO). In essential hypertension, there’s reduced NO availability, leading to vasoconstriction and increased peripheral resistance.
- Salt and water retention: Excessive salt intake, especially in salt-sensitive individuals, leads to fluid retention and elevated blood volume. This increases cardiac output and leads to sustained high blood pressure.
- Other contributing factors: Obesity, insulin resistance, and lifestyle factors (e.g., stress, alcohol, physical inactivity) all contribute to the development and progression of essential hypertension.
This multifactorial interplay results in increased peripheral vascular resistance (systemic vasoconstriction) and/or increased cardiac output, leading to persistently elevated blood pressure.
- Compare and contrast hypertensive urgency and hypertensive emergency.
Both hypertensive urgency and emergency are situations where blood pressure rises significantly, but they differ in their clinical presentation and required management.
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Hypertensive Urgency:
- Definition: Severe elevation in blood pressure (usually >180/110 mmHg) without acute end-organ damage.
- Presentation: The patient is usually asymptomatic or may present with headaches, dizziness, or nosebleeds.
- Management: It does not require immediate IV treatment. Instead, oral antihypertensives are used, and the goal is to lower the BP gradually over 24-48 hours. Common drugs include clonidine or captopril.
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Hypertensive Emergency:
- Definition: Severe hypertension (typically >180/120 mmHg) associated with acute end-organ damage (e.g., stroke, myocardial infarction, pulmonary edema, renal failure).
- Presentation: Symptoms vary depending on which organ is affected. For example, hypertensive encephalopathy can cause confusion or seizures, while myocardial ischemia presents with chest pain.
- Management: This is a medical emergency requiring rapid blood pressure reduction using intravenous agents (e.g., sodium nitroprusside, labetalol). The goal is to reduce the mean arterial pressure by no more than 25% within the first hour to avoid ischemia from sudden BP drops
- Outline the management of chronic hypertension in pregnancy.
Managing chronic hypertension in pregnancy requires a careful balance to protect both the mother and fetus. Treatment strategies include:
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First-line medication:
- Methyldopa is commonly used as it has a long-established safety profile in pregnancy. It’s also favored in cases of pre-eclampsia and eclampsia.
- Labetalol is increasingly preferred due to fewer side effects compared to methyldopa. It combines alpha- and beta-blocking effects, helping to lower blood pressure without excessive reflex tachycardia.
-
Other drugs:
- Calcium channel blockers (CCBs): These are generally safe, although data is limited. Nifedipine is used in some cases without significant risks of teratogenicity.
- Diuretics are not first-line but may be used in low doses for fluid management.
-
Drugs to avoid:
- ACE inhibitors and ARBs are contraindicated due to the risk of fetal malformations, particularly in the second and third trimesters (category D). They can cause fetal renal damage and death.
-
Complications if untreated:
Untreated hypertension can lead to severe complications such as pre-eclampsia, eclampsia, fetal growth restriction, and preterm birth. Thus, close monitoring and careful drug selection are vital throughout the pregnancy
- Discuss the complications of hypertension on major organs, including the heart, kidneys, brain, and eyes.
Chronic hypertension affects multiple organ systems, leading to both structural and functional damage:
-
Heart:
- Left Ventricular Hypertrophy (LVH): Chronic pressure overload increases myocardial wall thickness, leading to LVH. Over time, this results in diastolic dysfunction and heart failure.
- Coronary Artery Disease (CAD): Hypertension accelerates atherosclerosis in coronary arteries, increasing the risk of myocardial infarction.
- Heart failure (HF): Both systolic and diastolic heart failure can occur due to the increased workload and ischemic damage.
-
Kidneys:
- Hypertensive nephropathy occurs when hypertension damages renal arteries and glomeruli. This can lead to progressive kidney damage, proteinuria, and eventually chronic kidney disease (CKD).
-
Brain:
- Hypertension increases the risk of ischemic strokes, transient ischemic attacks, and intracerebral hemorrhages (ICH).
- Hypertensive encephalopathy is an emergency that presents with confusion, seizures, and even coma, caused by cerebral edema.
-
Eyes:
- Hypertensive retinopathy results from chronic pressure on retinal vessels. There are different grades of retinopathy, ranging from mild vessel narrowing to severe retinal hemorrhages, cotton wool spots, and even papilledema
- Explain the lifestyle modifications recommended for managing hypertension and how they contribute to lowering blood pressure.
Non-pharmacological interventions are essential for managing hypertension:
- Salt reduction: Reducing sodium intake to <100 mmol/day (around 6 g of NaCl) decreases water retention, thus lowering blood volume and blood pressure. This is particularly effective in salt-sensitive individuals.
- Weight loss: A body mass index (BMI) between 18.5–24.9 kg/m² is associated with reduced cardiovascular risk. Each kilogram of weight loss can reduce systolic BP by 1-2 mmHg.
- Exercise: Engaging in moderate physical activity (e.g., brisk walking) for at least 30 minutes on most days lowers BP by enhancing endothelial function and reducing peripheral vascular resistance.
- Diet: A diet rich in fruits, vegetables, low-fat dairy, and whole grains (as seen in the DASH diet) lowers BP by providing essential nutrients (e.g., potassium, magnesium) and limiting saturated fat.
- Limiting alcohol: Reducing alcohol intake can lower systolic BP by 2-4 mmHg, particularly in individuals who consume excessive amounts.
- Describe the pharmacological treatment options for managing hypertension, including first-line and second-line therapies.
- Diuretics: Thiazide diuretics (e.g., hydrochlorothiazide) reduce blood volume and are often first-line therapy, especially in older adults.
- ACE Inhibitors (ACEI): Drugs like enalapril inhibit the conversion of angiotensin I to angiotensin II, reducing vasoconstriction and aldosterone production. They’re useful in patients with diabetes and chronic kidney disease.
- Angiotensin II Receptor Blockers (ARBs): ARBs (e.g., losartan) block angiotensin II receptors, offering similar effects to ACE inhibitors, with fewer side effects like cough.
- Calcium Channel Blockers (CCBs): These drugs (e.g., amlodipine) block calcium influx in vascular smooth muscle, reducing vascular resistance. They are particularly useful in elderly patients and those with isolated systolic hypertension.
- Beta-Blockers: These reduce heart rate and cardiac output and are especially useful in post-myocardial infarction patients and those with arrhythmias
- Critically analyze the use of combination therapy in hypertension.
Combination therapy is often necessary for patients who cannot achieve adequate blood pressure control with a single drug:
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Advantages:
- Combination therapy targets different mechanisms involved in blood pressure regulation, such as combining a diuretic with an ACE inhibitor. This approach is more effective and reduces the need for higher doses of individual drugs, minimizing side effects.
- WHO recommends combinations like diuretics and ACE inhibitors, or calcium channel blockers and beta-blockers, to manage complex hypertension cases.
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Risks:
- Some combinations (e.g., ACE inhibitors with ARBs) are not recommended because they may increase the risk of hyperkalemia or renal impairment without improving outcomes.
- Careful monitoring is necessary to avoid interactions and manage potential adverse effects like hypotension or electrolyte imbalances.
This approach maximizes efficacy while minimizing side effects, making it a preferred strategy for patients with resistant hypertension.
- What are the first-line antihypertensive medications recommended in diabetic patients?
Answer: The first-line antihypertensive medications in diabetic patients are ACE inhibitors or angiotensin II receptor blockers (ARBs). These drugs not only lower blood pressure but also provide renal protection by reducing proteinuria and delaying the progression of diabetic nephropathy.
- What is resistant hypertension, and how is it managed?
Answer: Resistant hypertension is when blood pressure remains elevated despite the use of three or more antihypertensive medications, including a diuretic, at optimal doses. Management includes ruling out secondary causes (e.g., renal artery stenosis), optimizing treatment with additional drug classes (e.g., aldosterone antagonists), and lifestyle modifications.
- What is the significance of target organ damage in hypertension?
Answer: Target organ damage refers to the damage caused by prolonged high blood pressure to critical organs, including the heart (e.g., left ventricular hypertrophy), kidneys (e.g., chronic kidney disease), brain (e.g., stroke), and eyes (e.g., hypertensive retinopathy). Detection of such damage indicates severe or poorly controlled hypertension and increases the risk of complications.
- What is isolated systolic hypertension, and why is it common in the elderly?
Answer: Isolated systolic hypertension (ISH) is when only the systolic blood pressure (SBP) is elevated (>140 mmHg) while the diastolic blood pressure (DBP) remains normal (<90 mmHg). It is common in the elderly due to decreased arterial elasticity, leading to stiffening of the large arteries. As a result, systolic pressure increases, while diastolic pressure remains stable or decreases
- Why are ACE inhibitors contraindicated in pregnancy?
Answer: ACE inhibitors are contraindicated in pregnancy because they can cause significant fetal harm, particularly during the second and third trimesters. They are associated with fetal renal dysgenesis, oligohydramnios, skull hypoplasia, and even fetal death due to their teratogenic effects on the developing renin-angiotensin system
- How does the DASH diet help in controlling hypertension?
Answer: The DASH diet (Dietary Approaches to Stop Hypertension) helps lower blood pressure by promoting a diet rich in fruits, vegetables, whole grains, and low-fat dairy, while limiting saturated fats, cholesterol, and sodium. This diet provides essential nutrients like potassium, magnesium, and calcium, which help regulate blood pressure
- What is white-coat hypertension, and how is it diagnosed?
Answer: White-coat hypertension refers to elevated blood pressure readings in a clinical setting but normal readings at home or in a non-clinical environment. It is diagnosed through ambulatory blood pressure monitoring (ABPM) or home blood pressure monitoring, which tracks the patient’s blood pressure over 24 hours or in their everyday setting
- What role does the kidney play in the development of hypertension?
Answer: The kidney plays a central role in hypertension through its regulation of blood volume and the renin-angiotensin-aldosterone system (RAAS). Impaired sodium excretion, excessive activation of RAAS, and renal artery stenosis can lead to fluid retention, increased blood volume, and elevated systemic vascular resistance, all contributing to sustained hypertension
