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CVS block > Hypertension 1 > Flashcards

Hypertension 1 Flashcards

1
Q

When does a person have hypertension?

A

Bp- 140/90 (britain)

Bp- 130/80 - Optimal bp target 125/70 (american)

WHO- 140/90

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2
Q

What is the relationship between BP and risk of CVD?

A

There is a graded relationship between increasing BP and risk of CVD starting 115/75mmhg

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3
Q

What doubles the risk of CVD death?

A

An increase in BP of 20 mmHg systolic and 10 mmHg diastolic above ideal values doubles risk of CVD death regardless of age.

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4
Q

How common is hypertension?

A

Affects about 30-40% of the adult population

Prevalence >50% of persons over 60

Important risk factor for myocardial infarction, heart failure, stroke, cardiovascular disease and itaccounts for 41% of all cvd deaths

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5
Q

What causes blood pressure to fluctuates?

A

Physical stress and mental stress

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6
Q

What is stage 1 hypertension?

A

Clinic Bp 140/90 or higher

ABPM daytime average 135/85 mmHg or higher

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7
Q

What is stage 2 hypertension?

A

Clinic BP 160/100 or higher

ABPM daytime average 150/95 mmHg or higher

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8
Q

What is stage 3 or severe hypertension?

A

Clinic systolic BP 180/120 mmHg or higher

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9
Q

What is primary hypertension?

A

80-90% of cases and no cause has been identified

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10
Q

What is secondary hypertension?

A

10-20% of cases

Results in

  • Chronic renal disease
  • Renal artery stenosis
  • Endocrine disease - cushings, conn’s syndrome (primary hyperaldosternism), phaeochromocyoma

Secondary hypertension is more common in younger patients

All hypertensive patients <40 should be referred to specialist for further investigations

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11
Q

What are hypertension associated risks?

(meaning what makes a patient more likely to have hypertension)

A

Risk from hypertension is associated with other risk factors

  • Cigarette smoking
  • Diabetes 5 - 30 x increase of MI
  • Renal disease
  • Male -2x risk
  • Hyperlipidaemia
  • Previous stroke/MI
  • Left ventricule hyperterphohy 2x risk
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12
Q

What is the physiology of blood pressure?

A

BP is controlled by an integrated system

Primary contributers to BP are:
- Cardiac output: stroke volume x heart rate
- Peripheral vascular resistance

Each of these factors can be manipulated by drug therapy

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13
Q

What does sympathetic system activation produce?

A

Vasoconstriction - increases peripheral vascular resistance

Reflex tachycardia - Increases cardiac output

Increased stroke volume - Increases cardiac output

The actions of sympathetic system are rapid and account for second to second BP control.

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14
Q

When the sympathetic nervous system stimulates renin release what happens?

A

It produces angiotensin II and aldosterone

Angiotensin II - is a vasoconstrictor and stimulates the release of aldosterone from the adrenal glands

Aldosterone - Causes salt and water retention which increases the circulating blood volume.

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15
Q

What is RAAS?

A

Renin Angiotensin-Aldosterone system

It is pivotal in long term BP control

It is responsible for:
- Maintenance of sodium balance
- Control of blood volume
- Control of blood pressure

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16
Q

What is RAAS stimulated by?

A

Fall in Bp

Fall in circulating volume

Sodium depletion

  • Any of these stimulate the release of renin from the juxtaglomerular apparatus
17
Q

What does renin convert angiotensinogen to?

A

Angiotensin I

18
Q

What is angiotensin I converted to?

A

Angiotensin II by angiotensin converting enzyme (ACE)

19
Q

What are the polygenic aetilogy of hypertension?

A
  • Major genes (single genes abnormalities)
  • Poly genes (multiple genes involved)
  • There are > 30 genes recognized as important but they individually account for at most 0.5 mmHg each
20
Q

What are the polyfactorial aetilogy of hypertension?

A
  • Environment
  • Individual and shared
21
Q

What are the likely causes of hypertension?

A

Increased reactivity of resistance vessels and resultant increase in peripheral resistance
- Hereditary defect of the smooth muscle lining of arterioles

A sodium homeostatic effect
- In hypertensive individuals, the kidneys are unable to excrete appropriate amounts of sodium for any given BP (pressure naturesis). As a result sodium and fluid retained and the BP increases.

22
Q

What are other factors that cause hypertension?

A
  • Age
  • Genetics and family history
  • Environment
  • Weight
  • Alcohol intake
  • Race
23
Q

How does age cause hypertension?

A
  • Bp tends to rise with age - possibly as a result of decreased arterial compliance
  • Hypertension in the elderly should be treated
24
Q

How does genetics cause hypertension?

A
  • A history of hypertension tends to run in families
  • The closest correlation exists between siblings rather than parent and child
  • It is possible that environmental factors common to members of the family also have a role in the development of hypertension
25
Q

How does the environment cause hypertension?

A
  • Mental and physical stress both increase BP
  • Removing stress does not necessarily return BP to normal values
  • White coat hypertensives are at increased risk of CVD. Not to the same level as chronic hypertensives.
26
Q

How does alcohol cause hypertension?

A
  • It is one of the most common causes of hypertension in young men

Affects 1% of population
- Small amounts of alcohol tend to decrease BP
- Large amounts of alcohol tend to increase BP

  • If alcohol consumption is reduced, BP will fall over several days to weeks
  • Average fall is small 5/3 mmHg but can be significantly higher.
27
Q

How does weight cause hypertension?

A
  • Obese patients have a higher BP
  • Up to 30% of hypertension is attributable in part or wholly to obesity
  • In untreated patients, a weight loss of 9kg has been reported to produce a fall in BP of 19/18 mmHg
  • In treated patients a fall in Bp of 30/21 mmHg has been reported
  • Weight reduction is the most important non-pharmacological measure available
28
Q

How does birth weight cause hypertension?

A
  • Low birth weight is associated with higher likelihood of developing hypertension and heart disease in adulthood
  • For each Kg increase in birth weight, the systolic BP is 1 - 2 mmHg lower
29
Q

How does race cause hypertension?

A
  • Caucasians have a lower Bp than african populations living in the same environment
  • African populations living in rural areas have a lower Bp than those living in towns - reasons are not clear
  • African populations are genetically selected to be salt retainers and so are more sensitive to an increase in dietary salt intake
30
Q

How do u make a treatment for hypertension?

A
  • Confirm diagnosis
  • Assess risk factors
  • Assess end organ damage.

CVS block (17 decks)

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