Hypertension Flashcards
What is this describing?
BP >140/90mmHg, with no secondary cause identified.
Essential (primary) hypertension (95%)
What are the causes of secondary hypertension?
- Renal disease (75%) - glomerulonephritis, renal artery stenosis, chronic pyelonephritis, polycystic kidneys.
- Endocrine disease - Cushing’s, Conn’s, phaeochromocytoma, acromegaly
- Others - steroids, COCP, pregnancy, coarctation of the aorta, systemic sclerosis.
What is this describing?
BP >200/130mmHg and end organ damage.
Malignant hypertension
What are the complications of malignant hypertension?
- Bilateral retinal haemorrhage
- Headaches, visual disturbances
- AKI, HF, encephalopathy, stroke, seizures
What causes malignant hypertension?
Renovascular disease - breakdown of autoregulation and failure to protect microcirculation from high pressure.
What is this describing?
Elevated clinic blood pressure but normal daily average.
White Coat hypertension
What are the risk factors for developing hypertension?
Obesity, aerobic exercise <3x per week, moderate/high alcohol, metabolic syndrome, diabetes, black ethnicity, >60 years old, family history of hypertension or coronary artery disease, sleep apnoea.
What are the six main effects of hypertension?
- Accelerates atherosclerosis and arteriosclerosis
- Hypertensive heart disease
- Hypertensive renal disease
- Retinal changes
- Aortic dissection
- Intracerebral haemorrhage
What is arteriosclerosis?
Hardening of an artery or arteriole.
What are the two types of arteriosclerosis that hypertension can predispose to?
- Hyaline - gradual, smooth muscle replaced by collagen, decreased arterial compliance, age-related BP change, makes hypotension more dangerous
- Hyperplastic - characteristic of malignant hypertension
How does hypertension cause heart disease?
- Coronary artery atherosclerosis accelerated (IHD)
- Left ventricle pushes harder against high pressure and undergoes hypertrophy.
- Increased metabolic demands of myocardium which the heart cannot make.
- Eventual decompensation and failure.
How does hypertensive heart disease manifest?
MI, arrhythmias (AF), progressive left heart failure.
How does hypertension cause renal disease?
- Hyaline arteriosclerosis in renal arterioles causes chronic and progressive renal ischaemia.
- Tubular atrophy, intestinal fibrosis and progressive glomerular sclerosis = CKD.
What would a kidney USS show in hypertensive renal disease?
Small kidneys with atrophy and fibrosis.
What are the retinal changes seen in hypertension?
Flame haemorrhages, hard exudates, cotton wool spots and papilloedema.