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Cardiovascular Module > Hypertension > Flashcards

Hypertension Flashcards

1
Q

Hypertension

A

Raised pressure in a vascular bed
Disorder where the level of sustained arterial pressure is higher than expected for the age sex and race of the individual under consideration

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2
Q

What type of person is at risk of developing the complications of hypertension

A

A person with sustained resting diastolic blood pressure over 90 mmHg or systolic blood pressure over 140 mmHg

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3
Q

When can you say that someone has hypertension

A

When the system leak pressure is over 160 and/or diastolic pressure is over 95

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4
Q

When can you say that someone has borderline hypertension

A

One sister leak pressure is between 140 and 160 and/or the diastolic pressure is between 90 and 95

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5
Q

How do you call the hypertension where only the systolic pressure is elevated

A

Isolated systolic hypertension

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6
Q

How do you call the hypertension where both systolic and diastolic pressure’s are elevated

A

Diastolic hypertension

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7
Q

Between the isolated systolic hypertension and the diastolic hypertension which one is the most dangerous

A

Diastolic hypertension

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8
Q

How can the heights of the diastolic pressure help categorize hypertension further

A

Mild diastolic pressure is between 95 and 104

Moderates is between 105-114

Severe is above 115

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9
Q

What type of stimuli can increase normal blood pressure

A

cold
emotion
changing positions from supine to standing

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10
Q

What is labile hypertension

A

When increase in blood pressure is excessive after exposure to a stimuli

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11
Q

Why is the diagnosis of hypertension difficult

A

Several measurements are necessary

good equipment are necessary like having a cuff of appropriate size and shape

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12
Q

Hypertension classification by etiology

A

Idiopathic primary or essential (90 to 95% of cases)

Secondary due to underlying conditions (5 to 10% of cases)

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13
Q

Classification of hypertension based on the clinical pathological consequences

A

Benign hypertension (Indolent, progress over years, moderate rise in blood pressure, asymptomatic, compatible with long life) 95% cases

malignant hypertension (Rapid rise in blood pressure if no treatment can lead to organ damage and death in a year or two) 5% cases

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14
Q

essential hypertension etiology

A

Genetic factors

racial factors

environmental factors like stress smoking physical inactivity obesity and diets

cell membrane abnormalities

electrolytes control

nervous system reactivity

arterial reactivity

vasoactive agents circulating

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15
Q

How does genetic and racial factors was demonstrated to play into hypertension

A

Indicated by Strong family ( children of hypertensive parents have increased risk, increased incidence in biological siblings compared to adopted children )

Excessive high incidence in black population (40-45%)

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16
Q

hypertension in the black Americans compared to the white Americans

A

Incidence 2x higher in black Americans

Higher chances of complications

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17
Q

What are the single gene disorders that can cause rare severe forms of hypertension

A

Defects in aldosterone metabolizing enzymes ( Increased mineralocorticoid activity)

Defects in proteins involved in sodium reabsorption ( Can lead to an increase in the distal tubular reabsorption of sodium)

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18
Q

Genetic variation that can lead to hypertension

A

Polymorphism in
Angiotensinogen
ACE
Receptors for angiotensin II

Can explain racial difference in BP

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19
Q

How does angiotensin II alter blood pressure

A

Increase pressure by direct action on the vascular smooth muscle using vasoconstriction

Increase blood volume by stimulating aldosterone secretion which will increase the distal tubular reabsorption of sodium and water

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20
Q

Why is there a higher incidence of hypertension in urban population compared to rural population

A

Because of stress

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21
Q

What changes in diet’s can you make it to improve blood pressure

A

Decrease sodium intake

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22
Q

How is the level of catecholamines in people with essential hypertension

A

Increased at all level

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23
Q

Blood pressure equation

A

BP= CO x PR

So either CO or PR. has to increase for BP to increase

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24
Q

Causes of increase in cardiac output

A

Decreased sodium excretion or excess sodium intake => increased blood volume => increased SV => increased CO

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25
Causes of rise of PR
Increased blood flow => autoregulation to reduce perfusion so vasoconstriction => increased blood pressure Increased sympathetic tone due to increased renin leading to increased angiotensin II , presence of vasocontractive substances like catecholamines and endothelin, excessive response to behavioral or neurogenic factors Thickening of the wall due to repeated vasoconstriction
26
Secondary hypertension etiology
Renal disease Endocrine disease Drug induced Pre eclampsia of aorta Coarctation of aorta Alcohol abuse
27
Main cause of secondary hypertension
Renal causes - 80%
28
Renal diseases causes
Renovascular disorders Parenchymal disease
29
Renovascular hypertension
Above 50% Reduced renal blood => activation of renin angiotensin system increased renin and angiotensin II => increased HPT Juxtaglomerular hyperplasia develops
30
Causes of onstruction to renal arterial flow
Stenosis from atheroma near ostium of renal artery Fibromuscular dysplasia of renal artery Emboli in renal arterh
31
Renal parenchymal diseases
Chronic pyelonephritis Chronic glomerulonephritis Polycystic kidneys Diabetic nephropathy Chronic interstitial nephritis Hydronephrosis
32
Mechanism of hypertension in parenchymal disease
Sodium water retention due to chronic renal failure Renin angiotensin aldosterone
33
What other diseases can worsen hypertension in parenchymal disease
Endarteritis obliterans Arteriolar intimal hyperplasia
34
Endocrine diseases that can cause secondary hypertension
Phaeochromocytoma ( episodic and severe HPT due to high catecholamine secretion ) Conns syndrome ( mild hypertension due to high aldosterone causing water and salt retention) Cushing syndrome ( cortisol accumulation leading to hypertension) Congenital adrenal hyperplasia ( steroid synthesis intermediate retain sodium )
35
What is the mechanism of hypertension in acromegaly , thyrotoxicosis and hypothyroidism
Not known
36
Rare causes of hypertension
``` Renin secretion by tumors : Renal cell carcinoma Nephroblastoma Tumours of juxtaglomerular Ectopic renin secretion by bronchial carcinoma ```
37
Drugs that can cause HPT
Oral contraceptive pill Steroids Carbenoxolone MAO inhibitors in patient who consume tyramine containing food
38
Age of moderate rise in benign hypertension
45 , 55
39
Symptoms of benign hypertension
``` Palpitations Audible pulsation in head Headaches Diziness Fatigability Breathlessness on exertion Dyspnoea at rest ```
40
Consequence of hypertension
Left ventricular hypertrophy
41
How to detect left ventricular hypertrophy
ECG | Chest X ray
42
Are the morphological changes in large medium and small arteries the same in benign hypertension
They are the same in large and medium arteries and different in small arteries and arterioles
43
Large and medium sized arteries morphological changes in benign hypertension
Medial hypertrophy With increased smooth muscle mass and elastic fibers in early stages Thick intima due to more longitudinal smooth muscle fibers Collagen replace hyperplastic and hypertrophy changes Artery becomes rigid and less compliant Dilated lumen and elongated and tortuous vessels Medium sized artery => réduplication of internal elastic lamina
44
Hypertensive atherosclerosis in benign hypertension
Changes that occur in the large and medium vessels due to hypertension Pretty proteoglycans in the media of large arteries => forming cystic medial degeneration Atheroma more severe in chronic hypertension
45
Morphological changes in small arteries and artérioles in benign hypertension
Medial thickening of small arteries intimal thickening => luminal narrowing (hypertensive or hyperplastic arteriosclerosis) Hyaline atherosclerosis => Deposit of hyaline material gradually extends to the whole circumference of the wall and replace every part of it except the endothelium Subendothelial , homogeneous, glassy pink material Deposition of plasma derived proteins in the wall
46
Where can you see better the vascular changes occurring in benign hypertension
Spleen and kidney
47
Morphology of medium size renal arteries and artérioles in benign hypertension
Intimal proliferation Hyalinization of muscular media Focal areas of ischemia - Periglomerular fibrosis - Loss of tubules - Scarring - finely granular subcortical surfaces - Thinned cortices of kidney
48
Is renal failure common in benign hypertension
Not common , few case in malignant hypertension
49
Where are the changes less common in the body due to benign hypertension
``` Arterioles of the brain pituitary thyroids Heart GIT skin skeletal muscles ```
50
In what case can you see vascular changes with absence of hypertension
In diabetes mellitus and in old age
51
Diseases accelerated by hypertension
Atherosclerosis spontaneous intracerebral hemorrhage dissection of the aorta sub arachnoid hemorrhage
52
Malignant hypertension
``` Rapidly rising blood pressure Diastolic pressure over 120 Rapidly progressive renal injury(ureamia) Retinal hemorrhage Rarely hypertensive encephalopathy ```
53
And what cases do you see malignant hypertension
Patient with previous benign hypertension Secondary to renal disease (Accelerated hypertension) De Novo ( especially black males 30s-40s)
54
Consequences of malignant hypertension
Acute left ventricular failure left ventricular hypertrophy Papilloedema and retinal hemorrhages (blurred vision) Hematuria & renal failure due to Renal arteriolar fibrinoid necrosis Severe headaches Cerebral hemorrhage
55
Malignant hypertension small arteries and arterioles morphologic changes
hyperplastic arteriosclerosis or onion skin lesion => Intimal thickening => luminal narrowing Intramuscular coagulation red cell fragmentation => microangiopathic hemolytic anemia Hallmark => Fibrinoid necrosis ( necrotizing arteriolitis) => pyknosis, polymorph infiltration, extravasation of RBC, fibrin thrombosis ( small infarct)
56
Most affected organ by the morphologic changes
Kidney (Afférent glomerular artériole and distal interlobular arteries) May cause rupture of capillaries forming pétéchial haemorrhage on cortical surface ( flea bitten appearance )
57
Most common cause of death in hypertension
Heart disease central nervous system stroke renal failure
58
Heart disease caused by hypertension
Left ventricular hypertrophy Heart failure Angina pectoris Myocardial infarction
59
Neurological disease due to hypertension
Retinal - exudates hemorrhage papilloedema ``` Central nervous system changes : morning occipital headaches dizziness and vertigo cerebral hemorrhage infarction encephalopathy ```
60
Renal disease caused by hypertension
Arteriosclerotic changes in vessels and glomerular tuft Reduced GFR Proteinuria Haematuria
61
How should you approach the patient to diagnose hypertension
Should check three times and her relaxed conditions blood pressure should take into consideration white collar hypertension
62
Targets of patients evaluation for hypertension
Discovering correctable form of hypertension find a pre-treatment base line find factors that may influence the type of therapy determine presence of organ damage targeted determining the presence of other risk factors for cardiovascular disease
63
Optimal blood pressure
120/80
64
Normal blood pressure
Under 130 | under 85
65
High normal pressure
Between 130 to 139 | between 85 to 89
66
Hypertension stage one
Between 140 to 159 | between 90 to 99
67
Hypertension stage two
160 to 179 | 100 to 109
68
Hypertension stage III
Over 180/110
69
Isolated systolic high blood pressure
Over 140 | Diastolic under 90
70
Patient history to take in hypertension
``` Family history of hypertension previous blood pressure deviations cigarettes diet exercise social status work educational level Age ```
71
Physical exam in hypertension patient
``` Round face truncal obesity blood pressure in upper extremities lying and standing fundodoscopy examination of heart and lungs abdominal exams ```
72
Always included Basic test for hypertension
``` Urine ( protein, blood , glucose ) Microscopic urinalysis Hematocrit Serum potassium Serum creatinine Fasting glucose Total cholesterol ECG ```
73
Sometimes included basic for hypertension evaluation
``` Thyroid stimulating hormone white blood cell counts HDL and LDL cholesterol and triglycerides serum calcium and phosphate chest x-ray echocardiogram ```
74
Seven classes of drugs for hypertension
``` Diuretics ACE inhibitors angiotensin receptor blockers calcium channel blocker anti-adrenergic drugs vasodilators mineralocorticoid receptor antagonist ```
75
Calcium channel blocker’s classes
Dihydropyridines Benzothiazepines Phenylakylamine
76
Dihydropyridines
Nifedipine XL amlodipine Felodipine
77
Benzothiazepines
Diltiazem
78
Phenylakylamines
Verapamil
79
Angiotensin converting enzyme inhibitors
Captopril Lisinopril Enalapril Ramipril
80
Angiotensin receptor blocker
Losartan | Valsartan
81
Diuretics
Thiazide Loop acting Potassium sparing
82
Thiazide diuretics
Hydrochlorothiazide
83
Loop acting diuretics
Furosemide
84
Potassium sparing diuretics
Spironolactone Triamterene Amiloride
85
Anti-adrenergic agent
``` Central acting Autonomic ganglia nerve ending alpha receptors Beta receptors A-B receptors blockers ```
86
Anti-adrenergic central
Clonidine Methyl DOPA
87
Autonomy ganglia anti-adrénergic
Trimetaphan
88
Nerve ending anti adrenergic agent
Guanethidine
89
Alpha Receptors anti-adrénergic agents
Phentolamine Phenoxy benzamine Prazocin Doxazocin
90
Beta receptor anti Adrenergic agents
Propanolol Metoprolol Nadolol Atendol
91
a-b receptors anti adrénergic agents
Labetalol | Carvedilol
92
vasodilators
Hydralazine Minoxidil Nitropuside
93
Mineralo corticoid receptor blocker’s
Spironolactone | Eplerenone

Cardiovascular Module (21 decks)

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