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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
Q

Causes of rise of PR

A

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

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26
Q

Secondary hypertension etiology

A

Renal disease

Endocrine disease

Drug induced

Pre eclampsia of aorta

Coarctation of aorta

Alcohol abuse

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27
Q

Main cause of secondary hypertension

A

Renal causes - 80%

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28
Q

Renal diseases causes

A

Renovascular disorders

Parenchymal disease

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29
Q

Renovascular hypertension

A

Above 50% Reduced renal blood => activation of renin angiotensin system

increased renin and angiotensin II => increased HPT

Juxtaglomerular hyperplasia develops

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30
Q

Causes of onstruction to renal arterial flow

A

Stenosis from atheroma near ostium of renal artery

Fibromuscular dysplasia of renal artery

Emboli in renal arterh

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31
Q

Renal parenchymal diseases

A

Chronic pyelonephritis

Chronic glomerulonephritis

Polycystic kidneys

Diabetic nephropathy

Chronic interstitial nephritis

Hydronephrosis

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32
Q

Mechanism of hypertension in parenchymal disease

A

Sodium water retention due to chronic renal failure

Renin angiotensin aldosterone

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33
Q

What other diseases can worsen hypertension in parenchymal disease

A

Endarteritis obliterans

Arteriolar intimal hyperplasia

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34
Q

Endocrine diseases that can cause secondary hypertension

A

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 )

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35
Q

What is the mechanism of hypertension in acromegaly , thyrotoxicosis and hypothyroidism

A

Not known

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36
Q

Rare causes of hypertension

A 
Renin secretion by tumors : 
Renal cell carcinoma 
Nephroblastoma
Tumours of juxtaglomerular 
Ectopic renin secretion by bronchial carcinoma
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37
Q

Drugs that can cause HPT

A

Oral contraceptive pill

Steroids

Carbenoxolone

MAO inhibitors in patient who consume tyramine containing food

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38
Q

Age of moderate rise in benign hypertension

A

45 , 55

39
Q

Symptoms of benign hypertension

A 
Palpitations 
Audible pulsation in head 
Headaches
Diziness 
Fatigability 
Breathlessness on exertion 
Dyspnoea at rest
40
Q

Consequence of hypertension

A

Left ventricular hypertrophy

41
Q

How to detect left ventricular hypertrophy

A

ECG

Chest X ray

42
Q

Are the morphological changes in large medium and small arteries the same in benign hypertension

A

They are the same in large and medium arteries and different in small arteries and arterioles

43
Q

Large and medium sized arteries morphological changes in benign hypertension

A

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
Q

Hypertensive atherosclerosis in benign hypertension

A

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
Q

Morphological changes in small arteries and artérioles in benign hypertension

A

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
Q

Where can you see better the vascular changes occurring in benign hypertension

A

Spleen and kidney

47
Q

Morphology of medium size renal arteries and artérioles in benign hypertension

A

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
Q

Is renal failure common in benign hypertension

A

Not common , few case in malignant hypertension

49
Q

Where are the changes less common in the body due to benign hypertension

A 
Arterioles of the 
brain 
pituitary 
thyroids 
Heart
 GIT 
skin 
skeletal muscles
50
Q

In what case can you see vascular changes with absence of hypertension

A

In diabetes mellitus and in old age

51
Q

Diseases accelerated by hypertension

A

Atherosclerosis
spontaneous intracerebral hemorrhage
dissection of the aorta
sub arachnoid hemorrhage

52
Q

Malignant hypertension

A 
Rapidly rising blood pressure
Diastolic pressure over 120
Rapidly progressive renal injury(ureamia)
Retinal hemorrhage
Rarely hypertensive encephalopathy
53
Q

And what cases do you see malignant hypertension

A

Patient with previous benign hypertension

Secondary to renal disease (Accelerated hypertension)

De Novo ( especially black males 30s-40s)

54
Q

Consequences of malignant hypertension

A

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
Q

Malignant hypertension small arteries and arterioles morphologic changes

A

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
Q

Most affected organ by the morphologic changes

A

Kidney (Afférent glomerular artériole and distal interlobular arteries)

May cause rupture of capillaries forming pétéchial haemorrhage on cortical surface ( flea bitten appearance )

57
Q

Most common cause of death in hypertension

A

Heart disease
central nervous system stroke
renal failure

58
Q

Heart disease caused by hypertension

A

Left ventricular hypertrophy

Heart failure

Angina pectoris

Myocardial infarction

59
Q

Neurological disease due to hypertension

A

Retinal - exudates hemorrhage papilloedema

Central nervous system changes : 
morning occipital headaches 
dizziness and 
vertigo 
cerebral hemorrhage
 infarction 
encephalopathy
60
Q

Renal disease caused by hypertension

A

Arteriosclerotic changes in vessels and glomerular tuft

Reduced GFR
Proteinuria
Haematuria

61
Q

How should you approach the patient to diagnose hypertension

A

Should check three times and her relaxed conditions blood pressure

should take into consideration white collar hypertension

62
Q

Targets of patients evaluation for hypertension

A

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
Q

Optimal blood pressure

A

120/80

64
Q

Normal blood pressure

A

Under 130

under 85

65
Q

High normal pressure

A

Between 130 to 139

between 85 to 89

66
Q

Hypertension stage one

A

Between 140 to 159

between 90 to 99

67
Q

Hypertension stage two

A

160 to 179

100 to 109

68
Q

Hypertension stage III

A

Over 180/110

69
Q

Isolated systolic high blood pressure

A

Over 140

Diastolic under 90

70
Q

Patient history to take in hypertension

A 
Family history of hypertension 
previous blood pressure deviations
 cigarettes 
diet 
exercise 
social status 
work 
educational level
 Age
71
Q

Physical exam in hypertension patient

A 
Round face 
truncal obesity
 blood pressure in upper extremities lying and standing 
fundodoscopy 
examination of heart and lungs 
abdominal exams
72
Q

Always included Basic test for hypertension

A 
Urine ( protein, blood , glucose ) 
Microscopic urinalysis
Hematocrit
Serum potassium
Serum creatinine 
Fasting glucose 
Total cholesterol 
ECG
73
Q

Sometimes included basic for hypertension evaluation

A 
Thyroid stimulating hormone 
white blood cell counts 
HDL and LDL cholesterol and triglycerides 
serum calcium and phosphate 
chest x-ray echocardiogram
74
Q

Seven classes of drugs for hypertension

A 
Diuretics 
ACE inhibitors
angiotensin receptor blockers 
calcium channel blocker 
anti-adrenergic drugs 
vasodilators
 mineralocorticoid receptor antagonist
75
Q

Calcium channel blocker’s classes

A

Dihydropyridines

Benzothiazepines

Phenylakylamine

76
Q

Dihydropyridines

A

Nifedipine XL
amlodipine
Felodipine

77
Q

Benzothiazepines

A

Diltiazem

78
Q

Phenylakylamines

A

Verapamil

79
Q

Angiotensin converting enzyme inhibitors

A

Captopril
Lisinopril
Enalapril
Ramipril

80
Q

Angiotensin receptor blocker

A

Losartan

Valsartan

81
Q

Diuretics

A

Thiazide
Loop acting
Potassium sparing

82
Q

Thiazide diuretics

A

Hydrochlorothiazide

83
Q

Loop acting diuretics

A

Furosemide

84
Q

Potassium sparing diuretics

A

Spironolactone
Triamterene
Amiloride

85
Q

Anti-adrenergic agent

A 
Central acting
 Autonomic ganglia 
nerve ending 
alpha receptors 
Beta receptors
A-B receptors blockers
86
Q

Anti-adrenergic central

A

Clonidine

Methyl DOPA

87
Q

Autonomy ganglia anti-adrénergic

A

Trimetaphan

88
Q

Nerve ending anti adrenergic agent

A

Guanethidine

89
Q

Alpha Receptors anti-adrénergic agents

A

Phentolamine
Phenoxy benzamine
Prazocin
Doxazocin

90
Q

Beta receptor anti Adrenergic agents

A

Propanolol
Metoprolol
Nadolol
Atendol

91
Q

a-b receptors anti adrénergic agents

A

Labetalol

Carvedilol

92
Q

vasodilators

A

Hydralazine
Minoxidil
Nitropuside

93
Q

Mineralo corticoid receptor blocker’s

A

Spironolactone

Eplerenone

Cardiovascular Module (21 decks)

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