Hypertension

Question 1

What is the pathophysiology of essential hypertension?

Answer 1

Increased vascular resistance leading to increased cardiac output

Question 2

What lifestyle and physical factors contribute to hypertension which should be asked about in the history?

Answer 2

BMI (including hypercholesterolaemia), Exercise, Sedentary lifestyle, Smoking, Family history (including diabetes)

Question 3

What are the five most important causes of secondary hypertension and the mechanisms for each cause?

Answer 3

• Renal: Hypoperfusion: Activation of RAAS, retention of salt and water, owing to renal impairment in excretory
function leading to increased blood volume
• Endocrine: Hyperaldosteronism, thyroid or parathyroid disease, cushings, pheochromocytoma, hyperthyroidism
and acromegaly
• Coarctation: Causes renal hypoperfusion
• Neurogenic: Intracranial pressure
• Medications: Oral contraceptives, estrogen, appetite suppressants, chronic steroids, TCA’s, NSAIDs,
decongestants.
• Diabetes complications (diabetic nephropathy). Diabetes can damage your kidneys’ filtering system, which can
lead to high blood pressure.

Question 4

Retina

Answer 4

Haemorrhage, tortuous vasculature, ripping, papilloedema

Question 5

Left ventricle

Answer 5

LVH, LVF, MI, CHF

Question 6

Kidneys

Answer 6

Nephrosclerosis, CRF

Question 7

Lenticulostriate arteries in the brain (small vessels to deep white matter) which lead to ischemic and
haemorrhagic stroke

Answer 7

TIA, encephalopathy

Question 8

How do you diagnose left ventricular hypertrophy on ECG?

Answer 8

S wave in V1 + R wave V5/V6 > 35mm

Question 9

What are the changes on ECG in left ventricular strain and in which leads do they occur?

Answer 9

ST depression, T inversions. I, aVL, V5-V6