Hypertension Flashcards
EPIDEMIOLOGY
i) what is the global prevalence?
ii) what % are people in most deprived areas likely to have HTN compared to less deprived?
iii) name four things HTN is a risk factor for
i) 22%
ii) 30% more likely
iii) heart attack, CKD, heart failure, dementia
BLOOD PRESSURE
i) what is it?
ii) what is the equation?
i) force exerted by circulating blood against arteries and blood vessels
ii) BP = CO x SVR (systemic vasc resis)
PATHOGENESIS OF HYPERTENSION
i) how is sympathetic tone affected?
ii) is CO increased or decreased?
iii) is periph vasc resistance inc or dec?
iv) what effect does renin have on water and sodium?
i) increased symp tone
ii) inc CO
iii) inc periph vasc resistance due to endothelial dysfunction
iv) renin causes increased water and sodium retention
CAUSES OF HYPERTENSION
i) what is the cause of >90% HTN?
ii) name three conditions associated with renal HTN? what is the most significant cause?
iii) name three causes of endocrine HTN? what is the most common?
iv) name four drugs that can cause HTN
v) what would be suspected if somone has HTN with high Na and low K+
vi) which congenital malformation can cause HTN?
i) essential HTN
ii) renal - renal artery stenosis (most signif), polycystic kidney disease, glomerulonephritis
iii) hyperaldo (most common), cushing, PCT, hypo/hyperthyroid, hyperparathyroid, acromegaly
iv) COCP, steroids, NSAIDs, herbal supps, cocaine, antideps, EPO, tacrolimus, ciclosporin
v) HTN with high na and low k = hypoaldo (conns)
vi) coarctation of aorta
HTN CAUSES AND ASSOCIATIONS
i) name four causal factors (take them away and can cure)
ii) name the four most signficant associations?
i) high BMI, >14units alcohol, excess salt, lack of exercise, stress, caffeine
ii) smoker, hyperlipid, diabtetes, low socioeconomic status
HYPERTENSION & PRIMARY HYPERALDOSTERONISM
i) is plasma renin low or high? why?
ii) what is the most common cause of hyperaldo?
iii) what type of mass can cause it?
iv) what Na and K levels will be seen?
v) what will the aldo:renin ratio be?
vi) will there be a metabolic acid or alkalosis?
i) low plasma renin because aldo has negative feedback on renin
ii) bilateral adrenal hyperplasia
iii) aldosterone prod adenoma (conns)
iv) Low serum K+ as aldo promotes K+ excretion
- high or normal Na+ (Na reabs but also water)
v) high aldo:renin ratio
vi) metabolic alkalosis as aldo causes HCO3- retention and H+ excretion
HTN & HYPERALDO INVESTIGATIONS/TX
i) which imaging should be ordered? what are you looking for?
ii) what is adrenal vein sampling used for?
iii) name two surgical treatments
iv) which medical tratment may be given?
i) CT/MRI adrenals to look for hyperplasia/adenoma
ii) adrenal vein sampling to look whether the lesion is active
- take blood from renal vein and compare with contralateral side
iii) laparoscopic adrenalectomy and radiofreq ablation
iv) spironolactone (mineralocorticoid R antag)
HTN AND HYPERALDO - HIGH PLASMA RENIN
i) why is renin high?
ii) give three things that cause this?
iii) what creatnine levels may be seen? why?
iv) is aldo:renin ratio high or low?
v) name two imaging techniques that can be used
i) high renin due to low kidney perfusion
ii) renal artery stenosis, coarctation of aorta and reninoma (benign tumour that prod renin)
iii) high creatnine (kidney impairment)
iv) aldo:renin ratio is low
v) MR renal angio to exclude renal artery stenosis
- CT renal angio/renal doppler
HTN AND HIGH RENIN HYPER ALDO
i) give four treatments
i) medical therapy, renal angioplasty, stent insertion, surgical repair
COMPLICATIONS OF HTN
i) what is arteriosclerosis? name a type that can cause HTN
ii) what is the main thing that HTN causes that can signficantly increase risk of death?
i) thickening of blood vessels
- athero is a type
ii) end organ damage
TARGET ORGAN DAMAGE
i) what may be seen in the eyes? how is this diagnosed?
ii) what is seen in the brain?
iii) what is seen in the heart?
iv) what is seen in the kidneys?
i) retinopathy - dx by fundoscopy
ii) encephalopathy, stroke
iii) pulm oedema and MI
iv) AKI
