Hypertension

Question 1

What is hypertension

Answer 1

When systolic and diastolic values rise above specific treshold particular to age, gender, race

Question 2

Risk factors of hypertension

Answer 2

Age
Gender
Black race
Weight
Physical activity
Smoking
Family hx
Serum cholesterol
Diabetes mellites
Pre existing vascular dx

Question 3

Optimal BP

Answer 3

Less than 120/80

Question 4

Normal BP

Answer 4

Less than 130/85

Question 5

Highly normal BP

Answer 5

130-139/85-89

Question 6

Grade 1 hypertension

Answer 6

140-159/ 90-99

Question 7

Grade 2 hypertension

Answer 7

160-179 / 100-109

Question 8

Grade 3 hypertension n

Answer 8

More than 180/110

Question 9

Grade1 isolated systolic hypertension

Answer 9

140-159/ less than 90

Question 10

Grade 2 isolated systolic hypertension

Answer 10

More than 160/ less than 90

Question 11

Causes of secondary hypertension

Answer 11

Alcohol
Obesity
Pregnancy
Renal disease (glomerulonephritis, renal vascular dx, PCK dx)
Phaechromocytoma
Cushing syndrome
Primary hyperaldosteronism
Glucocorticoid suppresible hyperaldosteronism
Hyperparathyroidism
Thyrotoxicosis
Congenital adrenal hyperplasia
Liddles syndrome
Drugs
Aortic coarctation

Question 12

Percentage of idiopathic hypertension

Answer 12

95%

Question 13

Consequence of hypertension on large arteries

Answer 13

Thickened internal elastic lamina
Hypertrophied smooth muscles
Fibrous deposition
Dilated vessels that become tortuous with less compliant wall

Question 14

Consequence of hypertension on small arteries

Answer 14

Hyaline atherosclerosis
Lumen narrowing and aneurysm possible

Question 15

Why is there RAAS activation in hypertension

Answer 15

Increase in peripheral vascular resistance leading to decreased renal blood flow which activates RAAS

Question 16

Event that can lead to acute rise in BP

Answer 16

Intracranial ischemia of brainstem due to pressure leading to BP rise

Fluid overload

Underlying dx ( renal dx, spinal injury, metabolic dx, pregnancy , pre eclampsia )

Primary cardiac dx ( Myocardial ischemia , acute heart failure , aortic dissection

Drugs ( missed antihypertensive, cocaine, amphetamines)

Question 17

Main presentation of hypertension

Answer 17

Asymptomatic

Question 18

Findings on examination when hypertension

Answer 18

Radio femoral delay if aorta coarctation

Enlarged kidney if PKD

Abdominal bruits if renal artery stenosis

Face is and habitus of Cushing syndrome

Central obesity

Hyperlipidemia ( xanthomas, xantholesma )

LVF in severe hypertension

Question 19

Goal of investigation in hypertension

Answer 19

Confirm diagnosis by having accurate , representative BP measurements

Identify Contributory factors and underlying causes

Assess risk factors and cardiovascular risks

Detect present complications

Identify Comorbidities that can influence choice of antihypertensive

Question 20

4 mechanisms responsible for hypertension

Answer 20

1. Increase in sympathetic nervous system activity
2. Increase in Renin-angiotensin-aldosterone system activity
3. Increase in salt retention
4. Change in vessel wall integrity

Question 21

Types of hypertension

Answer 21

Primary
Secondary

Question 22

Causes of primary hypertension

Answer 22

•
1. Genetic factors. BP tends to run in families.
2. Fetal factors. Low birth weight is associated with subsequent high BP.
3.Environmental factors such as obesity, alcohol intake, sodium intake and stress.
4.Humoral mechanism. ( i.e.. RAAS and SNS)
5. Insulin resistance. There is an association between diabetes and hypertension and a sy been described of hyperinsulinemia, glucose intolerance,
reduced level of HDL cholesterol, hypertriglyceridemia and central obesity.
metabolic syndrome

Question 23

Causes of secondary hypertension

Answer 23

1. Renal dx. 80% - glomerulonephritis, diabetic nephropathy, etc.
2. Endocrine causes such as Cushing’s syndrome, acromegaly, Conn’s syndrome, phaeochromocytoma, etc.
   3.Congenital cardiovascular cause. With major cause as coarctation of the aorta.
   4.Drugs. E.g. Oral contraceptives containing estrogens, anabolic steroids, corticoster sympathomimetic agents, etc.
3. Alcohol
   6.Obesity
4. Pregnancy ( pre-eclampsia)

Question 24

Complications of hypertension

Answer 24

1. Heart (Heart attack, Left ventricular hypertrophy, MI, Coronary artery da
2. Brain (Stroke, TIA, Hypertensive encephalopathy, Dementia)
3. Eyes (Retinopathy, Blindness)
4. Kidney (Chronic kidney dx)
5. Vasculature (PAD, Aneurysm)

Question 25

Baseline Investigations

Answer 25

Investigations done for all patients.
1.Urinalysis for blood, protein and glucose
2.Blood urea, electrolytes and creatinine
3. Blood glucose
4. Serum total and HDL cholesterol
5. Thyroid function test
6. ECG