Hypertension Flashcards
What is hypertension
When systolic and diastolic values rise above specific treshold particular to age, gender, race
Risk factors of hypertension
Age
Gender
Black race
Weight
Physical activity
Smoking
Family hx
Serum cholesterol
Diabetes mellites
Pre existing vascular dx
Optimal BP
Less than 120/80
Normal BP
Less than 130/85
Highly normal BP
130-139/85-89
Grade 1 hypertension
140-159/ 90-99
Grade 2 hypertension
160-179 / 100-109
Grade 3 hypertension n
More than 180/110
Grade1 isolated systolic hypertension
140-159/ less than 90
Grade 2 isolated systolic hypertension
More than 160/ less than 90
Causes of secondary hypertension
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
Percentage of idiopathic hypertension
95%
Consequence of hypertension on large arteries
Thickened internal elastic lamina
Hypertrophied smooth muscles
Fibrous deposition
Dilated vessels that become tortuous with less compliant wall
Consequence of hypertension on small arteries
Hyaline atherosclerosis
Lumen narrowing and aneurysm possible
Why is there RAAS activation in hypertension
Increase in peripheral vascular resistance leading to decreased renal blood flow which activates RAAS
Event that can lead to acute rise in BP
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)
Main presentation of hypertension
Asymptomatic
Findings on examination when hypertension
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
Goal of investigation in hypertension
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
4 mechanisms responsible for hypertension
- Increase in sympathetic nervous system activity
- Increase in Renin-angiotensin-aldosterone system activity
- Increase in salt retention
- Change in vessel wall integrity
Types of hypertension
Primary
Secondary
Causes of primary hypertension
•
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
Causes of secondary hypertension
- Renal dx. 80% - glomerulonephritis, diabetic nephropathy, etc.
- 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. - Alcohol
6.Obesity - Pregnancy ( pre-eclampsia)
Complications of hypertension
- Heart (Heart attack, Left ventricular hypertrophy, MI, Coronary artery da
- Brain (Stroke, TIA, Hypertensive encephalopathy, Dementia)
- Eyes (Retinopathy, Blindness)
- Kidney (Chronic kidney dx)
- Vasculature (PAD, Aneurysm)
Baseline Investigations
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
