Hypertension Flashcards
What is hypertension?
A level of sustained arterial pressure that is higher than expected for the age, sex and ethnicity of the individual
Bloof pressure higher than ___/__mmHg is classified as hypertension and is treated
140/90
Hypertension is a risk factor for what?
- Cerebral haemorrhage
- Aneurysm
- Atheroma
- Renal failure
- Sudden cardiac death
What are the two classifications of hypertension?
- Primary
- Secondary
What is primary hypertension?
Hypertension with an unknown cause (idiopathic)
What is secondary hypertension?
Hypertension as a result of another condition
How is MABP calculated?
MABP = CO x TPR
or
MABP = (2 x systolic + diastolic)/3
What three main factors can alter blood pressure?
- HR
- Contractility
- Blood volume
Total peripheral resistance is increased by which factors?
Vasoconstrictors
(angiotensin II, catechloamines)
Total peripheral resistance is decreased by which type of factor?
Vasodilators
(nitric oxide, prostaglandins)
What may be the cause of primary hypertension?
- Genetics
- Salt intake
- Protein intake
Causes of secondary hypertension may include?
**mnemonicROPE
Renal disease
OBesity
* Endocrine disease
* Aortic disease
* Renal artery stenosis
* Drug therapy
Why can renal functioning be a cause of hypertension?
If disease is present such as renal artery stenosis, interstitial nephritis or glomerulitis.
This will lead to reduced renal blood flow
Excess renin release
Salt and water overload in the blood (increased retention)
What is benign hypertension?
Hypertension with no harmful symptoms
What may benign hypertension eventually cause, even if it has no direct effects?
- Left ventricular hypertrophy
- Congestive heart failure
- Renal disease
- Aneurysm rupture
Why is hypertension bad for the heart?
Increased presssure damages the heart causing it to undergo fibrosis and the contractile ability will decrease
What is microvascular injury and how is hypertension involved?
Hypertension can cause microvascula rinjury in small vessels
Thickening of the tunica media occurs as the arteries try to cope with the pressure
Hyaline arteriosclerosis occurs which involves plasma proteins and excessive extracellular matrix (from smooth muscle cells) being forced into the endothelial walls
This is associated with hardening of the arteries
What medical condition can occur as a result of preganancy associated hypertension?
Eclampsia
(convulsions and potential coma)
What are some risk factors for hypertension?
-
ROPE:
- R – Renal disease. renal artery stenosis.
- O – Obesity
- P – Pregnancy induced hypertension / pre-eclampsia
- E – Endocrine, hyperaldosteronism (“Conns syndrome”
What device can be used to confirm the diagnosis of hypertension?
Abulatory blood pressure monitor
(or home blood pressure monitor)
What is stage 1 hypertension?
Clincal BP - 140/90mmHg
ABPM/HBPM - 135/85mmHg
What is stage 2 hypertension?
Clinical BP - 160/100mmHg
ABPM/HBPM - 150/95mmHg
Severe hypertension is classed as systolic blood pressure exceeding ___mmHg or diastolic exceeding ___mmHg
180
110
What is the white coat effect?
When a patient will record a higher than normal BP reading in clinic
What is masked hypertension?
When a patient records a lower blood pressure reading in clinic than normal so high BP is not necessarily diagnosed
Which tests can be used to diagnose hypertension?
- Urine test (presence of protein)
- Blood test (glucose, electrolytes, creatinine, estimated glomerular filtration rate and cholesterol)
- Examine fundi for hypertensive retinopathy
- 12 lead ECG
What is a funduscopy?
A test using an ophthalmoscope to see inside the retina of the eye to examine for hypertensive retinopathy
What are some secondary causes of hypertension?
- Renal disease
- Obstructive sleep apnoea
- Aldosteronism
- Reno-vascular disease
- Uncommon causes include:
- Cushing’s, Pheochromocytoma, hyperparathyroidism, aortic coarction, intercranial tumour
What is fibromuscular dysplasia?
Abnormal growth within blood vessel walls
Can affect renal and carotid arteries
Affects younger women most commonly
Reducing CV risk has which two main areas to target?
- Lifestyle factors
- Pharmacotherapy
In the event of resistant hypertension, there can be numerous causes. List some of these and the drug which may be used if the condition is genuine
- Not taking medication
- Lifestyle factors
- Drug interactions
- Genuine resistance
Spironolactone - a diuretic can be used in genuine cases
using two drugs will lower the side effect of each other True / False
True
A patient comes back to the doctor’s office for a follow-up, their main complaint was severe headaches and palpitations they claim that their bp was 135/85 when they measured, you take their blood pressure and it is 110/70, what is your next approach?
Put them under 24 hour ambulatory bp monitoring (ABPM )
A patient presents with tachycardia and hypertension, he’s having tremors and you observe his nose bleeding, what is the diagnosis and cause of his symptoms?
Secondary HTN, Intake of cocaine
How do you treat patients who have hypertension but the renin level is low?
Diuretics
A 40 year old female patient comes to you presenting with obesity, buffalo hump and moon face, you check her glucose levels and they are high, she also has hypertension. What is the most likely cause of that high blood pressure?
Hypercortisolism
Which mechanism leads to hypertension in patients with hyperparathyroidism?
increase total resistance lead to increase BP
A 60 y.o. male patient present with altered mental status and dyspnea. Physical exam reveals blood pressure of 185/135mmHg and rales on lung auscultation. It was revealed that the patient has hypertension over 15 years. He was prescribed losartan to control the hypertension in the past 10 years regularly. But he stopped taking the medicine regularly a year ago. Chest X-Ray reveals pulmonary edema and cardiomegaly. EKG was taken and revealed atrial fibrillation with RBBB pattern. Urinalysis shows hematuria and albuminuria.
what is the type of hypertension? and Why ?
Sever Hypertension because
The patient had super high blood pressure
b) The patient had chronic hypertension
c) The patient had evidence of organ failure shown by urinalysis (hematuria and albuminuria)
d) The patient had possibly diastolic heart failure due to having rales on lung auscultation
????
