Hypertension

Question 1

What is hypertension?

Answer 1

A level of sustained arterial pressure that is higher than expected for the age, sex and ethnicity of the individual

Question 2

Bloof pressure higher than ___/__mmHg is classified as hypertension and is treated

Answer 2

140/90

Question 3

Hypertension is a risk factor for what?

Answer 3

1. Cerebral haemorrhage
2. Aneurysm
3. Atheroma
4. Renal failure
5. Sudden cardiac death

Question 4

What are the two classifications of hypertension?

Answer 4

1. Primary
2. Secondary

Question 5

What is primary hypertension?

Answer 5

Hypertension with an unknown cause (idiopathic)

Question 6

What is secondary hypertension?

Answer 6

Hypertension as a result of another condition

Question 7

How is MABP calculated?

Answer 7

MABP = CO x TPR

or

MABP = (2 x systolic + diastolic)/3

Question 8

What three main factors can alter blood pressure?

Answer 8

1. HR
2. Contractility
3. Blood volume

Question 9

Total peripheral resistance is increased by which factors?

Answer 9

Vasoconstrictors

(angiotensin II, catechloamines)

Question 10

Total peripheral resistance is decreased by which type of factor?

Answer 10

Vasodilators

(nitric oxide, prostaglandins)

Question 11

What may be the cause of primary hypertension?

Answer 11

• Genetics
• Salt intake
• Protein intake

Question 12

Causes of secondary hypertension may include?

Answer 12

**mnemonicROPE
Renal disease
OBesity
* Endocrine disease
* Aortic disease
* Renal artery stenosis
* Drug therapy

Question 13

Why can renal functioning be a cause of hypertension?

Answer 13

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)

Question 14

What is benign hypertension?

Answer 14

Hypertension with no harmful symptoms

Question 15

What may benign hypertension eventually cause, even if it has no direct effects?

Answer 15

• Left ventricular hypertrophy
• Congestive heart failure
• Renal disease
• Aneurysm rupture

Question 16

Why is hypertension bad for the heart?

Answer 16

Increased presssure damages the heart causing it to undergo fibrosis and the contractile ability will decrease

Question 17

What is microvascular injury and how is hypertension involved?

Answer 17

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

Question 18

What medical condition can occur as a result of preganancy associated hypertension?

Answer 18

Eclampsia

(convulsions and potential coma)

Question 19

What are some risk factors for hypertension?

Answer 19

• ROPE:
  
  • R – Renal disease. renal artery stenosis.
  • O – Obesity
  • P – Pregnancy induced hypertension / pre-eclampsia
  • E – Endocrine, hyperaldosteronism (“Conns syndrome”

Question 20

What device can be used to confirm the diagnosis of hypertension?

Answer 20

Abulatory blood pressure monitor

(or home blood pressure monitor)

Question 21

What is stage 1 hypertension?

Answer 21

Clincal BP - 140/90mmHg

ABPM/HBPM - 135/85mmHg

Question 22

What is stage 2 hypertension?

Answer 22

Clinical BP - 160/100mmHg

ABPM/HBPM - 150/95mmHg

Question 23

Severe hypertension is classed as systolic blood pressure exceeding ___mmHg or diastolic exceeding ___mmHg

Answer 23

180

110

Question 24

What is the white coat effect?

Answer 24

When a patient will record a higher than normal BP reading in clinic

Question 25

What is masked hypertension?

Answer 25

When a patient records a lower blood pressure reading in clinic than normal so high BP is not necessarily diagnosed

Question 26

Which tests can be used to diagnose hypertension?

Answer 26

* Urine test (presence of protein) * Blood test (glucose, electrolytes, creatinine, estimated glomerular filtration rate and cholesterol) * Examine fundi for hypertensive retinopathy * 12 lead ECG

Question 27

What is a funduscopy?

Answer 27

A test using an ophthalmoscope to see inside the retina of the eye to examine for hypertensive retinopathy

Question 28

What are some secondary causes of hypertension?

Answer 28

* Renal disease * Obstructive sleep apnoea * Aldosteronism * Reno-vascular disease * Uncommon causes include: * Cushing's, Pheochromocytoma, hyperparathyroidism, aortic coarction, intercranial tumour

Question 29

What is fibromuscular dysplasia?

Answer 29

Abnormal growth within blood vessel walls Can affect renal and carotid arteries Affects younger women most commonly

Question 30

Reducing CV risk has which two main areas to target?

Answer 30

1. Lifestyle factors 2. Pharmacotherapy

Question 31

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

Answer 31

* Not taking medication * Lifestyle factors * Drug interactions * Genuine resistance Spironolactone - a diuretic can be used in genuine cases

Question 32

using two drugs will lower the side effect of each other True / False

Answer 32

True

Question 33

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?

Answer 33

Put them under 24 hour ambulatory bp monitoring (ABPM )

Question 34

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?

Answer 34

Secondary HTN, Intake of cocaine

Question 35

How do you treat patients who have hypertension but the renin level is low?

Answer 35

Diuretics

Question 36

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?

Answer 36

Hypercortisolism

Question 37

Which mechanism leads to hypertension in patients with hyperparathyroidism?

Answer 37

increase total resistance lead to increase BP

Question 38

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 ?

Answer 38

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 ????