hypertension

Question 1

what is a generalised and useful hypertension definition?

Answer 1

‘HT is that blood pressure at which the benefits of treatment with antihypersensitive drug reducing CV, cerebrovascular and peripheral vascular risk outweighs the risk of treatment

Question 2

what is the NICE BP requirement for hypertension?

Answer 2

140/90

Question 3

what are some of the morbidities associated with hypertension?

Answer 3

ischaemic heart disease and stroke (raised to 7% and 10% by just even increase by 2mmHg in BP) and 20mmHg doubles risk of CVD mortality

Question 4

name some risk factors in hypertension

Answer 4

myocardial infarction, heart failure, stroke, CVD (accounting for 41% of ALL CVD deaths)

Question 5

what is the requirement for stage 1 hypertension?

Answer 5

Clinic BP 140/90 or higher
ABPM daytime average 135/85 mmHg or higher

Question 5

what is the requirement for stage 1 hypertension?

Answer 5

Clinic BP 140/90 or higher
ABPM daytime average 135/85 mmHg or higher (do ABPM monitoring which is continuous over the day for more reliability)

Question 6

what is the requirement for stage 2 hypertension?

Answer 6

Clinic BP 160/100 or higher
ABPM daytime average 150/95 mmHg or higher

Question 7

stage 3 hypertension?

Answer 7

Clinic systolic BP 180/120mmHg or higher

Question 8

what are some of the most common secondary causes of secondary hypertension:

Answer 8

Chronic renal disease
Renal artery stenosis
Endocrine disease – Cushing’s, Conn’s syndrome ( Primary hyperaldosternism), Phaeochromocyoma

Question 9

what is the risk factor with the highest mortality?

Answer 9

inactivity

Question 10

what are the primary contributors to BP physiology?

Answer 10

CO = stroke vol. x heart rate, peripheral vascular resistance

Question 11

what does the SNS do to peripheral vascular resistance and CO?

Answer 11

vasoconstriction - increased PVR
reflex tachycardia and increased SV (increased CO)

Question 12

what does the the SNS stimulate the release of and what 2 things does this produce and their effect?

Answer 12

renin

it produces angiotensin 2 (a vasoconstrictor), think TENSE
aldosterone (causes salt and water retention which increases circulating blood volume)

Question 13

what is the renin angiotensin-aldosterone system (RAAS) responsible for?

Answer 13

Maintenance of sodium balance
Control of blood volume
Control of Blood pressure

Question 14

what stimulates the RAAS and where is renin released from in response to these?

Answer 14

fall in BP, circulating volume and sodium depletion

renin is released from the kidneys

Question 15

write down the steps of RAAS in response to stimulation

Answer 15

Renin converts angiotensinogen to angiotensin I
Angiotensin I is converted to angiotensin II by Angiotensin converting enzyme (ACE)
Angiotensin II is a potent vasoconstrictor and stimulates the release of aldosterone from the adrenal glands.

Question 16

the sodium homeostatic effect is one of the likely causes of hypertension, explain what is meany by this

Answer 16

kidneys are unable to secrete sodium and as a result it is retained and BP increases

Question 17

what are the steps of diagnosing and then dealing with hypertension in a patient?

Answer 17

confirm diagnosis - assess risk factors - assess end organ damage

Question 18

when should treatment for stage 1 hypertension be offered?

Answer 18

people younger than 80 with one or more of the risk factors and BP of 135/85

if younger than 40, assess for end organ damage

for elderly (55-80), target blood pressure is 145/85

Question 19

when should stage 2 hypertension be treated?

Answer 19

if over 150/95

Question 20

what treatment should patients over 55 or from African descent be treated with?

Answer 20

calcium channel blocker or thiazide

Question 21

what should patients under 55 be treated with?

Answer 21

ACE inhibitor or ARB

note: do not give to pregnant or African people

Question 22

How do Angiotensin Converting Enzyme Inhibitors (ACEI) work and give two examples?

Answer 22

they completely inhibit ACE which is helpful as this enzyme converts angiotensin 1 to active angiotensin which is a potent vasoconstrictor

ramipril and perindopril (any ending in -il)

Question 23

when should ACEI not be used?

Answer 23

renal artery stenosis, impaired renal functioning, hyperkalaemia, and fertile women