Hypertension

Question 1

____________is the most important risk factor for many cardiovascular diseases?

Answer 1

Elevated blood pressure

Question 2

What is the estimated prevalence of hypertension in the African region?

Answer 2

30.8%

Question 3

76.2 million Nigerians are hypertensive but only about 23 million are on treatment.
True or False?

Answer 3

True

Question 4

The projected global prevalence by 2025 is 29.2% (1.54 billion)
[_______for males and _______ for females]

Answer 4

29% for males and 29.5% for females.

Question 5

80% of this burden will be in developed countries.
True or False?

Answer 5

False. 80% of the burden will be from emerging/developing countries.

Question 6

The rising prevalence in emerging countries is largely due to _________.

Answer 6

Lifestyle

Question 7

What was the prevalence of hypertension in Nigeria in 1999 and 2020?

Answer 7

12%
32.5% respectively.

Question 8

In Nigeria, HTN with its complications accounts for 25% of emergency medical admission in urban hospitals.
True or False?

Answer 8

True.
HTN ranks first among CVDs, accounting for 25% of emergency medical admission in urban hospitals in Nigeria.

Question 9

Briefly discuss the factors that control Mean Arterial Pressure (MAP)

Answer 9

MAP is dependent on 2 main physiological factors:
1. Cardiac Output
2. Total Peripheral Resistance

1. Cardiac Out put is dependent on 2 things:
   a. Stroke volume (SV), which is
   dependent on:
   i. venous return, which is in turn
   dependent on
   > blood volume
   > respiratory pump
   > skeletal pump
   b. Heart Rate (HR), which is affected
   by:
   i. sympathetic and,
   ii. parasympathetic control
2. Peripheral Resistance
   a. vascular tone:
   i. sympathetic and,
   ii. metabolic control
   b. blood viscosity

Question 10

What is systolic blood pressure?

Answer 10

Pressure in the arteries when the heart is beating.

Question 11

What is diastolic blood pressure?

Answer 11

Pressure in the arteries when the heart is resting in between beats.

Question 12

As many as 2.8 million children also have high blood pressure.
True or False?

Answer 12

True

Question 13

What are the classifications of HTN

Answer 13

1. Primary hypertension: This, also called essential hypertension, is hypertension that has no obvious or identifiable cause i.e. it is not a result of an underlying condition. It results from an inter-play of genetic and environmental factors.
2. Secondary hypertension: This occurs as a result of underlying health conditions.

Question 14

What is the aetiopathogenesis of Primary hypertension

Answer 14

i. Multifactorial
ii. Genetic causes
iii. Sodium sensitivity
iv. Potassium deficiency
v. High oxidative stress
vi. Reduced endothelin-derived vasodepressor agents e.g. nitric acid and prostacyclin
vii. Increased endothelin-derived vasoconstrictor agents e.g. endothelin, dopamine, thromboxane and adrenaline.

Question 15

Mention 6 causes of secondary hypertension.

Answer 15

i. Primary aldosteronism
ii. Renal disease
iii. Prolonged steroid therapy and Cushing’s Syndrome
iv. Pheochromocytoma (tumor of the adrenal gland)
v. Coarctation of the aorta (a congenital narrowing of the aorta)
vi. Hyperthyroidism or hyperparathyroidism

Question 16

Mention 6 complications of hypertension

Answer 16

i. Arteriosclerosis
ii. Stroke
iii. Enlarged heart
iv. Blindness
v. Kidney damage
vi. Heart attack

Question 17

What are the risk factors for HTN?

Answer 17

> Non-modifiable
1. Age
2. Male sex
3. Post-menopause
4 Black race
5. Family history

> Modifiable
6. Elevated LDL
7. Decreased HDL
8. Diabetes

> Behavioural
9. Diet
10. Stress
11. Sedentary lifestyle
12. Smoking
13. Alcohol intake
14. Obesity
15. Poor sleeping habits

Question 18

The following risk factors have been identified as the major obstacles in hypertension treatment in Africans. They are:

Answer 18

i. High sodium intake (Africans are salt-sensitive)
ii. Low potassium intake
iii. Obesity
iv. Physical inactivity

Question 19

What are some clinical manifestations of HTN?

Answer 19

Although HTN usually produces no specific complaints or manifestations other than elevated systolic and/or diastolic BP, some signs may include:
i. Morning occipital headache
ii. Dizziness
iii. Fatigue
iv. Epistaxis (nosebleed) and blurred vision may happen in severe hypertension.

Question 20

Home measurement of greater than ____ is considered to be hypertensive.

Answer 20

greater than 135/85 mmHg

Question 21

What are three precautions that must be taken when measuring a patient’s BP?

Answer 21

1. Patient must be seated for at least 5 minutes in a chair, with feet on the floor and arm supported at heart level.
2. An appropriate-sized cuff ( cuff bladder encircling at least 80% of the arm) must be used.
3. At least 2 measurements must be taken.

Question 22

List the laboratory tests performed to investigate hypertension

Answer 22

Routine Tests
1. Electrocardiogram
2. Urinalysis
3. Blood Glucose
4. Serum potassium, calcium, creatinine or the corresponding eGFR
5. Lipid profile (9 to 12-hr fast prior)

Optional Test
1. Albumin/Creatinine ratio

Question 23

What are the goals of therapy in hypertension treatment?

Answer 23

1. To reduce cardiac and renal morbidity and prevent mortality
2. To reduce BP below 140/90 mmHg in all patients
3. To reduce BP below 130/80 in patients with diabetes, CKD, high added risks and compelling diseases, such as stroke, myocardial infarction, renal dysfunction and proteinuria.

Question 24

What are lifestyle modifications adopted in the treatment of HTN?

Answer 24

1. Weight loss
2. Increase physical activity
3. Reduce salt intake [no more than 100mmol/day ( 2.4g of sodium or 6g of sodium chloride]
4. Stop smoking
5. Limit alcohol intake
6. Limit cholesterol intake
7. Adequate potassium intake

Question 25

What are the corresponding SBP reduction ranges for the following lifestyle modifications?

Weight reduction
DASH eating
Dietary sodium reduction
Physical activity
Moderation of alcohol consumption.

Answer 25

Moderation of alcohol consumption 2-4 mmHg
Dietary sodium reduction 2-8 mmHg
Physical activity 4-9 mmHg
Weight reduction 5-20 mmHg/10kg
DASH eating 8-14 mmHg

Question 26

What is the pharmacotherapy objective of HTN treatment?

Answer 26

1. Use of drugs that will achieve predictable and sustained BP reduction
2. Use of drugs that will confer protection to target organs
3. Use of drugs with good safety profile
4. Target BP should be140/90 mmHg or lower
5. Target BP is below 130/80 in patients with diabetes, CKD, high added risks and compelling diseases, such as stroke, myocardial infarction, renal dysfunction and proteinuria.