Hypertension

Question 1

What is Essential (Primary) Hypertension and its implicated factors?

Answer 1

No identifiable cause of high blood pressure.
* Obesity
* Insulin resistance
* High alcohol intake
* High salt intake (in salt-sensitive patients)
* Aging
* Sedentary lifestyle
* Stress
* Low potassium intake
* Low calcium intake

Question 2

What is Non-Essential (Secondary) Hypertension and its causes?

Answer 2

• Renal artery stenosis= narrowing of one or both renal arteries. About 90 percent of RAS is caused by atherosclerosis
• Chronic renal disease= main causes are diabetes and high blood pressure, also glomerulonephritis, polycystic kidney disease
• Primary hyperaldosteronism= adrenal glands produce too much aldosterone – increased Na+ retention and increased blood volume
• Stress= Hormonal release (adrenaline, cortisol
• Sleep Apnea= Changes in O2 levels causes increased BP
• Hyper- or hypothyroidism= Changes in thyroxine levels
• Pheochromocytoma= tumour of the adrenal glands, excess production adrenaline
• Preeclampsia= High blood pressure in pregnancy
• Aortic coarctation= narrowing in the aorta
• Drugs= Oral contraceptives, antidepressants, cocaine

Question 3

What is stage 1 hypertension?

Answer 3

• Clinic BP is 140/90 mmHg or higher
• Ambulatory blood pressure monitoring (ABPM) daytime average or home blood pressure monitoring (HBPM) average blood pressure is 135/85 mmHg or higher

Question 4

What is stage 2 hypertension?

Answer 4

• Clinic BP is 160/100 mmHg or higher
• ABPM daytime average or HBPM average blood pressure is 150/95 mmHg or higher

Question 5

What is severe hypertension?

Answer 5

• Clinic systolic BP is 180 mmHg or higher
• Clinic diastolic BP is 110 mmHg or higher

Question 6

What are the cardiovascular diseases associated with chronic hypertension?

Answer 6

• Atherosclerosis
• Cardiomyopathies
• Cardiac Failure
• Vascular Disease

Question 7

How does the autonomic nervous system effect/ cause hypertension?

Answer 7

Parasympathetic
* Decreased vagal tone
* Muscarinic receptors . Decrease heart rate / vasodilation (M2-heart; M3 blood vessels)
Sympathetic
* Heart
* Beta1 – increased rate and force contraction
* Vascular
* Alpha 1 vasoconstriction
* Beta 2 vasodilation
* Renal/hormonal
* Adrenal gland - adrenaline/noradrenaline

Question 8

What does the SNS so to the heart?

Answer 8

• SNS accelerates (+) heart’s actions leading to:
• Increased chronotropic effect (increase in rhythm)
• Increased impulse conduction (tachycardia)
• Increased inotropic effect (force of contraction)

Question 9

What does RAAS (Renin-angiotensin-aldosterone system) so in the body?

Answer 9

• regulate blood pressure and fluid balance during for example instances of hypovolemia or blood loss
• There are three mechanisms by which this system can be activated:
  1. Baroreceptors with the carotid sinus can detect decreases in blood pressure
  2. Decrease in sodium chloride concentration
  3. Decreased rate of blood flowthrough the macula densa

Question 10

What do ACE inhibitors do?

Answer 10

Decrease production ATII

Question 11

What are CCB (Calcium Channel Blockers)?

Answer 11

• CCBs block voltage gated L-Type channel(L=long-lasting) :
• Smooth muscle relaxation
• Cardiac muscle - negative chronotropic and inotropic effects

Question 12

What are some examples of CCBs?

Answer 12

Dihydropyridines (DHP)- Nifedipine, amlodipin
Non-dihydropyridines(NDHP)- Verapamil, diltiazem (NDHP Also block Ca2+ entry in GI smooth muscle - constipation)