hypertension

Question 1

what is hypertension?

Answer 1

blood pressure that is >140/90mmHg

Question 2

what mechanisms is blood pressure controlled by?

problems with this can result in high blood pressure

Answer 2

Autonomic Nervous System
Capillary Fluid Shift Mechanism
Renin Angiotensin Aldosterone System (RAAS)
Adrenaline.

Question 3

what are stage 1 and 2 hypertension?

Answer 3

Stage 1 Hypertension = ABPM > or equal to 135/85mmHg

Stage 2 Hypertension = ABPM > or equal to 150/95mmHg

Question 4

what diseases cause hypertension?

Answer 4

Renal Disease (2nd most common cause):
- Renal Artery Stenosis
- Polycystic Kidney Disease

Endocrine Disease:
- Conn’s Syndrome
- Cushing’s Disease
- Acromegaly
- Phaeochromocytoma

Question 5

what is hypertension a major risk factor for?

Answer 5

stroke and heart attack

it accounts for 50% of vascular deaths

Question 6

what 6 specific conditions/signs should you look out for in hypertension patients?

Answer 6

Retinopathy
Renal Disease
Renal Bruits
Radio-femoral delay
Weak Femoral Pulses
Proteinuria

Question 7

what are 7 signs and symptoms?

Answer 7

Usually asymptomatic, unless it is very high (eg >200/120mmHg) then it can present with:

Chest Pain
Breathing
Difficulty
Headache
Palpitations
Fatigue
Vision problems

Question 8

what 7 investigations are used?

Answer 8

Sphygmomanometer (BP Cuff)

Blood - FBC, U&E’s, Glucose, Lipids, ANCA, Calcium, Phosphate, ANF, Autoantibody screen

ECG

ECHO

Urine Dipstick (Haematuria and Proteinuria)

Renal Ultrasound (and ultrasound of the bladder)

24 Hour Ambulatory BP Monitoring (ABPM)

Question 9

what are some reatments used?

Answer 9

Calcium Channel Blocker

ACE Inhibitor or Angiotensin Receptor Blocker (ARB)

Thiazide-type Diuretic (Then add on therapy eg. Spironolactone)

Surgery

General Advice:
Reduce salt intake
Exercise
Protein diet
Smoking Cessation
Reduce Alcohol
Weight Loss (every 1kg weight loss brings your BP down 2/1mmHg)

(Try to treat the underlying cause, if it can be identified)

(The goal of treatment is to get BP <140/90mmHg, but if diabetic then <130/80mmHg, but if aged >80 then <150/90mmHg)