Hypertension

Question 1

What is hypertension

Answer 1

Hypertension is known as high blood pressure, it is asymptomatic and known as a silent killer. A condition where the pressure in the blood vessels are persistently elevated above normal range.
Normal range in adult males:120/90
Normal range in adult females:120/80

Question 2

Who’s most likely to suffer from hypertension?

Answer 2

• Older people
• Adult males
• Black people

Question 3

Why are more people being diagnosed with hypertension?

Answer 3

There is an increasing prevalence as people are making poorer lifestyle choices, e.g., more obese people in the UK due to more processed food consumption. We also have an aging population

Question 4

What are the dangers of hypertension?

Answer 4

It is asymptomatic, most cases of HT is discovered by accident. It is often an indication of another condition

Question 5

What is blood pressure controlled by?

Answer 5

It is controlled by the medulla oblongata which uses hormones as well as nerves to cause and increase/ decrease on BP
BP is detected by baroreceptors in the carotid arteries and in the aortic arch. When baroreceptors are stretched they send a signal to the medulla which coordinates a response

Question 6

Describe the Renin angiotensin aldosterone system

Answer 6

Renin is released at the entrance to the renal artery. The release of renin is stimulated by a lack of blood flow to the kidneys.
Renin converts angiotensinogen to angiotensin 1.
Angiotensin 1 then circulates the body & is converted to angiotensin 2 in the lungs causing vasoconstriction & activating thirst receptors as well as aldosterone
Aldosterone regulates Na+ & H2O, it makes you reabsorb salt & therefore water.

Question 7

What are the 5 types of hypertension

Answer 7

• Primary/essential
• secondary
• whitecoat
• malignant
• masked

Question 8

Define primary hypertension

Answer 8

Primary hypertension is where there is no known cause for hypertension, it could be a accumulation of factors e.g., genetic & environmental.
e.g., hereditary, obesity, high intake of salt in diet
90% of hypertension is primary
Low birth weight is also associated with primary hypertension
It cannot be cured, but can be controlled

Question 9

Define secondary hypertension

Answer 9

Secondary hypertension accounted for 10% of HT cases. This HT is diagnosed due to identifiable factors e.g., renal diseases
Treatment for 2nd HT is treatment of main diagnosis

Question 10

Define white coat hypertension

Answer 10

This is a falsely given high reading during taking of BP. likely due to nerves or stress of being at the doctors office

Question 11

Define Malignant hypertension

Answer 11

This is where patients have a systolic above 180mmHg & a diastolic BP above 120mmHg, this is considered an emergency, this can lead to permanent organ damage without treatment

Question 12

Define Masked hypertension

Answer 12

This a an inverse of whitecoat HT, where no problems are present during the BP reading and spikes later
Use of a portable BP monitor to be worn all day to diagnose masked HT

Question 13

What is the equation to calculate blood pressure

Answer 13

BP= cardiac output x peripheral resistance

Question 14

What factors influence Cardiac output?

Answer 14

• Stroke volume (influenced by venous return & contractility)
• Heart Rate

Question 15

What factors influence peripheral resistance?

Answer 15

• Circulating regulators
• Local regulators
• Blood viscosity
• Direct innervation

Question 16

What reading do you need to be considered hypertensive in the UK?

Answer 16

140/90
140 systolic
90 diastolic

Question 17

What are the long term effects of hypertension?

Answer 17

It can lead to permanent organ damage e.g.:
- Damage to kidneys leading to renal failure

• Damaged retina in eyes leading to hemorrhages/ blindness
• Damage to the brain causing a stroke

Question 18

Define hypertrophy

Answer 18

the enlargement of an organ or tissue from the increase in size of its cells:

Question 19

Define aortic dissection

Answer 19

Where the endothelium becomes torn, blood then rushes in causing the endothelium & myocardium to be split
Endothelium is ripped away from smooth muscle

Question 20

Define ischaemia

Answer 20

A restriction of blood supply to any tissue

Question 21

Define vascular hypertrophy

Answer 21

A condition where the smooth muscle of blood vessels are enlarged to cellular expansion, can be caused by stress
It can cause an increase in peripheral resistance & BP

Question 22

Define Afterload

Answer 22

The pressure against which the heart has to pump the blood. The pressure caused on the other side of the aorta
An increase in afterload reduces stroke volume

Question 23

What are the lifestyle treatments for hypertension?

Answer 23

• Changes in diet e.g., low salt diet, reduced caloric intake
• Regular exercise to aid in weight loss
• weight loss, reducing fat around the abdomen, can aid in causing a drop in blood pressure
• Stop or cut down on smoking
• Drink alcohol in moderation
• Eat a balanced diet

Question 24

What are the pharmacological treatments for hypertension?

Answer 24

• Diuretics to remove excess fluid and sodium, reducing volume in blood vessels,
• Beta-blockers: These block beta receptors found in the aortic arch & carotid arteries, stopping the effects of circulating adrenaline that can cause vasoconstriction
• CCB: calcium channel blockers used to stop contraction of smooth muscle in arterioles, preventing vasoconstriction
• ACE/ARBS: these affect RAS system, ACE enalapril stops angiotensin1 from converting to angiotensin 2. ARB’s block angiotensin receptors
• Nitrates can also be used to induce vasodilation