Hypertension

Question 1

Define hypertension

Answer 1

• Mild = 140-159/ 90-99
• Mod = 160-179/ 100-109
• Severe = 180+/ 110+

Question 2

Define primary & secondary hypertension

Answer 2

Primary - no known cause

Secondardy - known cause (ie Renal vascular disease)

Question 3

Outline some causes of secondardy hypertension & their pathophysiology

Answer 3

Pheochromocytoma

• Inc adrenaline causes inc HR & vasoconstricting (raising TPR)

Renal vascular disease

• Low perfusion increases H20 retention increasing blood volume

Question 4

What changes occur to muscular arteries in hypertension?

What effect does this have?

Answer 4

Increased muscular layer (media)
Decreased lumen size

Reduces blood supply, causing ischaemia

Question 5

Define Malignant hypertension

Outline the effects of malignanct hypertension

Answer 5

Sudden & rapid developent of hypertension

Sys >200/Dias >130

• Eyes - papilloedema, haemorrhage, exudates
• Brain - RICP
• Heart - LV strain
• Kidneys - haematouria, proteinura, AKI

Question 6

Outline the lifestyle treatment for Hypertension

Answer 6

• Lifestyle
  
  • Diet (low Na+)
  • Physicle exercise

Question 7

Outline the medical treatment for Hypertension

Answer 7

ABCD

• ACEi
  
  • ​DM, CCF, Post MI
  • Young white
  • SE: angiooedema, cough, ↑K⁺, ↓Na⁺, ↑creatinine
• B-blocker​
  
  • Young, white, in;
    
    • HF [Carvediolol]
    • Angina & MI [Attenolol]
    • Aortic dissection [Labetalol]
  • Young white
  • SE: ↓HR & ↓BP, ↑phosopholipids, ↑depression, ↑COPD/asthma, ↑K⁺
• Ca²⁺ channel blocker
  
  • ​Elderly afroamericans
  • SE; oedema, constipation, HF
    
    • Dihydropyridines [nifedipine, amlodipine] - peripheral vasodilation, ↑HR
    • Non-dihydropyridines [diltiazem, verapamil] - ↓inotrop/ contractility
• Diuretics
  
  • ​Elderly afroamericans
  • SE;
    
    • Thiazide [distal tubule eg metolazone] - ↓K⁺, ↑Ca²⁺, ↑Cr, ↑uricacid, ↑lipids, ↑glucose,
    • Loop [frusemide] - ↓K⁺, ↓Ca²⁺, ↑Cr