Hypertension

Question 1

What pathology does HT predispose in the medium arteries?

Answer 1

Berry aneurysms

Question 1

What should you do when HT is diagnosed in a patient?

Answer 1

Look for a secondary cause

Assess risk factors

Look for organ damage

Formulate a treatment plan

Question 2

T/F Atherosclerosis doesn’t cause hypertension

Answer 2

False, there is one circumstance when it can

• when renal arterioles are affected > hypofusion of kidneys > activation of RAAS > HT

Question 3

Why does the aorta harden with age?

Answer 3

Fragmentation of elastin and increased deposition of collagen in the media

Increased collagen in the intima

Question 3

Which proteins get deposited in hyaline arteriolosclerosis?

Answer 3

Albumin and fibrin predominantly

Question 3

Which pathological process is responsible for most coronary artery occlusions in MIs? (eg is it emboli)

Answer 3

Atherosclerosis with thrombosis

Question 3

What is the pathogenesis of microangiopathic hemolytic anemia

Answer 3

RBCs are physically damaged by fibrin mesh (from clotting) in small vessels

Question 3

How can malignant HT cause encephalopathy?

Answer 3

Failure of autoregulation of blood supply to the brain > Hyperperfusion > Cerebral oedema

Question 4

How does having HT affect the development of hyaline arteriolosclerosis?

Answer 4

Increases its development

Question 6

T/F Resistance in large arteries has the greatest affect on BP

Answer 6

False, resistance of arterioles does

Question 8

What percentage of hypertension is primary?

Answer 8

90-95%

Question 8

What are some secondary causes of hypertension?

Answer 8

Renal - eg diabetic glomerulosclerosis

Endocrine - eg adrenocortical adenoma producing cortisol

Vascular - eg coartation of the aorta

Medications

Question 9

What are the BP cut offs for hypertension?

Answer 9

>140mmHg systolic

>90mmHg diastolic

Question 11

What percentage of Australians are predicted have hypertension or are being treated for hypertension?

Answer 11

30%

Question 12

What are three complications of aortic dissection?

Answer 12

Haemoperidium (blood flows back towards the heart and into the pericardium)

Rupture of wall

Extension of dissection leading to compression of a branch

Question 12

Is reduction in lumen size a factor in the cause of heart failure due to concentric hypertrophy?

Answer 12

No

• Impairing diastolic filling
• Increasing the myocardial oxygen demand
• Reducing the coronary perfusion pressure gradient

Are more important

Question 14

What pathology does HT predispose in the arterioles?

Answer 14

Hyaline arteriolosclerosis

Question 16

What is the difference between benign and malignant hypertension?

Answer 16

Benign isn’t v. high and develops slowly

Malignant is v. high and can develop quickly

Question 17

Name some of the factors that contribute to the development of primary hypertension

Answer 17

Genetics eg sympathetic responses

Lifestyle eg obesity

Age

Gender

Race eg higher in black people

Question 19

What effect does hyaline arteriolosclerosis have on BP?

Answer 19

Slight increase

Question 21

What is the effect of age related hardening of the aorta on BP?

Answer 21

Causes increased BP

Question 22

In which layer of artery walls does blood sit in aortic dissection?

Answer 22

The medium - it’s the only layer strong enough

Question 23

What are two causes of stroke?

Answer 23

Embolism

Haemorrhage

Question 24

What is the difference between primary and secondary hypertension?

Answer 24

Secondary has an identifible cause whereas primary does not