Hypertension Flashcards
What does a high BP (particularly systolic/pulse pressure) put you at risk of?
cardiovascular disease
What other CVD risk factors are often associated with hypertension?
diabetes, smoking, abnormal lipids, obesity
What are the cardiovascular diseases that are more likely with hypertension?
ischaemic heart disease, atherosclerosis, cerebrovascular disease, aortic dissection, renal vascular disease, small vessel disease of kidney, brain, and retina, heart failure
What is the definition of hypertension?
140/90
What is primary/essential hypertension?
hypertension with no specific identifiable cause
What percentage of hypertension is primary?
90-95%
What is secondary hypertension?
hypertension with a specific underlying cause
What is benign hypertension?
hypertension that rises slowly
What is malignant hypertension?
hypertension that is quickly developing and can get very high - may occur in someone who already has benign hypertension
What 2 forces result in blood pressure?
cardiac output (stroke volume and heart rate) and resistance in arterioles
What are age related arterial changes potentiated by?
high blood pressure
What happens to the aorta with age?
loss of elasticity and hardening, fragmented elastin in media and increased collagen in media and intima - aorta often dilates - stiffening leads to loss of compliance which increases BP
What happens to small and medium arteries with age?
fragmentation of elastin in media and increased collagen in media and intima causing intimal thickening
What happens to arterioles with age?
hyaline arteriolosclerosis - thickened wall with narrowed lumen - may cause increased BP with age
What genes contribute to the pathogenesis of hypertension?
sympathetic responses, transport of ions across cell membranes, arteriolar responses to local regulatory factors, activity components of RAAS
What lifestyle factors contribute to the pathogenesis of hypertension?
salt in diet, alcohol, physical activity, abdominal obesity and metabolic syndrome
What causes hypertension with wide pulse pressure?
decreased compliance of the aorta
What is the biggest cause of secondary hypertension?
renal disease
When does atherosclerosis cause hypertension?
ONLY in renal artery arteriosclerosis via activation of RAAS
What causes an aortic aneurysm?
atherosclerosis prevents blood from getting to the media which causes weakening which results in a focal dilation
Where is the blood in an aortic dissection?
in the media
What are the complications of an aortic dissection?
haemopericardium and cardaic tampenade, haemothorax, compression of common carotid causing stroke, compression of coronary arteries causing MI
What is the main cause of LV concentric hypertrophy?
hypertension
How does concentric hypertrophy cause diastolic failure?
impaired filling due to stiff wall
How does concentric hypertrophy cause systolic failure?
impaired contraction because of stiff wall
How does concentric hypertrophy cause risk of an MI?
increased oxygen demand and reduction in perfusion gradient due to increased pressure in wall
What do most patients with complications from hypertension die from?
cardiac complications
Why is hypertension a risk factor for end stage renal disease?
elevated pressure damages the glomerulus and hyaline arteriolosclerosis causes ischaemia
What is a marker of chronic kidney disease and a predictor of its progression?
proteinuria
What does a kidney in end stage renal disease look like macroscopically?
granular with cortical atrophy
What does a kidney in end stage renal disease look like microscopically?
lymphocytes, atrophied tubules, sclerosed glomeruli, collagen in bowman’s space
What type of blockage is the usual cause of an infarction in the kidney?
atheroembolism
What are lacunar infarcts?
small infarcts in the brain caused by hyaline arteriolosclerosis
What is a berry aneurysm?
an aneurysm in the circle of willis leading to a subarachnoid haemorrhage if it ruptures
What is the result of hyaline arteriolosclerosis in the retina?
AV nipping, exudates, ischaemia, haemorrhage - can cause visual deterioration
What are the complications of malignant hypertension?
retinopathy, acute renal failure, haemolytic anemia, encephalopathy
