Hypertension Flashcards
Give the definition of hypertension.
Defined as systolic BP>140mmHg and/or diastolic BP>85mmHg measured on three separate occasions.
Malignant hypertension is defined as BP200/130mmHg.
What factors can predispose to the development of hypertension?
Sympathetic nervous system stim. Activation of renin-angiotensin system. Endothelial dysfunction (reduced production of NO) Genetic factors Intrauterine factors (low birth weight) Lifestyle factors (smoking, alcohol, obesity)
Describe the epidemiology of essential hypertension.
Affects approx 40% of adult population. Incidence increases with age. More common in black americans and Japanese. Lowering BP reduces mortality and morbidity caused by stroke and coronary artery disease.
Describe the pathogenesis of hypertension.
Likely that genes contribute. Activ of autonomic nervous system and renin-angiotensin system lead to production of angiotensin II (vasoconstrictor) and aldosterone (salt and water retention). Other vasoactive substances and dysfunction of vascular endothelium contribute. Ultimately internal elastic lamina thickens, fibrotic intimal thickening of arteries and smooth muscle hypertrophy occurs. Arterial wall layers replaced by pink hyaline material with luminal narrowing.
What would a patient with hypertension complain of in their history?
Usually asymptomatic Px may have symptoms of the complications or cause. Accelerated or malignant hypertension could cause scotomas, blurred vision, headache, seizures…
What would be found on examination of a patient with hypertension?
Measure BP at two or three occasions before diagnosing hypertension and record lowest reading. May be loud second heart sound or fourth heart sound. Examine for causes, eg radiofemoral delay for aortic coarctation etc.
Give the Keith-Wagner classification of retinopathy.
I. Silver wiring II. as above with arteriovenous nipping. III as above plus flame haemorrhages and cotton wool exudates IV as above plus papilloedema.
Draw the algorithm for treatment of newly diagnosed hypertension.
What is malignant hypertension?
