Hypertension

Question 1

Epidemiology of Hypertension?

Answer 1

Primary 90-95%
Secondary 2-10%
prevalence increase a lot over 60
some countries 50% over 60
F,    >45 M=F

Question 2

Aetiology of hypertension

Answer 2

primary = enviromental/genetic/lifestyle
secondary = due to another disease
commonly caused by renal disease or pregnancy:

Renal disease - approximately 75% are from intrinsic renal disease: glomerulonephritis, polyarteritis nodosa,
systemic sclerosis,
chronic pyelonephritis, or polycystic kidneys.
Approximately 25% are due to renovascular disease - most frequently atheromatous (eg, elderly cigarette smokers with peripheral vascular disease) or fibromuscular dysplasia (more common in younger females).

Endocrine disease:[4] 
Cushing's syndrome
Conn's syndrome
Phaeochromocytoma
Acromegaly
Hyperparathyroidism
Coarctation.
Pre-eclampsia and hypertension in pregnancy.[6] 
Drugs and toxins - eg, alcohol, cocaine, ciclosporin, tacrolimus, erythropoietin, adrenergic medications, decongestants containing ephedrine and herbal remedies containing licorice.

Question 3

pathogenesis

Answer 3

unknown - but risk factors clear

Stage 1 hypertension - BP in surgery/clinic is ≥140/90 mm Hg
Stage 2 hypertension - BP in surgery/clinic is ≥160/100 mm Hg a
Severe hypertension - BP in surgery/clinic is ≥180/110 mm Hg or higher.

Question 4

natural history

Answer 4

asymptomatic
damage to capiliary beds 
endothelia of vessels
risk fact for stroke/MI
vascular disease
chronic renal disease
increased mortality risk

Question 5

symptoms

Answer 5

assymptomatic
but Malignant (accelerated) hypertension: this is a syndrome characterised by severe hypertension accompanied by end-organ damage - eg, encephalopathy, dissection, pulmonary oedema, nephropathy, eclampsia, papilloedema and/or angiopathic haemolytic anaemia.
Accelerated hypertension needs urgent (same day) assessment and immediate treatment to reduce the BP within minutes to hours.[3]This is also termed hypertensive emergency.

Question 6

Signs

Answer 6

blood pressure
4th heart sound - S4 is caused by the atria contracting forcefully in an effort to overcome an abnormally stiff or hypertrophic ventricle -(which can arise from hypertension). This causes abnormal turbulence in the flow of blood that can be detected by a stethoscope.

Question 7

Complications

Answer 7

MI, Renal failure, stroke, death, CHD/CAD

Question 8

Prognosis

Answer 8

controlled with medication, 70% survival rate,