Hypertension

Question 1

What is the definition of hypertension?

Answer 1

Blood pressure ≥140/90 mmHg

HTN is not a disease but a risk factor for CHD and CVA

Question 2

How common is hypertension?

Answer 2

Very common - 20-30% of adult population, 40-50% in black Africans

Question 3

Who does hypertension affect?

Answer 3

Anyone and everyone, higher in black Africans and older people

Question 4

What are the primary risk factors for hypertension?

Answer 4

1. Genetic
2. Fetal birth weight -low birth weight = ↑ risk of HTN; fetal adaptations to intrauterine undernutrition with long-term changes in vessel wall structure
3. Lifestyle: obesity, smoking, alcohol, sodium/salt diet, metabolic syndrome

Question 5

What are the secondary causes for hypertension?

Answer 5

1) Congenital: Adrenal hyperplasia; Aortic coarctation; II hydroxylase deficiency
2)Acquired: i. Renal disease:
Diabetic nephropathy; Chronic glomerulonephritis; Adults polycystic kidney disease; Chronic tubulointerstitial nephritis; Renovascular disease eg renal artery stenosis, CKD
ii. Endocrine diseases:
Conn’s syndrome; Adrenal hyperplasia; Phaeochromocytoma; Cushing’s synd; Acromegaly
iii. Drugs: interfere with response of some anti-hypertensives
:The pill, NSAIDS, Cyclosporin, Steroids
iv. Pregnancy: cardiac output (CO) ↑ in pregnancy but as TPR (total peripheral resistance) ↓ then normally BP is lower than those not pregnant; HTN in 10% pregnancies; when detected in 1st trimester or continuing after pregnancy then usually due to pre-existing HTN; when detected in 2nd trimester (‘pregnancy-induced’) then this normally resolves by term; NB pregnancy-induced HTN + proteinuria = pre-eclampsia
v. White coat syndrome!

Question 6

What are the symptoms of hypertension?

Answer 6

• usually asymptomatic
• headache/visual disturbances (occasionally)
• sweating, palpitations, or headaches =?phaeochromocytoma
• Severe HTN = ?headache, epistaxis, nocturia; SOB due to LVH or HF, whilst angina/peripheral artery disease= ?atheromatous renal artery disease
• symptoms of end organ damage– LVH, TIAs, angina, retinopathy, proteinuria

Question 7

What is the sign of hypertension on examination?

Answer 7

Optimal
<120 / <80
Normal
120-129 and/or <85
High normal = preHTN
130-139 and/or 85-89
HYPERTENSION
Grade 1 (mild)
140-159 and/or 90-99
Grade 2 (mod)
160-179 and/or 100-109
Grade 3 (severe)
>180 / >110
Isolated systolic HTN
Grade 1
140-149 / <90
Grade 2
>160 / <90

Risk of mortality and morbidity ↑ with ↑ systolic and diastolic pressures – each measure has a prognositic value too
If at home, then >135/85 = HTN; ambulatory BP monitoring >125/80 = HTN
Risk of mortality and morbidity ↑ with ↑ systolic and diastolic pressures – each measure has a prognositic value too
If at home, then >135/85 = HTN; ambulatory BP monitoring >125/80 = HTN

Question 8

What are the differential diagnosis of hypertension?

Answer 8

1) Malignant hypertension-short onset, diastolic pressure over 140 mmHg
2) Gestational hypertension/pregnancy-induced hypertension (PIH)
3) Pre-eclampsia-during pregnancy with proteinuria