Hypertension

Question 1

What is hypertension(High blood pressure)?

Answer 1

Blood pressure in the arteries are elevated.

Question 2

Does high blood pressure cause any symptoms?

Answer 2

Nope. Long term high blood pressure then risk of coronary artery disease, stroke, heart failure, peripheral vascular disease, vision loss, and chronic kidney disease

Question 3

High blood pressure is classified as? What percent of hypertension is primary and what are the factors?

Answer 3

Primary/essential high blood pressure and secondary high blood pressure.
90-95% are primary due to lifestyle (excess salt, smoking,alcohol, weight) and genetic factors.

Question 4

Define secondary high blood pressure

Answer 4

Blood pressure due to unidentifiable cause like chronic kidney disease, narrowing of the kidney arteries, an endocrine disorder, or the use of birth control pills.

Question 5

How is blood pressure measured? Normal blood pressure, and high blood pressure limit?

Answer 5

The systolic and diastolic pressures, which are the maximum and minimum pressures.
Normal blood pressure at rest is 100–140 mmHg systolic and 60–90 mmHg diastolic.
High blood pressure is if the resting blood pressure is at or above 140/90 mmHg for most adults.

Question 6

Percent rate at which hypertension affects global population? In 2010?

Answer 6

16 and 37%. In 2010 hypertension in 18% of all deaths (9.4 million globally)

Question 7

What is more accurate than the regular blood pressure treatment? Why?

Answer 7

Ambulatory blood pressure monitoring over a 24-hour period, reduces nervousness and anxiety

Question 8

Signs and symptoms of hypertension What are 6 of the signs and symptoms and what is it usually associated with?

Answer 8

Rarely any symptoms, identified through screening, or seeking healthcare for an unrelated problem.
Some report headaches, dizziness, vertigo, tinnitus (buzzing or hissing in the ears), altered vision, fainting episodes; all associated with anxiety.

Question 9

How is hypertension detected during physical examination?

Answer 9

Changes in the optic fundus seen by ophthalmoscopy.
The severity of the changes of hypertensive retinopathy (damage to retina due to high blood pressure) is from I–IV
The severity of the retinopathy = duration or the severity of the hypertension.

Question 10

Secondary hypertension symptoms and 5 examples

Answer 10

Hypertension+ more signs and symtoms=secondary hypertension.
Examples:
Cushing’s syndrome: causes truncal obesity, glucose intolerance, moon face, a fat hump by the neck/shoulder, and purple abdominal stretch marks. Hyperthyroidism: weight loss with increased appetite, fast heart rate, bulging eyes, and tremor.
Renal artery stenosis (RAS): a localized abdominal bruit to the left or right of the midline or in both locations Coarctation of the aorta: decreased blood pressure in the lower extremities, absent femoral arterial pulses. Pheochromocytoma: abrupt (“paroxysmal”) episodes of hypertension with headache, palpitations, pale appearance, and excessive sweating.

Question 11

What is hypertensive crisis?

Answer 11

Severely elevated blood pressure (equal to or greater than a systolic 180 or diastolic of 110)

Question 12

What are the two categories of hypertensive crisis?

Answer 12

Hypertensive urgency and hypertensive emergency

Question 13

Define Hypertensive urgency What is given usually to lower BP within 24 to 48 hours?

Answer 13

No evidence of end organ damage resulting from the elevated blood pressure. Oral medications are used to lower the BP gradually over 24 to 48 hours.

Question 14

Define Hypertensive emergency What organs are affected? What symptoms are produced?

Answer 14

Evidence of direct damage to 1 or more organs like the brain, kidney, heart and lungs, producing symptoms like confusion, drowsiness, chest pain and breathlessness. Blood pressure must be reduced rapidly to stop ongoing organ damage

Question 15

What are the 3 classifications for hypertension in pregnancy? Which one is the most common and the percent rate?

Answer 15

Classified as pre-existing hypertension, gestational hypertension, or pre-eclampsia
Pre-eclampsia occurs in 5% of pregnancies and is responsible for approximately 16% of all maternal deaths globally.

Question 16

Define pre-eclampsia What severe condition can it lead to and describe 6 complications

Answer 16

Occurs in 2nd half of pregnancy and following delivery by increased blood pressure and the presence of protein in the urine.
Pre-eclampsia can occasionally progress to a life-threatening condition called eclampsia, which is a hypertensive emergency and has several serious complications including vision loss, brain swelling, seizures, kidney failure, pulmonary edema, and disseminated intravascular coagulation (a blood clotting disorder).

Question 17

5 reported symptoms of pre-eclampsia

Answer 17

no symptoms detected by routine screening but common ones are headache, visual disturbance, vomiting, pain in stomach and swelling

Question 18

What life threatening condition can pre-eclmpsia progress to?

Answer 18

Eclampsia, a hypertensive emergency, includes vision loss, brain swelling, seizures, kidney failure, pulmonary edema and disseminated intravascular coagulation

Question 19

What is gestational hypertension?

Answer 19

Hypertension during pregnancy without protein in the urine.

Question 20

Describe hypertension in infants and children

Answer 20

Infants: Failure to thrive, seizures, irritability, lack of energy, and difficulty in breathing
Children: headache, unexplained irritability, fatigue, failure to thrive, blurred vision, nosebleeds, and facial paralysis.

Question 21

What are the causes of primary hypertension

Answer 21

Genetic variants and environmental factors.
DNA methylation might affect in some way linking common genetic variation to multiple phenotypes
Test performed for sentinel SNP (known and new) showed that genetic variants singly or in aggregate contribute to risk of clinical phenotypes related to high blood pressure
High salt intake raises the blood pressure in salt sensitive individuals; lack of exercise, obesity, and depression, caffeine consumption, vitamin D deficiency Insulin resistance, sugar
Low birth weight, maternal smoking, high blood urea and lack of breast feeding may be risk factors for adults
Blood pressure higher in winter

Question 22

What are the causes of secondary hypertension?

Answer 22

Occurs because of an identifiable cause.
Kidney disease: common
Endocrine conditions: Cushing’s syndrome, hyperthyroidism, hypothyroidism, acromegaly, Conn’s syndrome or hyperaldosteronism, hyperparathyroidism and pheochromocytoma.
Other: obesity, sleep apnea, pregnancy, coarctation of the aorta, excessive eating of liquorice, excessive drinking of alcohol, and certain prescription medicines, herbal remedies and illegal drugs
Arsenic exposure through drinking water

Question 23

Diagnosis of hypertension in Kidney, Endocrine, Metabolic, Other and Lab tests

Answer 23

Complete history, physical examination
Kidney:Microscopic urinalysis, protein in the urine, BUN and/or creatinine
Endocrine: Serum sodium, potassium, calcium, TSH
Metabolic: Fasting blood glucose, HDL, LDL, and total cholesterol, triglycerides
Other: Hematocrit, electrocardiogram, and chest radiograph
Lab tests performed to check damage in heart, kidney or eyes

Question 24

Which age group is secondary hypertension common for?

Answer 24

Preadolescent children; usually a kidney case

Question 25

Primary hypertension is common in which age group?

Answer 25

adolescents due to obesity, genetics

Question 26

What is the rate for prehypertension?

Answer 26

Systolic: 120-139 Diastolic:80-89

Question 27

What is the rate for stage 1 hypertension?

Answer 27

Systolic: 140-159 Diastolic: 90-99

Question 28

What is the rate for stage 2 hypertension?

Answer 28

Systolic: 160-179 Diastolic: 100-109

Question 29

What is the rate for stage 3 hypertension?

Answer 29

Systolic: ≥180 Diastolic: ≥110

Question 30

Isolated Systolic Hypertension rate?

Answer 30

Systolic: ≥140 Diastolic: <90

Question 31

In primary hypertension, what accounts for blood pressure while cardiac output remains normal?

Answer 31

Increased resistance to blood flow

Question 32

Define hyperkinetic borderline hypertension

Answer 32

Younger people with prehypertension or ‘borderline hypertension’ have high cardiac output, an elevated heart rate and normal peripheral resistance
They develop essential hypertension in later life as their cardiac output falls and peripheral resistance rises with age

Question 33

What frequently increases in older people with hypertension

Answer 33

Pulse pressure( diff between diastolic and systolic)

Question 34

How does hypertension cause diastolic dysfunction?

Answer 34

Decreased peripheral venous compliance which may increase venous return, increase cardiac preload

Question 35

What causes high pulse pressure in older people?

Answer 35

The high pulse pressure in elderly people with hypertension or isolated systolic hypertension is explained by increased arterial stiffness

Question 36

Hypertension is the leading cause of

Answer 36

Cardiovascular mortality

Question 37

How was hypertension discovered?

Answer 37

William Harvey described the circulation of blood, Stephen Hales made the first publishment of blood pressure
Scipione Riva-Rocci discovered the cuff based sphygmomanometer, allowing measurement of systolic and diastolic pressure in the clinic.
Nikolai Korotkoff improved the technique

Question 38

How to prevent hypertension?

Answer 38

Maintain body weight, reduce dietary sodium,

brisk walking, limit alcohol consumption, rich diet

Question 39

Medications for hypertension?

Answer 39

Thiazide-diuretics, calcium channel blockers, angiotensin converting enzyme inhibitors and angiotensin receptor blockers.

Question 40

What are the outcomes of hypertension?

Answer 40

Hypertension is the most important preventable risk factor for premature death
Increases the risk of ischemic heart disease, strokes, peripheral vascular disease heart failure, aortic aneurysms, diffuse atherosclerosis, chronic kidney disease, pulmonary embolism, cognitive impairment and dementia, hypertensive retinopathy and hypertensive nephropathy