Hypertension Flashcards
What is hypertension a risk factor for?
Cerebral haemorrhage, atheroma, renal failure, sudden cardiac death.
What populations have higher and lower incidences of hypertension?
Higher in black populations, lower in south pacific.
What are the aetiological classifications of hypertension?
Primary (unknown cause) and secondary (known cause).
What are the clinicopathological classifications of hypertension?
Benign (often primary), malignant (often secondary, extreme).
Blood flow in what organ is important in determining blood pressure?
Kidneys.
What are the contributing factors to primary hypertension?
Genetic factors, salt intake, protein intake, RAAS, sympathetic activity.
What are the types of diseases that can cause secondary hypertension?
Renal disease, endocrine disease, aortic disease, renal artery stenosis, drug therapy (steroids).
How can renal disease cause hypertension?
Can cause reduced renal blood flow leading to excess renin release and salt and water overload.
Give some endocrine causes of hypertension.
Adrenal gland hyperfunction, adrenal gland tumours, Conn’s syndrome (excess aldosterone), Cushing’s syndrome (excess corticosteroid), phaeochromocytoma (adrenal gland tumour, excess noradrenaline).
What is coarctation of the aorta and can it cause hypertension?
Congenital narrowing of segments of the aorta, yes.
Over time, what can benign hypertension cause?
LVH, congestive cardiac failure, atheroma, aneurysm rupture (aortic dissection, Berry aneurysms), renal disease.
What can LVH cause in the heart?
Poor myocardial perfusion, increased susceptibility to arrhythmias, interstitial fibrosis (cells less able to communicate with each other), micro-infarcts, diastolic dysfunction, cardiac failure.
What is the relation between hypertension and aortic dissection?
Increases risk.
What microvascular injury does hypertension cause in the kidneys and eyes?
Thickening of media (smooth muscle). Hyaline arteriosclerosis (plasma proteins forced into vessel wall, thickening of vessels).
At what diastolic pressure would hypertension be considered malignant?
When diastolic pressure is greater than 130-140.
What are the complications of malignant hypertension?
Cerebral oedema (seen as papilloedema [swelling of optic disk]), acute renal failure, acute heart failure, headache and cerebral haemorrhage, blood vessels show fibrinoid necrosis and endarteritis proliferans of their walls.
What is pre-eclampsia?
Hypertension and proteinuria.
What are the recommendations for measuring blood pressure?
Use a relaxed, temperate setting with the person quiet and seated.
When will automated blood pressure cuffs not work?
If pulse rate is irregular.
What are the definitions of stage 1, stage 2 and stage 3 hypertension?
Stage 1: clinic 140/90, daytime average 135/85.
Stage 2: clinic 160/100, daytime average 150/95.
Stage 3: clinic systolic 180mmHg or diastolic 110mmHg.
What tests should you offer for all patients with hypertension?
Test urine for protein; take blood to measure glucose, electrolytes, creatinine, estimated glomerular filtration rate and cholesterol; examine fundi for hypertensive retinopathy; arrange a 12 lead ECG.
What are the signs of end organ damage in hypertension?
LVH, creatinine raised, albuminuria/microalbuminuria, retinopathy.
What is hypertensive retinopathy?
When the artery thickens and contricts a vein in the eye. Can include haemorrhage, hard exudates and a blurred disk.
How would LVH and heart strain show up in an ECG?
ST depression.
