Hypertension

Question 1

How do you calculate blood pressure?

Answer 1

CO X SVR

Question 2

What is high normal BP?

Answer 2

130-139/85-89 so you wouldn’t intervene but could suggest lifestyle changes

Question 3

What is Grade 1 and grade 2 hypertension?

Answer 3

systolic + 20
diastolic + 10
so stage 1 - 140-159/90-99
stage 2 - 160-179/100-109

Question 4

What to do when a patient has isolated systolic hypertension?

Answer 4

systolic is > 140 and diastolic is <90
less serious unless in the elderly
lifestyle interventions then drugs is not effective

Question 5

what is the difference between systolic and diastolic bp?

Answer 5

systolic is max bp during ventricular contraction, diastolic is min bp during relaxation

Question 6

what is hypotension?

Answer 6

<90/<60

Question 7

what is postural hypertension?

Answer 7

if systolic decreases by 20 or diastolic by 10 when you stand

Question 8

who is postural hypotension more common in?

Answer 8

older patients, especially with diabetes or if on some antihypertensives

Question 9

What are some CNS effects of hypotension?

Answer 9

dizziness
impaired cognition
fatigue
visual disturbances

Question 10

what are some muscle effects of hypotension?

Answer 10

paracervical ache (upper back)
general fatigue

Question 11

what are some heart effects of hypotension?

Answer 11

angina

Question 12

how many people have hypertension?

Answer 12

16 million

Question 13

how many women compared to men have high blood pressure?

Answer 13

30% of women, 32% of men

Question 14

what is the main reason why systolic bp increases with age?

Answer 14

loss of compliance if arteries

Question 15

what is the framingham heart study?

Answer 15

study of factors that contribute to cardiovascular disease, intensive monitoring of framingham study led to identification of major CVD risk factors

Question 16

what did the framingham studies conclude?

Answer 16

hypertensives are a cause for concern as have 6 fold increase in stroke, 3 fold increase in cardiac death and peripheral arterial disease is twice as common

Question 17

what can hypertension cause?

Answer 17

major RF for much more serious conditions - stroke, coronary heart disease, renal impairment and peripheral vascular disease

Question 18

Who is particularly vulnerable to hypertension?

Answer 18

diabetics and the obese

Question 19

how does chronic hypertension damage the heart?

Answer 19

thickened left ventricle due to myocardial hypertrophy to increase pressure in systole overcoming raised end diastolic aorta pressure

Question 20

why is concentric hypertrophy bad?

Answer 20

stroke volume decreased so tachycardia is required, also hypertrophic cardiac muscle has poor blood supply leading to ischemic damage

Question 21

Why is eccentric hypertrophy bad?

Answer 21

whole ventricle enlarges, wall may or may not thicken, heart is enlarged so lower systolic pressure produced, reduced SV, weaker heart, maybe heart failure

Question 22

what is hypertensive retinopathy?

Answer 22

damage to retinal blood vessels as they are particularly sensitive to chronic hypertension

Question 23

what are ‘silver/copper wire’ arteriolar?

Answer 23

where centre of arteriole shines due to reflected light as get narrowing at points where arteriolar and venules cross?

Question 24

what are some signs of retinal damage?

Answer 24

silver copper wire arterioles
cotton wool spots
blot and flame haemorrhages
microaneurysms
swelling of optic disc

Question 25

what is the difference between primary and secondary hypertension?

Answer 25

primary we don't know the cause when secondary is due to renal disease, endocrine disease, coarctation of the aorta, iatrogenic (due to drugs), thyroid disease

Question 26

is primary or secondary hypertension more common?

Answer 26

primary - 90-95% of cases | secondary - only 5%

Question 27

how is blood pressure controlled!

Answer 27

``` baroreceptors in carotid artery (neuronal) for rapid response RAAS system (hormonal) which provides a more steady response ```

Question 28

what system is normally defected in chronic hypertension?

Answer 28

RAAS hormonal

Question 29

what system could be defected in aneurysms or haemorrhagic strokes?

Answer 29

neuronal system as controls moment to moment BP fluctuations preventing sudden spikes

Question 30

What are the possible causes of hypertension?

Answer 30

impaired production of NO as acts as a vasodilator but when endothelium is damaged by free radicals or cytokines NO production is decreased raised renin release due to kidney damage reduced ANP release which is released from the atrial wall heart muscle cells, reduces ECF volume by increasing renal sodium excretion hence increasing water excretion so if lost salt and water retention

Question 31

what should the treatment be for high renin hypertension

Answer 31

dietary salt restriction | diuretics as water retention

Question 32

which ethnicity is more sensitive to salt intake?

Answer 32

afro-caribbean

Question 33

what happens if you reduce salt intake too much?

Answer 33

hyponatremia, brain swelling

Question 34

what are the symptoms of mild and severe hyponatremia?

Answer 34

loss of energy and fatigue, confusion, muscle weakness nausea, vomiting, headache, spasms, restlessness, seizures, coma

Question 35

why are green vegetables in diet important?

Answer 35

foods high in potassium means dietary potassium is increase and helps sodium potassium balance, potassium just as important as sodium

Question 36

what percentage of 45 year olds type 2 diabetics have hypertension?

Answer 36

40%

Question 37

what percentage of type 2 diabetics aged 75 have hypertension?

Answer 37

60%

Question 38

why is hypertension common in diabetics?

Answer 38

damages endothelium and reduces NO production

Question 39

what causes the link between obesity and hypertension?

Answer 39

high lepton levels as fat cells so increased symp vasoconstriction hyperinsulinaemia and insulin resistance

Question 40

what drug treatment should be given for stage 1 hypertension?

Answer 40

antihypertensive if also have organ damage, CD, renal disease, diabetes

Question 41

what treatment should be given for patients with stage 2 hypertension?

Answer 41

antihypertensives to those of any age

Question 42

what lifestyle changes should be encouraged?

Answer 42

lose weight moderate exercise diet rich in vegetables low salt diet

Question 43

what is the first step of treatment?

Answer 43

ACE inhibitors or ARB unless they are Afro Carrib give CCB

Question 44

What treatment do you give if CCB causes oedema or intolerance or high risk of heart failure?

Answer 44

Thiazide like diuretic

Question 45

what thiazide like diuretics should be offered?

Answer 45

chlortalidone | indapamide

Question 46

when should beta blockers be used?

Answer 46

in young people if intolerance to ACE inhib or ARB's, increased symp drive otherwise don't use as risk of diabetes developing

Question 47

what treatment should be given in step 2 if step 1 doesn't work?

Answer 47

CCB with ACE inhib/ARB | if can't use CCB use thiazide like diuretic

Question 48

what treatment should be given in step 3?

Answer 48

3 drug combo of ACE inhibitor/ARB, CCB and thiazide like diuretic

Question 49

what treatment should be given in step 4?

Answer 49

resistant hypertension | consider adding 4th antihypertensive or seek expert advice, make sure patient is taking drug

Question 50

how do CCB's work?

Answer 50

block entry of calcium, reduce electrical conduction of the heart, reduce force of contraction of muscle cells and dilate arteries

Question 51

how do thiazide like diuretics work?

Answer 51

block thiazide sensitive sodium chloride symp peter in DCT inhibiting reabsorption so more water moves in DCT and leaves body - increases urinalysis output and decreases body water and salt volume