Hypertension

Question 1

What is hypertension

Answer 1

• high blood pressure

Question 2

define systolic BP, and Diastolic BP

Answer 2

• SBP: arterial pressure when the heart is contracting

- DBP: arterial pressure when the heart is relaxing

Question 3

Which artery used to take BP

Answer 3

• brachial artery

Question 4

Why is a high bp dangerous

Answer 4

• a high BP is a serious pb for the blood vessels
• in can cause wear and tear on the endothelial cells -> causing damage to the endothelial cells (like tiny cracks) -> which can cause: myocardial infarction, aneurysm, stroke

Question 5

State the different stages of HTN

Answer 5

• normal: 120mmHg / <80mmHg
• elevated: 120-129mmHg / <80mmHg
• Stage 1: 130-139 mmHg / 80-89mmHg
• Stage 2: >140 mmHg / DBP > 90 mmHg

Question 6

Is it possible to only have SBP or DBP elevated ?

Answer 6

• yes, called Isolated systolic HTN, or isolated diastolic HTN

Question 7

State the different types of hypertension

Answer 7

• Essential hypertension (primary hypertension)
• Secondary hypertension
• Malignant hypertension
• hypertensive crisis: hypertensive urgency, hypertensive emergency

Question 8

Essential hypertension: C

Answer 8

• 90% of hypertensions
• no clear causes
• overtime, pressure in the arteries increases

Question 9

Essential hypertension: RF

Answer 9

• old age
• obesity
• salt heavy diet
• sedentary lifestyle

All can be improved with lifestyle changes

Question 10

Secondary hypertension

Answer 10

• has an underlying cause

Question 11

Secondary hypertension: C: low renal blood flow

Answer 11

• Low renal blood flow (ex: atherosclerosis, vasculitis, aortic dissection)
• > kidney senses a low RBF -> stimulates the renin secretion -> causes water retention -> increases fluid volume -> causes HTN
• other renal causes: DM nephropathy, glomerulonephritis, renovascular disease, pyelonephritis

Question 12

Secondary hypertension: C: primary hyperaldosteronism (aldosteronoma)

Answer 12

• too much aldosterone -> increases Na+ and water reuptake -> causes HTN
• Conn’s, Cushing, pheochromocytoma, acromegaly, hyperthyroidism

Question 13

Secondary hypertension: other causes

Answer 13

• pregnancy HTN (pre-eclamplsia)
• obesity
• licorice intake
• drugs

Question 14

Symptoms of primary, secondary HTN and HTN emergency

Answer 14

• Primary: usually none, referred to as silent killer
• Secondary: has a variety of symptoms associated with the underlying cause
• HTN emergency: confusion, drowsiness, chest pain, breathlessness

Question 15

Hypertensive crisis, definition

Answer 15

• if the BP gets really high, really fast

- SBP > 180mmhg, DBP > 120 mmHg

Question 16

Hypertensive crisis: subdivision

Answer 16

• hypertensive urgency: no damage to the end organs (brain, heart, kidneys, lungs)
• hypertensive emergency: damage to the end organs -> presence of new retinal hemorrhages, exudates, or papilledema (optic disc swelling caused by increased intracranial pressure, swelling is bilateral), cerebral infarction, pulmonary edema, CHF, hypertensive encephalopathy
• Malignant hypertension is a type of hypertensive emergency, requires immediate treatment

Question 17

HTN: RF

Answer 17

• Age: M>55, W>65
• smoke
• dyslipidemia
• high glucose
• obesity
• peripheral artery disease
• carotid artery thickening

Question 18

HTN: Diagnosis

Answer 18

• BP taken in both arms, twice per day, for 3 days, with an ambulatory monitor
• look for end damage organ

Question 19

Treatment options:

Answer 19

• lifestyle changes

- drugs

Question 20

Treatment: Lifesytle changes

Answer 20

• change in diet, exercise, stress reduction
• decrease salt intake
• limit alcohol
• aerobic exercise
• DASH diet: Dietary Approach to Stop Hypertension -> fruits, less fats, grains, fish, beans, seeds, and decrease sweets and added sugars
• stop smoking

Question 21

Treatment: Drugs

Answer 21

• Thiazide diuretics, calcium antagonists, ACE inhibitors, Angiotensin receptor antagonist, Beta Blockers
• Monotherapy: CCB, ACEi, ARB, BB
• Combinations: ACEi + CCB + Thiazide

Question 22

Treatment: for gestational HTN

Answer 22

“hypertensive mums love nifedipine”

• Hydralazine
• Alpha-methyldopa
• Labetalol
• Nifedipine

Question 23

Considerations regarding the T

Answer 23

• the cardiovascular risks, Renal, DM, presence of organ damage, presence of coexisting disorders that may limit the use of certain drugs, drug interactions, costs

Question 24

Considerations: Thiazides

Answer 24

• Thiazide, a diuretic used to treat hypertension
• effective, cheap, 1st line treatment,
• isolated HTN in elderly
• HF

Question 25

Considerations: Loop diuretics

Answer 25

• end stage renal disease and heart failure

Question 26

Considerations: Ca antagonists

Answer 26

• Dihydropyridine

- Verapamil

Question 27

Hypertensive heart diseases, what is it

Answer 27

• refers to heart problems caused by high blood pressure

Question 28

Hypertensive heart diseases: cause

Answer 28

The heart working under increased pressure causes some different heart disorders.

• systemic HTN (concentric LVH)
• Pulmonary HTN (RVH and dilation)

Question 29

Hypertensive heart diseases: pathomechanism

Answer 29

• myocyte hypertrophy is an adaptive response and there are limitations to this adaptive capacity
• Persistent HTN -> will cause dysfunction, cardiac dilation, CHF and SCD

Question 30

Hypertensive heart diseases: Conditions caused by HTN

Answer 30

• CHD
• IHD
• hypertrophy
• congestive HF
• hypertensive cardiomyopathy
• arrhythmia
• renal damage or cerebrovascular stroke

Question 31

Hypertensive heart diseases: symptoms:

Answer 31

• fatigue
• irregular pulse
• feet swelling
• dyspnoea
• weight gain
• nausea
• shortness of breath
• difficulty sleeping
• bloating
• greater need to urinate