Hypertension Flashcards
Define hypertension
a disorder in which the level of sustained arterial pressure is higher than expected for the age, sex, race of the individual
State the WHO value for hypertension
>140/90
What does hypertension cause?
cardiac failure
What is hypertension a risk factor for?
- cerebral haemorrhage - atheroma - renal failure - sudden cardiac death
BP= ?x?
cardiac output x peripheral resistance
What determines cardiac output?
- heart rate - contractility - blood volume
What determines peripheral resistance?
- constrictors - dilators
Describe primary hypertension
Accounts for 90% of cases No obvious cause, usually genetic. Related to salt, protein, RAA & sympathetic activity
State five diseases that cause secondary hypertension
- renal disease
- endocrine disease
- aortic disease
- renal artery stenosis
- drug therapy
How do renal causes lead to hypertension?
Reduced renal blood flow, excess renin release & salt/water overload
Name four endocrine causes of hypertension
- Adrenal gland hyperfunction/tumours
- Conn’s syndrome - excess aldosterone
- Cushing’s - excess corticosteroid
- Pheochromocytoma - excess noradrenaline
Give example of other causes of secondary hypertension
Drugs, coarctation of the aorta, sleep apnoea
What does benign hypertension eventually cause?
- LV hypertrophy - congestive cardiac failure - increased atheroma - increased aneurysm rupture - renal disease - stroke
Describe left ventricular hypertrophy
Increased LV load, poor perfusion, interstitial fibrosis, micro-infarcts, diastolic dysfunction leads to arrhythmias and cardiac failure
Describe microvascular injury
blood vessel wall changes in small arteries & arterioles retina and kidney blood vessel damage, tunica media thickens
What is hyaline ateriosclerosis?
plasma proteins forced into vessel wall
What value is given to malignant hypertension?
diastolic >130-140
What does malignant hypertension cause?
acute renal failure acute heart failure cerebral oedema (see as papilloedema in retina) headache &cerebral haemorrhage fibrinoid necrosis & endarteritis proliferous in vessel walls
Name A, C & D
A - ACE inhibitor/ARBs
C - Calcium channel blocker
D - Thiazide - like diuretic
What treatment is given to fertile females?
Beta blockers
Define resistant hypertension, what is the treatment
BP not controlled by 3 drugs, spironolactone
What is the problem with spironolactone?
It is toxic in high doses especially in diabetics & patients with renal failure. Side effect is gynecomastia
What is white coat hypertension?
amubulatory pressure low, clinical pressure high
What is masked hypertenstion?
ambulatory pressure high, clinical pressure low
What is the difference between stage 1 & 2 hypertension?
- clincial >140/90 ABPM >135/85
- clinical >160/100 ABPM >150/95
Severe hypertension >180/110
What investigations would you carry out on a patient with hypertension?
- Urine for protein
- Bloods - glucose, electrolytes, creatinine, cholesterol
- Examine fundi for retinopathy
- 12 lead ECG
- Medical History
- Family History
- CV examination
- Smoking
