Hypertension Flashcards
Initial management hypertension over 55y OR Afro - Caribbean
C, A&C, A&C&D, resistant hypertension - A&C&D plus further D or B
ABCD of drugs used in initial treatment hypertension
ACE inhibitors / Angiotensin receptor blockers
Beta blockers
Calcium antagonists
Diuretics (thiazide)
Initial management hypertension below 55y, not Afro-Caribbean
A, A&C, A&C&D, resistant hypertension A&C&D plus further D or B
Essential (idiopathic) hypertension
95% of cases
Multifactorial, multigenic
Intacting environmental factors
Genetic polymorphism s in hypertension…
Encoding parts renin-angiotensin system
In particular Angiotensinogen, and angiotensin receptor loci
Environmental factors in hypertension
Stress Obesity Smoking Physical inactivity Heavy salt consumption
Hypertension due to adrenal / renal disease
5% Adrenal cortical hyper function - Cushing's etc Exogenous hormones - glucocorticoids etc Phaechromocytoma Renal artery stenosis
Hyaline arteriosclerosis
Arteriolar wall thickened, protein deposition (hyalinized), lumen narrowed
Affects small arterioles - kidney, retina, heart
Impaired blood and oxygen distribution
Feature of diabetic microangiopathy
Hyaline arteriosclerosis causes changes due to…
Plasma proteins leak across injured endothelial cells
Increased smooth muscle matrix synthesis in response to chronic haemodynamic stress
Complications of hypertension
Atherosclerosis Cardiac hypertrophy, heart failure Multi-infarct dementia Aortic dissection Renal failure
Accelerated (malignant) hypertension
Rapidly rising bp
Rapid intimal hyperplasia +/- necrosis of vessel
Can lead to death within 2 years - acute renal failure, cerebral haemorrhage
Hyperplastic arteriosclerosis in accelerated hypertension
Onion skinning
Internal obliteration of lumen
Concentric laminations - smooth muscle cells, fibrinoid deposits, vessel wall necrosis - esp. In kidney
