Hypertension

Question 1

How many people does hypertension affect

Answer 1

2 billion

Question 2

What is the target systolic BP

Answer 2

120

Question 3

Give some identifiable causes of hypertension

Answer 3

Renal disease, including renal artery stenosis
Tumours secreting aldosterone (Conn’s)
Tumours secreting catecholamines (pheochromocytoma)
Oral contraceptive pill
Pre-eclampsia / pregnancy associated hypertension
Rare genetic cause e.g. Liddle’s syndrome

Question 4

What causes of hypertension are primary or essential

Answer 4

unidentifiable

genetic or environmental

Question 5

Give examples of unidentifiable causes

Answer 5

Liddle’s syndrome
Complex polygenic

Dietary salt (sodium)
Obesity / overweight, lack of exercise
Alcohol
Pre-natal environment (~birthweight)
Pregnancy (pre-eclampsia)

Question 6

How does age affect blood pressure

Answer 6

mean BP and pulse pressure increases
Diastolic BP does not
those >60 would be expected to be hypertensive

Question 7

What is hypertension associated with haemodynamically

Answer 7

Increased total peripheral resistance
Decreased arterial compliance
Normal cardiac output 
Normal blood volume / ECV
Central volume shift

Question 8

What can increased TPR be caused by

Answer 8

Vasoconstriction
Growth and remodelling (structural narrowing)
Capillary loss through rarefaction

Question 9

Define isolated systolic hypertension

Answer 9

systolic blood pressure ?140
diastolic <90
Increased stiffness of medium/large arteries e.g. brachial, femoral
Pulse wave is reflected and much greater

Question 10

How is the kidney involved in hypertension

Answer 10

Key role in BP regulation

Regulation of sodium, water and extracellular fluid

Question 11

What factors have been associated with hypertension

Answer 11

Endocrine and paracrine factors

SNS

Question 12

How does hypertension affect the large arteries

Answer 12

May cause arterial rupture or dilations (aneurysms)

Leads to thrombosis or haemorrhage (i.e. strokes)

Question 13

How does hypertension affect the eye and microcirculation

Answer 13

The retina illustrates microvascular damage
Thickening of the wall of small arteries, arteriolar narrowing, vasospasm, impaired perfusion and increased leakage into the surrounding tissue

Question 14

How does hypertension affect the kidney

Answer 14

Renal dysfunction e.g increased albumin excretion in the urine
Extreme is rare but leads to rapidly progressive renal failure

Question 15

What lifestyle modifications can be made for hypertension

Answer 15

Weight loss
Exercise
Eat healthy
Less alcohol

Question 16

What treatments are available for hypertension

Answer 16

ACE inhibitors
Angiotensin receptor blockers
Diuretics
Beta blockers
Calcium channel blockers

Question 17

What are ACE inhibitors

Answer 17

Inhibit ACE so that less angiotensin I is converted to angiotensin II
Effects include
Reduced aldosterone release, ADH secretion, sodium reabsorption, sympathoexcitation, arterial vasoconstriction

Question 18

What are diuretics

Answer 18

Used in patients experiencing a hypertensive crisis (large fluid overload)
Thiazides and thiazide-like product reduce PVR

Question 19

What are beta blockers

Answer 19

blockage of the beta1 receptors in the heart or kidney

Reduces rate and force of contraction, cardiac output, renin secretion, activity of RAAS

Question 20

What are calcium channel blockers

Answer 20

Reduces calcium influx and actin myosin cross bridge cycling

Inhibits calcium influx that reduced contractility (negative inotropy) and rate of conduction (negative dromotropy)

Question 21

Define hypertension

Answer 21

The level of blood pressure above which investigation and treatment do more good than harm