Hypertension

Question 1

2 types of hypertension

Answer 1

1. Primary (essential) hypertension - without a cause
2. Secondary hypertension
   caused by
   - artherosclerosis
   - renal disease
   - renin producing tumors
   - TSH
   - cortisol

Question 2

Ix prior to surgery in hypertensive ptns

Answer 2

Not indicated 
But for secondary hypertension - Serum electrolytes 
- serum sodium and potassium
- urea & nitrogen
- TSH
- cortisol level

Question 3

What are contraindications of surgery in hypertensive patients

Answer 3

Not based on actual BP but clinical judgements on risks and benefits

• sudden unexplained increase in BP
• signs and symptoms of hpt crisis (diplopia, dizziness, headache, dyspnea, sudden chest pain, sudden leg swelling)

Question 4

What are causes of sudden hypertension intraoperatively

Answer 4

Hypoxia
Hypercarbia
Anxiety
Pain
Full bladder
Medication (epinephrine)
Idiopathic

Question 5

What is hypertensive urgency?

Answer 5

BP is high above 180/120mmgHg but asymptomatic
Needs to be warded for monitoring
To lower down BP (not abruptly) to nothing lower than 160/110 to prevent risk of cerebral or myocardial hypoperfusion

Question 6

What is hypertensive emergency

Answer 6

When BP is >180/120mmHg 
WITH evidence of end organ damage (brain, heart, kidney)
Signs and symptoms 
- papilloedema, 
- retinal hemorrhage
- renal fialure
- neurologic symptoms
- cardia symptoms (chest pain)