Hypertension

Question 1

What are the primary and secondary causes of hypertension? How prevalent is each type?

Answer 1

Primary (90%): unknown cause, asymptomatic

Secondary (10%): defined cause with symptoms, causes include;
1. Endocrine: cushings, conn syndrome (excessive aldosterone), phaeochromocytoma (excessive adrenaline)

2. Coarctation of the aorta
3. Pre-eclampsia

Question 2

What 2 main factors cause hypertension?

Answer 2

Increased TPR, and increased CO

Question 3

What are the stages of hypertension? Which BP is associated with each stage?

Answer 3

Stage 1: 140/90
Stage 2: 160/100
Stage 3: 180/110

Question 4

Explain the pathophysiology of what can occur to the heart as a result of hypertension

Answer 4

1. Decreased supply of oxygen to the heart due to:
   - damaged coronary endothelium
   - coronary arteriosclerosis
   - Low O2 supply = ischemia
2. Increased demand of the heart due to:
   - hypertension increases the afterload/strain on the heart = LV hypertrophy
   - LV requires more oxygen and isn’t receiving enough
   - LV Failure = pulmonary edema
   - LV ischemia which can make the LV stiffened

Question 5

Explain the pathophysiology of what can occur to the brain as a result of hypertension

Answer 5

An atherosclerotic plaque can rupture causing a thromboemboli that occludes the carotid/cerebral vessels = TIA = stroke

Increased pressure can cause minor aneurysms to burst leading to a hemorrhagic stroke

Question 6

Explain the pathophysiology of what can occur to the kidney as a result of hypertension

Answer 6

Nephrosclerosis - damage to the vessel wall

1. Decreased blood supply = ischemia and atrophy of the renal glomeruli and tubules
2. Renal failure = increased blood volume

Question 7

Explain the pathophysiology of what can occur to the eyes as a result of hypertension and what you would see as a consequence of this process

Answer 7

1. Increase in pressure can cause the arterioles to vasoconstrict = Silver wiring
2. retinal veins vasoconstrict = AV nipping
3. The chronic increase in pressure can eventually lead to rupture and hemorrhage = papilloedema (swollen optic disc) which can present with blurry vision

Question 8

Explain the pathophysiology of what can occur to the aorta as a result of hypertension

Answer 8

Since the aorta is an elastic artery it can become weakened and dilate (aneurysm) as a result of increased pressure and chronic atherosclerosis/arteriosclerosis

This can lead to an AAA or an aortic dissection

Question 9

What surgical option can treat an AAA?

Answer 9

Trouser graft repair

Question 10

What are some signs for hypertension?

Answer 10

1. LV heave = palpable apex
2. Atrial gallop: blood ‘bounces’ off the stiffened ischemic LV
3. A2 sound: sound of the aortic valve closing
4. Eyes: AV nipping, silver wiring and papilloedema may be noticed

Question 11

What are some symptoms of hypertension?

Answer 11

Often asymptomatic but if it’s “accelerated hypertension” may have blurry vision, headache, dizziness

Question 12

What investigations could you do for hypertension?

Answer 12

1. ECG: see LV hypertrophy
2. ECHO
3. X-ray - cardiomegaly
4. Blood test: glucose, cholesterol, steroids
5. Urine: protein, blood

Question 13

What is the Qrisk assessment and what factors does it account for?

Answer 13

Assesses your 10-year risk of getting CVA, MI and takes into consideration age, BP, cholesterol, smoking and alcohol

Question 14

What are 3 causes of hypertension in pregnancy?

Answer 14

1. Gestational hypertension
2. Pre-exiting (chronic)
3. Pre-eclampsia

Question 15

What 3 signs would you see in pre-eclampsia?

Answer 15

+/- edema, proteinurea, hypertension

Question 16

What are the kinds of ‘hypertension crisis’?

Answer 16

Emergency: 200/130 BP and means there is damage to end organs which may include encephalopathy, visual disturbances, Heart and renal failure

Urgency: 180/120 BP: no damage to end organs

Question 17

What is the management of hypertension? What kinds of drugs are offered?

Answer 17

1. Lifestyle
2. Drugs: A = ACE inhibitor, C = calcium channel blocker, D = diuretic, O = other (alpha or beta-blocker, another diuretic, etc.)

Question 18

Explain the system you would use in deciding which hypertensive drugs to prescribe for your patient

Answer 18

<55 = A
> 55 and/or black = C
As severity increases: 
1. A + C
2. A + C + D
3. A + C + D + other