Hypertension

Question 1

The WHO define what blood pressure as hypertension?

Answer 1

> 140/90

Question 2

What percentage of the population are hypertensive?

Answer 2

25%

Question 3

Why are repeated BP measurements important for patients to take?

Answer 3

There is normal variation in blood pressure at different times of day

Question 4

What are White Coat Hypertension and Labile Hypertension?

Answer 4

White Coat - BP high when patient has it measured by medical professional

Labile - blood pressure repeatedly or suddenly changes from normal to abnormally high levels (often during stressful situations)

Question 5

What does hypertension cause, and what is it a risk factor for?

Answer 5

CAUSES cardiac failure

RF for:
cerebral haemorrhage
atheroma						         
renal failure
sudden cardiac death

Question 6

Blood pressure is usually higher in black populations. TRUE/FALSE?

Answer 6

TRUE

Question 7

What equation can be used to calculate the blood pressure?

Answer 7

Cardiac output (C.O.) X Peripheral Vascular Resistance

Question 8

What factors can change the cardiac output?

Answer 8

Heart rate
Contractility
Blood Volume

Question 9

What can change the peripheral vascular resistance?

Answer 9

Constrictors eg. Angiotensin II , Catecholamines

Dilators eg. Nitric oxide, Prostaglandins

Question 10

What is thought to cause, or contribute to, Primary Hypertension?

Answer 10

• No obvious cause
• Genetic factors/ FHx
• Salt intake
• RAAS
• Increased Sympathetic activity

Question 11

What underlying diseases can cause secondary hypertension?

Answer 11

• Renal disease
• Endocrine disease
• Aortic disease
• Renal artery stenosis
• Drug therapy

Question 12

How can renal disease cause hypertension?

Answer 12

• reduces renal blood flow
  => excess renin release
• salt and water overload

Question 13

What endocrine disease can cause secondary hypertension?

Answer 13

• Adrenal gland hyperfunction/ tumours
• Conn’s syndrome - excess Aldosterone
• Cushing’s syndrome - excess corticosteroid
• Phaeochromocytoma - excess noradrenaline

Question 14

What disease of the aorta can cause hypertension?

Answer 14

Coarctation of the aorta
- congenital narrowing of segments of the aorta
=> increased vascular resistance in these segments

Question 15

Benign hypertension eventually causes what consequences in the heart and major blood vessels?

Answer 15

• Left ventricular hypertrophy
• Congestive cardiac failure
• Atheroma
• Aneurysm rupture (e.g. Berry aneurysms, AAA)
• Aortic dissection
• Renal disease

Question 16

What happens to the heart during left ventricular hypertrophy?

Answer 16

- increased LV load
=> needs to work harder
=> eventually poor perfusion
- interstitial fibrosis
- micro-infarcts
- diastolic dysfunction

Question 17

What outcomes can patients experience in LV hypertrophy?

Answer 17

• sudden cardiac death (due to arrhythmia generating)

- cardiac failure

Question 18

Rupture of a Berry Aneurysm in the brain causes what condition?

Answer 18

Subarachnoid haemorrhage

Question 19

Even if a patient has benign hypertension, small rises in the diastolic pressure can cause a large increase in risk. TRUE/FALSE?

Answer 19

TRUE
Every 10mmHg of diastolic pressure above 85
=> doubles risk of MI

Every 8mmHg of diastolic pressure above 85
=> doubles risk of stroke

Question 20

What is meant by microvascular injury and where does it occur?

Answer 20

• Blood vessel wall changes in small arteries and arterioles
• Thickening of media (smooth muscle)
• Hyaline arteriosclerosis - plasma proteins forced into vessel wall
• Occurs in Retina and kidney (common in diabetes)

Question 21

What is malignant hypertension?

Answer 21

• Diastolic pressure >130-140

Question 22

When does malignant hypertension occur?

Answer 22

• develops from either benign primary or secondary hypertension (‘accelerated’ hypertension)
• Can arise de-novo

Question 23

What consequences can be caused by malignant hypertension?

Answer 23

• cerebral oedema - seen as papilloedema
• Acute renal failure
• Acute heart failure
• Headache and cerebral haemorrhage

Question 24

How does malignant hypertension acutely affect blood vessels?

Answer 24

• fibrinoid necrosis

- endarteritis proliferans of their walls