Hypertension

Question 1

What are the primary and secondary causes of hypertension?

*Include examples of secondary

Answer 1

Primary: unknown, asymptomatic

Secondary: defined caused *endocrine: cushings, conn syndrome (excessive aldosterone), phaeochromocytoma

• Coarctation of the aorta
• Pre-eclampsia

Question 2

What 2 main cardiac factors cause hypertension?

Answer 2

Increased TPR, and increased CO

Question 3

What is the 1st stage ambulatory and 3rd stage clinical values of HTN?

Answer 3

> 135/85

> 180 systolic or >110 diastolic

Question 4

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

Answer 4

LV hypertrophy -> increase O2 demand (lead to pulmonary congestion)

Coronary arteriosclerosis -> reduces O2 supply (harder and thicker)

Question 5

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

Answer 5

Ruptured atherosclerotic plaque -> thromboemboli->

OR micro-aneurysms rupture

-> TIA

Question 6

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

Answer 6

1. Nephrosclerosis - damage to the vessel wall
2. Decreased blood supply -> ischemia -> atrophy of renal glomeruli + tubules
   - > Renal failure - increases 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

Increased pressure:
Silver wiring: arterioles vasoconstrict

AV nipping: retinal veins vasoconstrict

-> chronic increase -> paplilloedmea and hemorrhage

Question 8

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

Answer 8

Aneuryms (elastic artery) + chronic atherosclerosis -> AAA or 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

LV heave = palpable apex
S4 “Atrial gallop”: blood ‘bounces’ off the stiffened ischemic LV
S2 sound
Eyes: AV nipping, silver wiring and papilloedema may be noticed

Question 11

What are some symptoms of hypertension?

Answer 11

Often asymptomatic, if “accelerated htn”; blurry vision, headache, dizziness

Question 12

How is hypertension diagnosed at clinic?

What investigations could you do for hypertension?

Answer 12

BP 140/90

1. ECG: see LV hypertrophy
2. ECHO
3. X-ray - cardiomegaly
4. Blood test: glucose, cholesterol, steroids
5. Urine: protein, blood
6. retina: fundoscopy
7. femoral pulse (exclude aortic coarctation)
8. renal bruit

Question 13

What can you use to assess your 10 year risk of CVA, MI?

Answer 13

QRISK assessment tool

*looks at age, BP, cholesterol, smoking, alcohol

Question 14

What are 3 causes of hypertension in pregnancy?

Answer 14

Gestational, preexisting (chronic), preeclampsia

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

200/130 = damage to end organs: encephalopathy, visual disturbances, heart/renal failure

Question 17

Briefly describe the system of drugs given for hypertension

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

Answer 17

A: Ace inhibitor
C: calcium channel blocker
D: Thiazide like diuretic

<55: A
>55 and/or black: C

A+C
A+C+D
Resistant HTN: A,C,D and consider further diuretic or alpha/beta blocker