Hypertension and Heart Failure

Question 1

Why is hypertension important?

Answer 1

Because it is a key risk factor in the development of heart failure

Question 2

What sort of heart failure does hypertension cause?

Answer 2

It mainly causes diastolic because the pressure overload caused hypertrophy and impaired relaxation. However some systolic dysfunction also occurs because the increased blood pressure means pulse waves return to the heart quicker which raises afterload and affects systolic function

Question 3

What is the New York Heart Association Heart Failure Classification System?

Answer 3

It categorises heart failure on a scale of I to IV
I= no limitation of physical activity (compensatory mechanisms are successful)
II=Slight limitation of physical activity
III= Marked limitation of physical activity
IV= Symptoms occur even at rest; discomfort with any physical activity

Question 4

What tests are done to diagnose heart failure?

Answer 4

ECG
Xray (pulmonary oedema and cardiomegaly)
Bloods e.g BNP (released from damaged cells)
ECHO (measures ejection fraction)

Question 5

How is ejection fraction affected by heart failure type?

Answer 5

Systolic dysfunction shows Reduced Ejection Fraction

Diastolic dysfunction shows preserved ejection fraction

Question 6

What is hypertension a risk factor for?

Answer 6

Stroke, MI, Heart failure, CKD, Cognitive decline

Question 7

What happens if hypertension is untreated?

Answer 7

It can cause vascular and renal damage that leads to a treatment resistant state and eventually very serious cardiovascular events

Question 8

How much does blood pressure need to rise to cause a significant risk?

Answer 8

Each 2mmHg increase in systolic blood pressure is associated with an increased risk of mortality:

• 7% from heart disease
• 10% from stroke

Question 9

How common is essential hypertension?

Answer 9

It is VERY common

• It affects 25% of UK adults
• Generally of primary/essential/unknown origin
• Prevalence is influenced by age/genetics/lifestyle factors
• 50% of above 60 year olds have hypertension

Question 10

What are the hypertension definitions?

Answer 10

Stage 1= >140/90mmHg
Stage 2= >160/100mmHg
Stage 3= >180/110mmHg

Question 11

When should anti-hypertensives be given?

Answer 11

• Stage 1 if <80 years old

- Stage 2 at any age

Question 12

What is classed as a white coat effect?

Answer 12

An increase in BP of >20/10mmHg from ambulatory to clinic

Question 13

What should all hypertensive patients receive?

Answer 13

• Urine test for presence of protein (indicative of CKD)
• Bloods: Glucose, U&E, Creatinine, eGFR, Cholesterol, BNP
• Fundus examination for Hypertensive Retinopathy
• 120-lead ECG
• Should also receive lifestyle advice to stop smoking, improve diet and exercise more etc

Question 14

What are the stages of of Antihypertensive treatment?

Answer 14

STAGE 1:
A) <55 y/o = ACEi or ARB
B) >55 y/o, Black ethnicity = Calcium Channel blocker

STAGE 2:
ACEi/ARB, & Calcium Channel Blocker

STAGE 3:
ACEi/ARB, Calcium Channel Blocker and Thiazide-Like Diuretic

STAGE 4: (resistant hypertension)
ACEi/ARB, Calcium Channel Blocker, Thiazide-Like diuretic, Alpha Blocker, Seek Further Advice