Hypertension- classification, causes and consequences

Question 1

Learning outcomes

Answer 1

• Describe the range of blood pressure in health and the classification of systemic hypertension
• Distinguish between classical primary hypertension and isolated systolic hypertension
• Discuss the prevalence of systemic hypertension
• Define the white-coat effect and white-coat hypertension
• Distinguish between primary and secondary hypertension

Question 2

What is atherosclerosis?

Answer 2

Atherosclerosis- lipid rich plaque formation in walls of blood vessels
Total occlusions occuring from plaque rupture will cause acute CV events- MI, stroke etc- caused by Hypertension
•The cause of most vascular disease–Stroke, myocardial infarction, peripheral vascular disease, aneurysms, vascular dementia
•High blood pressure is a major contributing factor
•Other risk factors–Personal history of cardiovascular disease –Smoking–Dyslipidaemia–Diabetes mellitus–Family history of premature cardiovascular disease

HT can also lead to heart failure and chronic kidney disease

Question 3

Symptoms of hypertension

Answer 3

Usually asymptomatic- have to look for signs

Accelerated hypertension is an exception- this is very rare

Isolated systolic hypertension- Normal diastolic BP, high systolic: common in older people, as assoc. w stiffening of blood vessels

Question 4

Blood pressure measurements- meaning

Answer 4

• 1st number = systolic BP = maximum pressure in vessels after cardiac contraction
• 2nd number = diastolic BP = minimum pressure in vessels during cardiac relaxation
• Units = mmHg

Normal: 90/60 –120/80 mmHg
High-normal: 120/80-140/90 mmHg

Question 5

How common is hypertension?

Answer 5

• ~1 billion people globally have high blood pressure
• Number one correctable risk factor for death
• Accounts for > 10 million deaths annually
• 62% of cerebrovascular disease and 49% of ischaemic heart disease are attributable to hypertension

Question 6

Investigating a patient with hypertension

Answer 6

1. Establish if hypertension is present- Any evidence of white coat effect: higher BP than normal while investigated in presence of healthcare professional
   2 .Look for evidence of target organ damage
2. Look for evidence of a secondary cause

To avoid WCE, ambulatory/home bp monitoring every 30 mins during day and hour every night, can be performed
Nocturnal dipping- Normal BP falling while patient sleeps

Question 7

Secondary causes of hypertension

Answer 7

• Primary hyperaldosteronism – an excessive production of aldosterone
• Cushing’s syndrome – an excess of corticosteroid production
• Phaeochromocytoma – excessive catecholamine production
• Renal artery stenosis –a narrowing of the main artery supplying the kidney
• Intrinsic renal disease – such as glomerulonephritis
• Coarctation of the aorta –a narrowing in the aorta
• Obstructive sleep apnoea

Question 8

What is the difference between primary and secondary hypertension?

Answer 8

Primary hypertension- high BP with no other disease process- genetic/lifestyle factors
Secondary hypertension- another disease process that is occurring- likely that treatment of cause will cure secondary hypertension