Hypertension Complications

Question 1

Complications of HTN?

Answer 1

complications are related to persistent elevation of BP and the development of atherosclerosis

Question 2

Target organs?

Answer 2

1. heart
2. brain
3. kidneys
4. eyes

Question 3

Hypertensive heart disease?

Answer 3

Arterial hypertension is the most common risk factor for cardiovascular disease
1. Left ventricular hypertrophy, hypertrophic cardiomyopathy, dilated cardiomyopathy
2. Congestive heart failure
3. Coronary artery disease and myocardial infarction
4. Atrial fibrillation
5. Aortic aneurysm
6. Aortic dissection
7. Carotid artery stenosis
8. Peripheral artery disease
9. Atherosclerosis

Question 4

Cerebrovascular disease?

Answer 4

1. Stroke
2. TIA
3. cognitive changes e.g. memory loss

Question 5

What to do in Peripheral vascular disease?

Answer 5

do a ABPI

Question 6

Hypertensive nephrosclerosis?

Answer 6

1. a renal vascular injury secondary to long-standing arterial hypertension
2. CKD

Question 7

Investigations of hypertensive nephrosclerosis?

Answer 7

1. Initially microalbuminuria and microhematuria
2. ↑ BUN, Cr, and uric acid levels
3. Nephrosclerosis with proteinuria (usually < 1 g/day) and progressive renal failure occur with disease progression

Question 8

Diagnostics of hypertensive nephrosclerosis?

Answer 8

renal biopsy shows vascular, glomerular and tubulointerstitial changes

Question 9

Treatment of hypertensive nephrosclerosis?

Answer 9

1. ACE inhibitors
2. ARBs

Question 10

Hypertensive retinopathy?

Answer 10

1. Arteriosclerotic and hypertension-related changes of the retinal vessels
2. Initial reactive vasoconstriction (vasospasm), followed by sclerosis with breakdown of blood-retinal barrier and subsequent hemorrhage and exudation

Question 11

Fundoscopic examination in hypertensive retinopathy?

Answer 11

1. Cotton wool spots
2. Retinal hemorrhages (i.e., flame-shaped hemorrhages)
3. Microaneurysms
4. Macular star (results from exudation into the macula)
5. Hard exudates
6. Arteriovenous nicking
   - a tapering of a retinal venule at the point where a retinal arteriole crosses the retinal venule
7. Hourglass shape on fundoscopic examination
   - Associated with advanced hypertensive retinopathy

Question 12

Eye examination in hypertension?

Answer 12

1. Marked swelling and prominence of the optic disk with indistinct borders due to papilledema and optic atrophy (end-stage disease)
2. The presence of papilledema in a hypertensive patient may indicate a hypertensive crisis and warrants urgent lowering of blood pressure

Question 13

Hypertensive retinopathy classification?

Answer 13

Grade 1 - 4

Question 14

Grade I hypertensive retinopathy?

Answer 14

minimal narrowing of retinal arteries
- non-malignant

Question 15

Grade II hypertensive retinopathy?

Answer 15

narrowing of the retinal arteries in conjuction with regions of focal narrowing and arterio-venous nipping
- non-malignant

Question 16

Grade III hypertensive retinopathy?

Answer 16

abnormalities seen in Grades I and II as well as retinal hemorrhages, hard exudation and cotton wool spots
- malignant

Question 17

Grade IV hypertensive retinopathy?

Answer 17

abnormalities encounters in Grades I - III as well as swelling of the optic nerve head and macular star
- malignant

Question 18

Hypertensive crisis?

Answer 18

Acute severe HTN; Severe abrupt elevation in BP

Question 19

Causes of hypertensive crisis?

Answer 19

1. Common in patients with a history of HTN who have failed to comply with medications or who have been under-medicated.
2. Drugs that may exacerbate hypertension (e.g., MAO inhibitors, TCAs, NSAIDS, cocaine, amphetamines, ecstasy, stimulant diet pills)
3. Phaeochromocytoma, hyperthyroidism
4. Acute and rapidly progressive renal disorders
5. Collagen vascular diseases (e.g., SLE)
6. Eclampsia/Pre-eclampsia
7. Head trauma, spinal cord disorders

Question 20

Manifestations of hypertensive crisis?

Answer 20

asymptomatic, non-specific symptoms (headache dizziness, epistaxis)

Question 21

Signs and symptoms of neurological end organ dysfunction?

Answer 21

1. Hypertensive encephalopathy (headache, N&V, seizures,papilledema, confusion, coma)
2. CVA
3. focal neurological deficits
4. altered mental status

Question 22

Signs and symptoms of opthalmic end organ dysfunction?

Answer 22

Acute hypertensive retinopathy
1. blurry vision
2. decrease in visual acuity
3. retinal flame hemorrhages
4. papilledema

Question 23

Signs and symptoms of renal organ dysfunction?

Answer 23

1. Renal insufficiency
2. AKI
3. acute hypertensive nephrosclerosis

Question 24

Signs and symptoms of cardiac dysfunction?

Answer 24

1. heart failure
2. flash pulmonary edema
3. MI
4. aortic dissection

Question 25

Management?

Answer 25

Confirm BP manually and on bilateral upper limbs
1. First hour: goal of reduction inmean arterial pressureby no more than 25%
2. Over the next 2–6 hours: Reduce to160/100–110 mm Hg.
3. Once at goal (typically< 160/110 mm Hg) Transition to PO medications.
- If left untreated, hypertensive emergencies are associated with a 1-year mortality rate of > 80% and a median survival of 10–11 months.

Question 26

Management of hypertensive urgency?

Answer 26

1. Initiate, reinstitute, or modify oral antihypertensive therapy
2. Refer for evaluation of newly diagnosed hypertension and assessment for secondary hypertension
3. Arrange follow-up, monitoring, and counselling.

Question 27

Management of hypertensive emergency?

Answer 27

ABCDE approach
1. IV antihypertensives (Labetalol, sodium nitroprusside, hydralazine)
2. Monitor cardiac and renal function, determine cause
3. May need HDU or ICU admission
4. Determine cause