Hypertension COPY Flashcards
Facts on hypertension
- World’s number 1 cause of preventable and premature mortality and morbidity - A 2mmHg rise in BP causes a 7% increase of mortality from IHD and a 10% increased risk of mortality from stroke
What does hypertension greatly contribute to?
End organ damage
What conditions can be easily developed due to hypertension?
- IHD - Retinopathy - Peripheral vascular disease - Stroke - CHD - Heart failure - Renal failure - Proteinuria
How many times greater is your risk of stroke if you are hypertensive compared to normal blood pressure?
4-6 times greater
What ways can blood pressure vary throughout the day?
- Physical stress - Mental stress
What is the definition of clinical hypertension?
The blood pressure at which the benefits of treatment outweigh the risks in terms of morbidity and mortality
Describe what is shown here
Shows blood pressure distribution between different cultures
- Group 1 = island dwellers in the pacific where BP is lower
- Group 5 shows western european BP
- Notice all follow an equal distribution within their populations
How does age affect hypertension?
As age increases BP increases
What is the correlation between high BP and risk of stroke and CHD?
As BP increases the chances of developing these increases
Which age decade has the biggest increase in IHD mortality compared to average blood pressure at the beginning of that decade?
40 - 49 years
What is stage 1 hypertension?
- Clinical blood pressure > 140/90mmHg
- ABPM (ambulatory blood pressure monitoring) average of >135/85
What is stage 2 hypertension?
- BP > 160/100mmHg
- ABPM average > 150/95mmHg
What is severe hypertension?
- Systolic > 180
- Diastolic > 110
What other factors also increase the risk of hypertension?
- Smoking
- Diabetes
- Renal disease
- Being a bloke
- Hyperlipidaemia
- Previous history of MI or stroke
- Left ventricular hypertrophy (PHT)
What three ways is the renin-angiotensin-aldosterone system activated?
- Fall in BP
- Fall in circulating volume
- Lack of sodium in blood
What can angiotensin II also cause (instead of the release of aldosterone from the adrenal glands)?
Myocyte hypertrophy
What are the polygenic aetiologies of hypertension?
- Major genes (very rare)
- Poly genes
What is meant that hypertension is polyfactorial?
- Can be influenced by multiple environmental factors
- Can be individual or shared (people sharing the same diet etc may be both hypertensive)
What are example of individual hypertension aetiologies?
- Oral contraceptives
- Physical inactivity
- Stress
- Lower education
- Small family size
What are the most likely causes (endogenous) of hypertension?
- Increased reactivity of resistance vessels increase TPR
- Sodium homeostatic effect (kidneys unable to excrete appropriate sodium levels so sodium and fluid retained and BP increases
How should hypertension in the elderly be treated?
- Aggressively
- They have more to lose
- MUST REMAIN PRAGMATIC
Is hypertension hereditary?
- Yes
- Tends to run in the family (or in a hypertensive family no one runs haha haaaaaa)
- Closest correlation between siblings rather than parent to child
What special type of siblings very commonly both have hypertension or both don’t
- Monozygotic twins
- Dizygotic do show a correlation though not as strong
What is the correlation between sodium and hypertension?
More salt in the diet the higher the BP
What is the correlation between potassium in the diet and hypertension?
More potassium, lower blood pressure
What is the most common cause of hypertension in a young scottish person?
Alcohol
What percent of the population are affected by hypertension caused by alcohol?
1%
What will the effects of small amounts of alcohol have on the BP?
Tend to actually lower it
What percentage of hypertension is attributable to being obese?
30%
Why does obesity increase blood pressure?
- Releases interleukin-6 which increase BP
- Activates sympathetic system more often
- Also related to sleep apnoea so increases hypertension
What is the correlation between birth weight and hypertension later in life?
Higher the birth rate the lower the BP
What is secondary hypertension?
Unknown cause
What is responsible for 20% of resistant hypertensions?
Renal disease
What renal diseases can cause hypertension?
- Chronic pyelonephritis (inflammation and fibrosis from repeat infection
- Fibromuscular dysplasia (a non atherosclerotic or fibrotic growth in the blood vessels most commonly in renal and carotid
- Renal artery stenosis (narrowing of renal arteries)
- Polycystic kidneys
What drugs can increase BP?
- NSAIDs
- Oral contraceptive
- Corticosteroids
What can pregnancy cause that affects BP?
- Preeclampsia (hypertension during pregnancy)
What endocrine conditions can affect BP?
- Conn’s Syndrome (excess aldosterone)
- Cushings Disease (excess cortisol)
- Phaeochromocytoma (tumour on adrenal resulting in excess epinephrine)
- Hypo/hyperthyroidism
- Acromegaly (too much HGH)
What vascular change can increase BP?
Aortic Coarctication
