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Systems: Cardiovascualar AB > Hypertension-Pathophysiology, Presentation and Investigation > Flashcards

Hypertension-Pathophysiology, Presentation and Investigation Flashcards

1
Q

What does a 2mmHg rise in BP increase?

A
  • Risk of mortality from IHD by 7%

- Risk of mortality from stroke by 10%

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2
Q

What organs can be effected by hypertension?

A
  • Brain
  • Eye
  • Vasculature
  • Kidneys
  • Heart
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3
Q

What are the possible complications of hypertension involving the brain?

A
  • Haemorrhage
  • Stroke
  • Cognitive decline
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4
Q

What are the possible complications of hypertension involving the eye?

A

Retinopathy

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5
Q

What are the possible complications of hypertension involving the vasculature?

A

Peripheral vascular disease

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6
Q

What are the possible complications of hypertension involving the kidneys?

A
  • Renal failure
  • Dialysis
  • Transplantation
  • Proteinuria
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7
Q

What are the possible complications of hypertension involving the heart?

A
  • Left ventricular hypertrophy
  • Coronary heart disease
  • Congestive heart failure
  • Myocardial infarction
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8
Q

What can cause BP to fluctuate during the day?

A
  • Physical stress

- Mental stress

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9
Q

Hypertension

A

Blood pressure above which the benefits of treatment outweigh the risks in term of morbidity and mortality

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10
Q

What kind of distribution does BP exhibit amongst a population?

A

Normal distribution with a bell curve

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11
Q

What were the findings of the Framingham Study?

A
  • Increasing blood pressure is associated with a progressive increase in the risk of stroke and CV disease
  • Risk however rises exponentially and not linearly with pressure
  • Age clearly plays a significant role also
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12
Q

What is considered to optimum BP?

A

< 120/80

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13
Q

What do most guidelines consider the point of hypertension?

A

140/90

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14
Q

Stage 1 hypertension

A
  • Clinic blood pressure is 140/90 mmHg or higher

- ABPM daytime average 135/85 mmHg or higher

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15
Q

Stage 2 hypertension

A
  • Clinic blood pressure is 160/100mmHg or higher

- ABPM daytime average is 150/95 mmHg or higher

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16
Q

Severe hypertension

A

Clinic systolic blood pressure is 180 mmHg or higher or diastolic blood pressure is 100 mmHg or higher

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17
Q

What are most cases of hypertension caused by?

A

Primary hypertension when no cause can be found

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18
Q

What are the causes of some cases of hypertension?

A
  • Secondary hypertension
  • Chronic renal disease
  • Renal artery stenosis
  • Endocrine disease: Cushings, Conn’s syndrome, phaechromocytoma, GRA
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19
Q

What other factors can increase the risk of morbidity of hypertension exponentially?

A
  • Cigarette smoking
  • Diabete mellitus
  • Renal disease
  • Male
  • Hyperlipidemia
  • Previous MI or stroke
  • Left ventricular hypertrophy
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20
Q

How is BP controlled by the body?

A

By an integrated system

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21
Q

What are the prime contributors to blood pressure?

A
  • Cardiac output
  • Stroke volume
  • Heart rate
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22
Q

What system can account for second to second blood pressure control?

A

Sympathetic system

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23
Q

How does the sympathetic system increase BP?

A
  • Produces vasoconstriction
  • Reflex tachycardia
  • Increased cardiac output
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24
Q

Which system is pivotal in long term BP control?

A

Renin-angiotensin- aldosterone system

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25
Q

What is the RAAS responsible for?

A
  • Maintenance of sodium balance
  • Control of blood volume
  • Control of blood pressure
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26
Q

What is RAAS stimulated by?

A
  • Fall in BP
  • Fall in circulating volume
  • Sodium depletion
27
Q

Where is renin released from?

A

Juxtaglomerular apparatus

28
Q

What stimulates renin release?

A
  • Fall in BP
  • Fall in circulating volume
  • Sodium depletion
29
Q

What does renin do?

A

Converts angiotensinogen to angiotensin I

30
Q

What coverts angiotensin I to angiotensin II?

A

Angiotensin converting enzyme

31
Q

Angiotensin is a potent…

A
  • Vasoconstrictor
  • Anti-natriuretic peptide
  • Stimulator of aldosterone release from the adrenal gland
32
Q

Aldosterone is a potent…

A
  • Anti-natriuretic peptide

- Antidiuretic peptide

33
Q

Angiotensin II is a potent…

A

Hypertrophic agent which stimulates myocyte and smooth muscle hypertrophy in the arterioles

34
Q

What kind of prognostic indicator s are myocyte and smooth muscle hypertrophy??

A

Poor prognostic indicators in patients with hypertension

35
Q

What may explain why hypertension and its associated risks persist in some patients despite treatment?

A

Myocyte and smooth muscle hypertrophy

36
Q

What are key targets in the treatment of hypertension?

A
  • Sympathetic system

- RAAS

37
Q

What is the aetiology of hypertension?

A

-Polygenic
: major genes, poly genes
-Polyfactorial: environment, individual/shared

38
Q

What are the likely causes of hypertension?

A
  • Increased reactivity of resistance vessels and resultant increase in peripheral resistance
  • A sodium homeostatic effect
39
Q

What may increase reactivity of resistance vessels?

A

Hereditary defect of the smooth muscle lining arterioles

40
Q

Why does BP increase due to a sodium homeostatic effect?

A

In essential hypertension the kindeys aree unable to excrete appropriate amounts of sodium for any given BP. As a result sodium and fluid are retained and BP increases

41
Q

What other factors may influence hypertension?

A
  • Age
  • Genetics and family history
  • Environment
  • Weight
  • Alcohol intake
  • Race
42
Q

How does age effect BP?

A

-BP tends to rise with age, possibly as a result of decreased arterial compliance

43
Q

How should hypertension be addressed in the elderly?

A
  • Should be treated aggressively

- Treating both systolic and diastolic hypertension in the elderly significantly reduces stroke and MI

44
Q

How do genetics effect BP?

A

A history of hypertension tends to run in families

45
Q

Where does the closest genetic correlation exist?

A

Between siblings

46
Q

How do genes influence hypertension?

A

To date >30 genes recognised as important but individually they account for at most 0.5mmHg each

47
Q

Why does removing stress not necessarily return BP to normal values?

A

True stress responders who have very high BP when they attend their doctor but low normal pressures otherwise tend to be highly resistant to treatment

48
Q

What effect does reducing salt intake have on BP?

A
  • In hypertensive individuals lowers BP

- In normotensives appears to have little effect

49
Q

What is one the most common cause of hypertension in young adults?

A

Alcohol

50
Q

What effect does alcohol have on BP?

A
  • Small amounts tend to decrease BP

- Large amounts tend to increase BP

51
Q

What happens if alcohol consumption is reduced?

A

BP will fall over several days to weeks

52
Q

How does weight effect BP?

A

Obese patients have a higher BP

53
Q

What will happen if patients lose weight?

A

Their BP will fall

54
Q

What is the most important non-pharmacological measure available for hypertension in obese patients?

A

Weight reduction

55
Q

What effect does birth weight have on BP?

A

-The lower the birth weight the higher the likelihood of developing hypertension and heart disease

56
Q

How does race effect BP?

A
  • Caucasians have a lower BP than black populations living in the same environment
  • Black populations living in rural Africa have a lower BP than those living in towns
57
Q

What is the genetic reasoning behind black populations having higher BP?

A

Black populations are genetically selected to be salt retainers and so are more sensitive to an increase in dietary salt intake

58
Q

What can sustained hypertension result in?

A

End-organ damage to blood vessels, heart and kidney

59
Q

What renal diseases can cause secondary hypertension?

A
  • Chronic pyelonephritis
  • Fibromuscular dysplasia
  • Renal artery stenosis
  • Polycystic kidneys
60
Q

What drugs can induce secondary hypertension?

A
  • NSAIDs
  • Oral contraceptive
  • Corticosteroids
61
Q

How can pregnancy lead to secondary hypertension?

A

Pre-eclampsia

62
Q

What endocrine disorders can lead to secondary hypertension?

A
  • Conn’s Syndrome
  • Cushings
  • Phaeochromocytoma
  • Hyperthyroidism
  • Hypothyroidism
  • Acromegaly
63
Q

What vascular condition can lead to secondary hypertension?

A

Coarctation of the aorta

64
Q

What respiratory condition can lead to secondary hypertension?

A

Sleep apnoea

Systems: Cardiovascualar AB (42 decks)

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