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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
What is the RAAS responsible for?
- Maintenance of sodium balance - Control of blood volume - Control of blood pressure
26
What is RAAS stimulated by?
- Fall in BP - Fall in circulating volume - Sodium depletion
27
Where is renin released from?
Juxtaglomerular apparatus
28
What stimulates renin release?
- Fall in BP - Fall in circulating volume - Sodium depletion
29
What does renin do?
Converts angiotensinogen to angiotensin I
30
What coverts angiotensin I to angiotensin II?
Angiotensin converting enzyme
31
Angiotensin is a potent...
- Vasoconstrictor - Anti-natriuretic peptide - Stimulator of aldosterone release from the adrenal gland
32
Aldosterone is a potent...
- Anti-natriuretic peptide | - Antidiuretic peptide
33
Angiotensin II is a potent...
Hypertrophic agent which stimulates myocyte and smooth muscle hypertrophy in the arterioles
34
What kind of prognostic indicator s are myocyte and smooth muscle hypertrophy??
Poor prognostic indicators in patients with hypertension
35
What may explain why hypertension and its associated risks persist in some patients despite treatment?
Myocyte and smooth muscle hypertrophy
36
What are key targets in the treatment of hypertension?
- Sympathetic system | - RAAS
37
What is the aetiology of hypertension?
-Polygenic : major genes, poly genes -Polyfactorial: environment, individual/shared
38
What are the likely causes of hypertension?
- Increased reactivity of resistance vessels and resultant increase in peripheral resistance - A sodium homeostatic effect
39
What may increase reactivity of resistance vessels?
Hereditary defect of the smooth muscle lining arterioles
40
Why does BP increase due to a sodium homeostatic effect?
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
What other factors may influence hypertension?
- Age - Genetics and family history - Environment - Weight - Alcohol intake - Race
42
How does age effect BP?
-BP tends to rise with age, possibly as a result of decreased arterial compliance
43
How should hypertension be addressed in the elderly?
- Should be treated aggressively | - Treating both systolic and diastolic hypertension in the elderly significantly reduces stroke and MI
44
How do genetics effect BP?
A history of hypertension tends to run in families
45
Where does the closest genetic correlation exist?
Between siblings
46
How do genes influence hypertension?
To date >30 genes recognised as important but individually they account for at most 0.5mmHg each
47
Why does removing stress not necessarily return BP to normal values?
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
What effect does reducing salt intake have on BP?
- In hypertensive individuals lowers BP | - In normotensives appears to have little effect
49
What is one the most common cause of hypertension in young adults?
Alcohol
50
What effect does alcohol have on BP?
- Small amounts tend to decrease BP | - Large amounts tend to increase BP
51
What happens if alcohol consumption is reduced?
BP will fall over several days to weeks
52
How does weight effect BP?
Obese patients have a higher BP
53
What will happen if patients lose weight?
Their BP will fall
54
What is the most important non-pharmacological measure available for hypertension in obese patients?
Weight reduction
55
What effect does birth weight have on BP?
-The lower the birth weight the higher the likelihood of developing hypertension and heart disease
56
How does race effect BP?
- 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
What is the genetic reasoning behind black populations having higher BP?
Black populations are genetically selected to be salt retainers and so are more sensitive to an increase in dietary salt intake
58
What can sustained hypertension result in?
End-organ damage to blood vessels, heart and kidney
59
What renal diseases can cause secondary hypertension?
- Chronic pyelonephritis - Fibromuscular dysplasia - Renal artery stenosis - Polycystic kidneys
60
What drugs can induce secondary hypertension?
- NSAIDs - Oral contraceptive - Corticosteroids
61
How can pregnancy lead to secondary hypertension?
Pre-eclampsia
62
What endocrine disorders can lead to secondary hypertension?
- Conn's Syndrome - Cushings - Phaeochromocytoma - Hyperthyroidism - Hypothyroidism - Acromegaly
63
What vascular condition can lead to secondary hypertension?
Coarctation of the aorta
64
What respiratory condition can lead to secondary hypertension?
Sleep apnoea

Systems: Cardiovascualar AB (42 decks)

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