Hypertension Pathophysiology, Presentation and Investigation

Question 1

What is hypertension?

Answer 1

The blood pressure above which the benefits of treatment outweigh the risks in terms of morbidity and mortality

Question 2

According to NICE 2011 definitions, what is stage 1 hypertension?

Answer 2

Clinical BP of 140/90mmHg or higher

ABPM daytime average of 135/85mmHg or higher

Question 3

According to NICE 2011 definitions, what is stage 2 hypertension?

Answer 3

Clinical BP of 160/100mmHg or higher

ABPM daytime average 150/95mmHg or higher

Question 4

According to NICE 2011 definitions, what is severe hypertension?

Answer 4

Clinical systolic BP of 180mmHg or higher, or diastolic BP of 110mmHg or higher

Question 5

In 95% of cases of hypertension, no cause can be found, what are these cases known as?

Answer 5

Primary hypertension

Question 6

The 5-10% of cases of hypertension for which a cause can be found are known as what?

Answer 6

Secondary hypertension

Question 7

What percentage of cases of hypertension are primary and what percentage are secondary?

Answer 7

95% primary

5-10% secondary

Question 8

Does removal of the cause of secondary hypertension cure the hypertension?

Answer 8

No - removal of cause does not guarantee that the hypertension or associated risk will return to normal

Question 9

What percentage of resistant hypertension is renal disease responsible for?

Answer 9

20%

Question 10

What are some renal diseases that cause hypertension?

Answer 10

Chronic pyelonephritis
Fibromuscular dysplasia
Renal artery stenosis
Polycystic kidneys

Question 11

What are some causes of drug-induced hypertension?

Answer 11

NSAIDs
OCP
Corticosteroids

Question 12

What condition in pregnancy can cause hypertension?

Answer 12

Pre-eclampsia

Question 13

What are some endocrine causes of hypertension?

Answer 13

Cushing's disease
Conn's syndrome 
Phaeochromocytoma
Hypothyroidism 
Hyperthyroidism
Acromegaly

Question 14

What is a vascular cause of hypertension?

Answer 14

Coarctation on the aorta

Question 15

Hypertension is the world’s number one cause of preventable mortality and morbidity, and the UK’s number one cause of premature morbidity and mortality. What is the risk of heart disease and stroke mortality with hypertension?

Answer 15

For a 2mmHg rise in BP there is a 7% increased risk of mortality from heart disease and a 10% increased risk of mortality from stroke

Question 16

What are some of the factors which increase the risk from hypertension?

Answer 16

Cigarette smoking 
Diabetes mellitus
Renal disease
Male
Hyperlipidaemia 
Previous MI or stroke 
Left ventricular hypertrophy

Question 17

What are some factors that affect the development of hypertension?

Answer 17

Age 
Genetics
Family history 
Environment
Weight 
Alcohol intake 
Race

Question 18

How does BP change with age?

Answer 18

Tends to rise with age

Question 19

How should hypertension be treated in the elderly?

Answer 19

As aggressively as possible - studies show benefit from treating both systolic and diastolic hypertension

Question 20

Why are genetics/family history considered to be risk factors for hypertension?

Answer 20

Hypertension tends to run in families with the closest correlation between siblings
Genes have been recognised as important in development of hypertension
Possible that environmental factors common to all members of a family have a role in the development of hypertension

Question 21

How do mental and physical stress affect BP?

Answer 21

Both increase BP

Question 22

How do people with white coat hypertension tend to respond to treatment?

Answer 22

Tend to be highly resistant to treatment

Question 23

What effect can reducing salt intake in hypertensive individuals have?

Answer 23

Lowers BP

Question 24

What salt reduction is necessary to lower BP?

Answer 24

Reducing salt intake to < 6 grams per day or to 1.5 gram/day

Question 25

What is one of the most common causes of hypertension in young people?

Answer 25

Alcohol

Question 26

What effect does alcohol have on BP?

Answer 26

Small amounts tend to decrease it but large amounts tend to increase it

Question 27

What is the average fall in BP with alcohol consumption reduction?

Answer 27

Around 5/3 mmHg

Question 28

How does weight affect BP?

Answer 28

Increases with weight

Obese patients have higher BP

Question 29

What percentage of hypertension is attributable to obesity?

Answer 29

30%

Question 30

What is the association between weight loss and BP reduction?

Answer 30

In non-medically treated patients, weight loss of 9kg has been reported to produce fall in BP of 19/18mmHg
In medically treated patients a fall of 30/21 mmHg has been reported

Question 31

What is the most important non-pharmacological measure in hypertension treatment?

Answer 31

Weight loss

Question 32

How is birth weight associated with hypertension?

Answer 32

Lower the birthweight, higher the likelihood of developing hypertension and heart disease in later life

Question 33

How does race affect BP?

Answer 33

Caucasians have a lower BP than black populations living in the same environment

Question 34

What are the potential complications of hypertension (end organ damage)?

Answer 34

Haemorrhage, stroke, cognitive decline
Retinopathy
Peripheral vascular disease
Left ventricular hypertrophy, coronary heart disease, congestive heart failure, MI
Renal failure, dialysis, transplantation, proteinuria

Question 35

What percentage of strokes are attributable to BP greater than 140mmHg?

Answer 35

40%

Question 36

What are the prime contributors to BP?

Answer 36

Cardiac output
Stroke volume
Heart rate
Peripheral vascular resistance