Hypertension pathophysiology, presentation and investigation

Question 1

Small rise in blood pressure can cause what

Answer 1

big change to outcomes

Question 2

blood pressure is the world’s…

Answer 2

number 1 cause of preventable morbidity and mortality

Question 3

end-organ damage examples in hypertension

Answer 3

Brain - haemorrhage, stroke, cognitive decline

Heart - LVH, CHD, CHF - congestive heart failure, MI

Eyes - retinopathy

Kidney - renal failure, dialysis, transplantation, proteinuria

Question 4

definition of hypertension

Answer 4

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

Question 5

At what blood pressure is a patient hypertensive

Answer 5

140/90

Question 6

what issues are there with blood pressure readings

Answer 6

they’re not very accurate - would need to do 30 readings to get within 10% of actual blood pressure

Question 7

ABPM benefits over clinic

Answer 7

some patients’ blood pressure increases a lot in clinic due to related stress or angst so monitoring it at home is more accurate

Question 8

primary/essential hypertension

Answer 8

90% of cases no cause can be found

Question 9

secondary hypertension

Answer 9

5-10% a cause can be found
chronic renal disease Renal artery stenosis
Endocrine disease, Cushings, Conn’s Syndrome, Phaeochromocytoma, GRA

Question 10

Renin-Angiotensin-Aldosterone System

Answer 10

responsible for maintenance of sodium balance, control of blood volume, control of blood pressure

Question 11

what is RAAS stimulated by

Answer 11

fall in BP
fall in circulating volume
sodium depletion

renin is released from the juxtaglomerular apparatus

Question 12

polygenic causes of hypertension

Answer 12

major genes

polygenes - polygenic multifactorial disorder involving the interaction of several genes with environmental factors

Question 13

polyfactorial causes of hypertension

Answer 13

environment

individual and shared

Question 14

general factors that cause hypertension

Answer 14

Age
Genetics and family history
Environment
Weight
Alcohol intake
Race/ethnicity

Question 15

Age and hypertension

Answer 15

BP increases with age

Question 16

Genetics and hypertension

Answer 16

tends to run in family

closest correlation - runs with siblings

siblings have shared parents and environment

Question 17

Environment and hypertension

Answer 17

Mental and physical stress both increase blood pressure

Question 18

sodium intake link to blood pressure

Answer 18

lower salt intake - lower blood pressure and vice versa

medication is far more effective when salt intake is lowered

Question 19

what is an under recognised cause of severe hypertension

Answer 19

sleep apnoea

Question 20

Race and hypertension

Answer 20

Caucasians have a lower BP than black

Stroke Is more common in people who moved to UK from populations that aren’t used to high salt environment – genetics

Question 21

which is the most fatal risk factor?

Answer 21

low fitness

Question 22

prime contributors to blood pressure

Answer 22

cardiac output - stroke volume and heart rate

peripheral vascular resistance

Question 23

sympathetic nervous system and blood pressure

Answer 23

Sympathetic system activation produces
vasoconstriction,
reflex tachycardia and increased cardiac output

In this way blood pressure is increased

The actions of the sympathetic system are rapid and account for second to second blood pressure control

Question 24

sodium’s effect on blood pressure: primary hypertension

Answer 24

the kidneys are unable to excrete appropriate amounts of sodium for any given BP. As a result sodium and fluid are retained and the BP increases

Question 25

alcohol link to blood pressure

Answer 25

One of the most common causes of hypertension in the young Scot

Affects 1% of the population
Small amounts of alcohol tend to decrease BP
Large amounts of alcohol tend to increase BP
If alcohol consumption is reduced BP will fall over several days to weeks.

Question 26

How does weight affect blood pressure

Answer 26

Obese patients have a higher BP

Up to 30% of hypertension is attributable in part or wholly to obesity

If a patient loses weight BP will fall

Weight reduction is the most important non-pharmacological measure available

Question 27

How does your birth weight affect blood pressure

Answer 27

Birth weight is also associated with the development of hypertension in later life.

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

Question 28

EWPHE study (European Working Party on High Blood Pressure in the Elderly )

Answer 28

study that has proven that treating both diastolic and systolic hypertension in the elderly significantly reduces stroke and MI

Question 29

MRC studies

Answer 29

medical research council

Question 30

SHEP studies

Answer 30

Systolic Hypertension in the Elderly Program

Question 31

systolic hypertension

Answer 31

defined as an elevated systolic blood pressure

Question 32

Understanding a blood pressure value ie(<120/80)

Answer 32

Your systolic blood pressure is the top number on your reading. It measures the force of blood against your artery walls while your ventricles contract, pushing blood out to the rest of your body

Your diastolic blood pressure is the bottom number. It measures the force of blood against your artery walls as your heart relaxes and the ventricles are allowed to refill with blood.