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Cardiovascular LK > Hypertension - Pathophysiology, Presentation & Investigation > Flashcards

Hypertension - Pathophysiology, Presentation & Investigation Flashcards

1
Q

What is the worlds number 1 cause of preventable morbidity and mortality?

A

Hypertension

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2
Q

What does a 2mmHg rise in blood pressure lead to?

A

7% increased risk of mortality from ischemic heart disease

10% increased risk of mortability from stroke

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3
Q

How does the treatment of hypertension rank compared to other illness in terms of cost effectiveness?

A

Most cost effective treatment ever

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4
Q

What is morbidity?

A

The condition of being diseased

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5
Q

What is the condition of being diseased called?

A

Morbidity

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6
Q

What is mortality?

A

The state of being subject to death

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7
Q

What is the state of being subject to death called?

A

Mortality

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8
Q

What is a potential complication of hypertension, in terms of other organs?

A

End organ damage

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9
Q

What end organ damage can hypertension cause?

A

Stroke (brain)

Retinopathy (eyes)

Peripheral vasciular disease (blood vessels)

Renal failure (kidneys)

Coronary heart disease (heart)

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10
Q

What percentage of all strokes are due to blood pressure greater than 140mmHg?

A

40%

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11
Q

What does blood pressure fluctuate during the day due to?

A

Mental stress

Physical stress

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12
Q

What is hypertension?

A

Blood pressure above which the benefits of treatment outweight the risks in terms of morbidity and mortality

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13
Q

What in increasing blood pressure associated with?

A

Increased risk in stroke and cardiovascular disease

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14
Q

How does risk of stroke or cardiovascular disease change with rise in blood pressure?

A

Rises exponentially

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15
Q

How does hypertension change with age?

A

Blood pressure increases so hypertension is more likely

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16
Q

When is a patient considered to be hypertensive?

A

140/90mmHg

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17
Q

What are the stages of hypertension?

A

Stage 1

Stage 2

Severe

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18
Q

What is stage 1 hypertension?

A

Clinic blood pressure of 140/90mmHg

Ambulatory blood pressure monitoring (ABPM) daytime average of 135/85mmHg

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19
Q

What does ABPM stand for?

A

Ambulatory blood pressure monitoring

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20
Q

What is stage 2 hypertension?

A

Clinic blood pressure of 160/100mmHg

Ambulatory blood pressure monitoring daytime average of 150/95mmHg

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21
Q

What is severe hypertension?

A

Clinic systolic blood pressure of 180mmHg or diastolic blood pressure of 110mmHg

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22
Q

What is close to somebodies actual blood pressure?

A

Average blood pressure during the waking period

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23
Q

Why are clinical blood pressures not trustworthy?

A

Blood pressure increases due to being there

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24
Q

What percentage of blood pressure is primary?

A

90%

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25
Q

What percentage of blood pressure is secondary?

A

10%

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26
Q

What are some examples of causes of secondary hypertension?

A

Chronic renal disease

Renal artery stenosis

Endocrine disease

Cushings

Conn’s syndrome

Phaechromocytoma

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27
Q

When should someone with hypertension be seen by a professional?

A

Anyone under 40 as younger people are more likely to have an underlying cause which can be treated to prevent hypertension

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28
Q

What cause of death worldwide is hypertension?

A

Number 1 cause of death

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29
Q

What percentage of deaths is hypertension directly or indirectly responsible for?

A

>20%

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30
Q

How does the risk of hypertension change with other risk factors?

A

Increases exponentially

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31
Q

What are examples of risk factors for hypertension?

A

Cigarette smoking (adds 20/10mmHg)

Diabetes mellitus (5-30x increase of myocardial infarction)

Renal disease

Male (2x risk)

Hyperlipidaemia

Previous myocardial infarction or stroke

Left ventricular hypertrophy (2x risk)

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32
Q

How more at risk of hypertension are males than females?

A

2x

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33
Q

How much pressure does smoking add to your blood pressure?

A

20/10mmHg

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34
Q

What are primary contributors to hypertension?

A

Cardiac output (heart rate and stroke volume)

Total peripheral resistance

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35
Q

How does the sympathetic system control blood pressure?

A

Activation causes vasoconstriction, reflex tachycardia and increased cardiac output

Increases blood pressure

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36
Q

Why do the actions of the sympathetic system account for short term control of blood pressure?

A

They are rapid

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37
Q

What is an example of a system that controls blood pressure long term?

A

Renin-angiotensin-aldosterone system

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38
Q

What is the renin-angiotensin-aldosterone system responsible for?

A

Maintenance of sodium balance

Control of blood volume

Control of blood pressure

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39
Q

What is the renin-angiotensin-aldosterone system stimulated by?

A

Fall in blood pressure

Fall in circulating volume

Sodium depletion

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40
Q

What is the process of the renin-angiotensis-aldosterone system?

A

1) Renin is released from the juxtaglomerular apparatus
2) Renin converts angiotensinogen into angiotensin I
3) Angiontensin I is converted to angiotensin II by angiotensin converting enzyme (ACE)
4) Angiotensin II is a potent vasoconstrictor, anti-natruiretic peptide and stimulator of aldosterone release from adrenal glands
5) Aldosertone is also a potent antinatriuretic and antidiuretic peptide

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41
Q

Where is renin released from?

A

Juxtaglomerular appartatus

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42
Q

What does ACE stand for?

A

Angiotensin converting enzyme

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43
Q

Where is aldosterone released from?

A

Adrenal glands

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44
Q

What are negative effects of angiotensin II?

A

Potent hypertrophic agent which stimulates myocyte and smooth muscle hypertrophy in arterioles

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45
Q

What are key targets for the treatment of hypertension?

A

Sympathetic and renin-angiotensin-aldosterone systems

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46
Q

What does RAAS stand up for?

A

Renin-angiotensin-aldosterone system

47
Q

What is the aetiology of hypertension?

A

Polygenic

Polyfactorial

48
Q

What does polygenic mean?

A

From several genes acting together

49
Q

What are the 2 different classes of genes that can cause hypertension?

A

Major genes (pronounced phenotype expression)

Poly genes (individual effect on phenotype is too small to be observed but can act together to produce an observable variation)

50
Q

What are some examples of different causes of hypertension?

A

Major genes

Polygenes

Environment

51
Q

What are examples of major genes that cause hypertension?

A

GRA

Angiotensinogen

Diabetes

52
Q

What are examples of polygenes that cause hypertension?

A

Obesity

Race

Blood pressure

53
Q

What are examples of environment causing hypertension?

A

Diet

Oral contraceptives

Physical activity

Stress

54
Q

What are some likely causes of hypertension?

A

Increased reactivity of resistance vessels and resultant increase in peripheral resistance

Sodium homeostatic effect

Age

Genetics and family history

Environment

Diet

Alcohol intake

Weight

Race

55
Q

What leads to increased reactivity of resistance vessels?

A

Hereditary defect of the smooth muscle lining arterioles

56
Q

How does a sodium homeostatic effect cause hypertension?

A

Kidneys being unable to excrete appropriate amounts of sodium for any given blood pressure leads to sodium and fluid being retained and the blood pressure increasing

57
Q

How does blood pressure change with age?

A

Increasing with age

58
Q

Why does blood pressure increase with age?

A

Due to decreased arteriolar compliance

59
Q

Why should hypertension in the elderly be treated as aggresively as in the young?

A

They have more to lose

60
Q

Why must treatment for hypertension in the elderly be pragmatic?

A

Elderly people cannot withstand physiological changes like young people

61
Q

Is there a link between genetics and hypertension?

A

Hypertension tends to run in families

62
Q

What is the closest correlation of hypertension within families?

A

Between siblings not parent and child

63
Q

How many genes have been recognised to be linked to hypertension?

A

More than 30, but each one only adds 0.5mmHg each

64
Q

What are examples of how the environment affects blood pressure?

A

Mental and physical stress increases blood pressure

65
Q

How does removing the environmental stress that causes blood pressure change the blood pressure?

A

It does not necessary decrease blood pressure

66
Q

How can you tell if someone is a true stress responder (high blood pressure due to stress/environment)?

A

Very high blood pressure in the clinic but low or normal otherwise

Tend to be highly resistant to treatment

67
Q

How does diet releate to hypertension?

A

Strong relationship between hypertension and salt intake

68
Q

What can hypertensive patients do to their diet to reduce their blood pressure?

A

Reduce salt intake

69
Q

What effect does people with normal blood pressure reducing salt intake have?

A

Little effect

70
Q

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

A

Alcohol intake

71
Q

How do small amounts of alcohol impact blood pressure?

A

Decrease blood pressure

72
Q

How does large amounts of alcohol intake impact blood pressure?

A

Increases blood pressure

73
Q

What happens to blood pressure if alcohol intake is reduced?

A

It falls over several days to weeks

74
Q

What is the average fall of someone who reduces alcohol intake?

75
Q

What is the blood pressure like in obese patients?

A

Higher than skinnier patients

76
Q

What percentage of hypertension is due in part or wholly to obesity?

77
Q

What will happen to a patients blood pressure if they lose weight?

A

It will fall

78
Q

What can weight loss of 9kg change blood pressure by in patients with no other treatment?

79
Q

What can weight loss of 9kg change blood pressure in patients with other treatment?

80
Q

What is the most important non-pharmacological measure for managing blood pressure?

A

Weight loss

81
Q

What is the relationship between birth weight and hypertension?

A

Birth weight is associated with the development of hypertension in later life, lower birth weight has a higher risk

82
Q

How does the blood pressure of caucasians and black people compare?

A

Black people have a higher blood pressure

83
Q

How does the blood pressure of black people living in rural Africa compare with ones living in towns?

A

Lower blood pressure in rural areas

84
Q

What percentage of hypertension is secondary?

85
Q

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

A

Not always

86
Q

What are some examples of causes of secondary hypertension?

A

Renal disease

Drug induced

Pregnancy

Endocrine

Vascular

Sleep apnoea

87
Q

What are examples of renal disease that can lead to hypertension?

A

Chronic pyelonephritis

Fibromuscular dysplasia

Renal artery stenosis

Polycystic kidneys

88
Q

What is chronic pyelonephritis?

A

Continuing pyogenic infection of the kidney

89
Q

What is continuing pyogenic infection of the kidney called?

A

Chronic pyelonephritis

90
Q

What is fibromuscular dysplasia?

A

Abnormal growth within the wall of an artery that is not due to atherosclerotic or inflammatory disease

91
Q

What is abnormal growth within the wall of an artery that is not due to atherosclerotic or inflammatory disease called?

A

Fibromuscular dysplasia

92
Q

What is renal artery stenosis?

A

Narrowing of one of the renal arteries

93
Q

What is narrowing of one of the renal arteries called?

A

Renal artery stenosis

94
Q

What is polycystic kidneys?

A

Inherited disorder which is cyst formation and enlargement of the kidneys

95
Q

What is an inherited disorder that causes cyst formation and enlargement of the kidneys called?

A

Polycystic kindeys

96
Q

What are examples of drugs that can cause secondary hypertension?

A

NSAIDs

Oral contraceptives

Corticosteroids

97
Q

What is pre-eclampsia?

A

Onset of high blood pressure during pregnancy

98
Q

What is onset of high blood pressure during pregnancy called?

A

Pre-eclampsia

99
Q

What are examples of endocrine problems that can lead to secondary hypertension?

A

Conn’s syndrome

Cushings disease

Phaechromocytoma

Hypo and hyperthyroidism

Acromegaly

100
Q

What is conn’s syndrome?

A

Excessive production of the hormone aldosterone resulting in low renin levels

101
Q

What is excessive production of the hormone aldosterone resulting in low renin levels called?

A

Conn’s syndrome

102
Q

What is cushing’s disease?

A

Primary adrenal gland disease

103
Q

What is phaeochromocytoma?

A

Neuroendocrine tumour of the medulla of the adrenal glands

104
Q

What is a neuroendocrine tumour of the medulla of the adrenal glands called?

A

Phaeochromocytoma

105
Q

What is hypo and hyperthyroidism?

A

Abnormally low or excessive thyroid production

106
Q

What is abnormally low or excessive thyroid production called?

A

Hypo or hyperthyroidism

107
Q

What is acromegaly?

A

Abnormal growth of the hands, feet and face caused by overproduction of growth hormone by the pituitary gland

108
Q

What is abnormal growth of the hands, feet and face caused by overproduction of growth hormone by the pituitary gland called?

A

Acromegaly

109
Q

What is an example of a vascular condition that can lead to secondary hypertension?

A

Coarctation of the aorta

110
Q

What is coarctation of the aorta?

A

Aorta is narrow

111
Q

What is it called when the aorta is narrow?

A

Coarctation of the aorta

112
Q

What is sleep apnoea?

A

Pauses in breathing during sleep

113
Q

What are pauses in breathing during sleep called?

A

Sleep apnoea

Cardiovascular LK (41 decks)

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