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

Hypertension - Pathophysiology, Presentation & Investigation Flashcards

1
Q

Define hypertension.

A

High blood pressure

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2
Q

What are the possible complications of hypertension for the heart?

(4)

A
  • left ventricular hypertrophy
  • coronary heart disease
  • congestive heart failure
  • myocardial infarction
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3
Q

What are the possible complications of hypertension for the eyes?

(1)

A

retinopathy

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4
Q

What are the possible complications of hypertension for the peripheries?

(1+)

A
  • peripheral vascular disease: peripheral blood vessels block, narrow or spasm
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5
Q

What are the possible complications of hypertension for the brain?

(4)

A
  • haemorrhage/aneurysm
  • stroke
  • cognitive decline
  • dementia/Alzheimer’s,
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6
Q

What are the possible complications of hypertension for the kidneys?

(4)

A
  • Renal Failure
  • Dialysis,
  • Transplantation
  • Proteinuria
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7
Q

What is one of the most devastating consequences to hypertension?

A
  • stroke - leads to death and permanent disability

- (CV disease second)

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8
Q

What can be said about blood pressure through the course of the day?

What factors influence this? (hint: both are similar) (2)

A

Blood pressure is a continuous variable which fluctuates widely during the day.

  • physical stress
  • mental stress
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9
Q

A person is considered hypertensive when their systolic pressure is ______ or above and diastolic pressure is ______ or above.

A

140mmHg

90mmHg

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10
Q

Risk rises exponentially and not linearly with pressure.

What does this tell us about hypertension and how it affects different people?

A

a persons age has a significant role.

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11
Q

What is the target blood pressure for adults?

And what is considered a normal blood pressure?

A

<120/80 mmHg

Systolic: 120-129mmHg
Diastolic: 80-84mmHg

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12
Q

What is considered a normal-high (pre-hypertensive) BP?

2

A

Systolic: 130-139mmHg
Diastolic: 85-89mmHg

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13
Q

How does the risk of cardiovascular disease and strokes change with increasing blood pressure?

A

it is an exponential increase

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14
Q

What factor also plays a part in the risk of cardiovascular disease and stroke with hypertension?

A

age

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15
Q

What is the optimum bp that must be aimed for in hypertensives?

A

<120/<80 mmHg

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16
Q

What is ABPM and what is its advantage over clinical blood pressure?

(2)

A
  • ambulatory blood pressure monitoring
  • it provides a more accurate measure of blood pressure as blood pressure measured in the clinic tends to be higher than normal.
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17
Q

If an elderly person aged 70 had a blood pressure of 140/90mmHg, would we be concerned or happy with this?

How would this BP be classified?

A

happy

it is in the upper region of normal (normal-high)

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18
Q

What is the clinic BP for type I hypertension, according to NICE guidelines?

How would this BP be classified?

A

140+/90+ mmHg

Stage 1, beyond pre-hypertensive

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19
Q

What is the clinic BP for type II hypertension, according to NICE guidelines?

How would this BP be classified?

A

160+/100+ mmHg

  • high
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20
Q

What is the clinic BP for type III hypertension, according to NICE guidelines?

How would this BP be classified?

A

180+/110+

  • severe hypertension
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21
Q

What percentage of hypertensive cases are idiopathic?

What is the term for this?

A

90%

primary hypertension

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22
Q

What is the ABPM for type I hypertension?

A

daytime average 135/85 mmHg

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23
Q

What is the ABPM for type II hypertension?

A

daytime average 150/95 mmHg

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24
Q

Who is secondary hypertension more likely to be found in?

A

younger (<40), perhaps in children

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25
Q

What are some causes of secondary hypertension?

3

A
  • chronic renal disease
  • renal artery stenosis
  • endocrine disease
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26
Q

What are examples of endocrine diseases where hypertension can become a complication of?

(4)

A
  • Cushngs
  • Conn’s syndrome
  • phaechromocytoma
  • GRA
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27
Q

Despite the clear relationship between BP and morbidity the risk from hypertension also depends on and increases exponentially with other factors.

What are they?

(7)

A
  • Cigarette smoking
  • Diabetes
  • Renal disease
  • Male
  • Hyperlipidaemia
  • Previous MI or stroke
  • Left ventricular hypertrophy
28
Q

If cigarette smoking itself does not raise blood pressure, why does smoking carry an equivalent risk of raising systolic pressure by 20mmHg?

(2)

A
  • Smokers suffer from lower fitness than non-smokers.

- Low fitness is the largest risk factor which kills hypertensive patients.

29
Q

How does having diabetes affect a the risk of MI in a hypertensive patient?

A

increases that risk by 5-30x

30
Q

What is the increased risk of morbidity due to hypertension of a male compared to a female?

A

2x

31
Q

What is the risk of morbidity of a hypertensive patient who smokes and has diabetes?

(2)

A
  • much higher than the two risks combined.

- diabetes and smoking work synergistically to increase risk of morbidity.

32
Q

What are the two prime contributors to blood pressure?

A
  • cardiac output (CO)

- total peripheral resistance (TPR)

33
Q

What two factors influence cardiac output (CO)?

A
  • stroke volume (SV)

- heart rate (HR)

34
Q

Sympathetic nervous system activation produces which effects?

(3)

A
  • vasoconstriction
  • reflex tachycardia
  • increased CO
35
Q

What is the collective effect from all the mechanisms employed by the sympathetic nervous system?

A
  • increased BP
36
Q

What does it mean by the actions of the sympathetic system are rapid?

(2)

A
  • rapid onset = fight or flight

- rapid fall in BP when threat goes away

37
Q

What are the three functions of the renin-angiotensin aldosterone system, in terms of aim/outcome?

A
  • maintenance of Na+ balance
  • control of plasma volume
  • control of BP (increases)
38
Q

What is the renin-angiotensin aldosterone system is stimulated by? (3)

What happens when any of above are stimulated?

A
  • fall in BP (MAP)
  • fall in circulating volume
  • sodium depletion (due to low filtrate production)
  • renin is released from the juxtaglomerular
39
Q

What course does renin go through?

2

A
  • renin converts to angiotensin I (inactive)

- angiotensin I is then converted to angiotensin II by ACE.

40
Q

Why is angiotensin II an active molecule?

A

It is a vasoconstrictor

41
Q

Who tends to have high levels of AT I and AT II?

A

people of young age

42
Q

How does AT II increase blood pressure?

2

A
  • it is a vasoconstrictor (increase BP)

- it induces the release of aldosterone from the adrenal gland (increase BP)

43
Q

Aldosterone is also a potent ___________ and __________ peptide.

A

antinatriuretic (ANP)

antidiuretic (ADH)

44
Q

Both the ___________ and _______ are key targets in the treatment of hypertension.

A

sympathetic

RAAS

45
Q

What does the hormone aldosterone do to increase blood pressure?

A
  • increases Na+ reabsorption
  • reduces diuresis
  • increases PV/BP
46
Q

The aetiology of hypertension is poly______ and ________.

A

polygenic

polyfactorial

47
Q

What are the two most likely causes of hypertension?

A
  • Increased reactivity of resistance vessels and resultant increase in TPR.
  • a sodium homeostatic effect.
48
Q

What causes hypertension in patients with a sodium homeostatic problem?

(2)

A
  • kidneys unable to excrete appropriate amounts of Na+ for any given BP.
  • Na+ and fluid are retained, PV increases, BP rises.
49
Q

What are some other factors that can cause hypertension?

7

A
  • age
  • genetics and family history
  • environment
  • weight
  • alcohol intake
  • race
  • Na+ intake
50
Q

How does BP change with increasing age?

Why is this thought to happen?

A

it increases

  • thought to be because arteries become more inelastic and compliance decreases.
51
Q

Why is it important to treat hypertensive elderly just as aggressively as younger people?

(2)

A
  • They have more to lose i.e. MI, stroke.

- they are more prone to side-effects of reduced BP, however we must be pragmatic about their overall health.

52
Q

Between which family member’s does the closest correlation between hypertension exist?

A

siblings

53
Q

What environmental factors increase the risk of hypertension?

(hint: similar)

(2)

A

mental and physical stress

54
Q

What effect does reducing Na+ intake have on hypertensives?

What effect does reducing Na+ intake have on normotensives?

A

reduces BP

little effect

55
Q

What is the correlations between alcohol consumption and blood pressure?

(2)

A

Small amounts of alcohol tend to reduce BP.

Large amounts of alcohol consumed chronically tend to increase BP.

56
Q

How does weight loss effect blood pressure?

Is weight loss recommended for hypertensives?

A

it reduces it dramatically

Yes - it is the best non-pharmacological treatment for hypertension.

57
Q

How does birth weight affect the likelihood of developing hypertension in later life?

A

Low birth weight increases likelihood of hypertension/CV disease in adult life.

58
Q

Which ethnicities are most susceptible to hypertension?

A

black populations - reasons are unclear

59
Q

With secondary hypertension, why does removal of the causing agent not guarantee improvement in blood pressure?

A

Sustained hypertension produced end-organ damage to blood vessels, heart and kidneys.

60
Q

Outline the causes of secondary hypotension.

6

A
  • renal disease
  • drug induced
  • pregnancy
  • endocrine disease
  • vascular
  • sleep apnoea
61
Q

Give examples of renal diseases which can cause secondary hypertension.

(4)

A
  • renal artery stenosis
  • fibromuscular dysplasia
  • polycystic kidneys
  • chronic pyelonephritis
62
Q

What is chronic pyelonephritis?

A

inflammation and fibrosis of the kidneys associated with repeated infections

63
Q

What is fibromuscular dysplasia?

A

narrowing of the arteries resulting in muscle overgrowth (hypertrophy)

64
Q

What are the drug induced causes of secondary hypertension?

3

A
  • NSAIDS
  • oral contraceptive
  • corticosteroids
65
Q

What condition in pregnant women causes hypertension?

A

pre-eclampsia – rise in BP after 20th week.

66
Q

Which endocrine disorders can cause hypertension?

5

A
  • Conn’s syndrome - hyperaldosteronisms
  • Cushing’s disease
  • pheochromocytoma
  • hypo- and hyper-thyroidism
  • acromegaly
67
Q

What vascular disease can causes secondary hypertension?

A

coarctation (stenosis) of the aorta

Cardiovascular System (37 decks)

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