Hypertension - physiology

Question 1

Define hypertension

Answer 1

Persistent elevation of arterial BP

Question 2

What are the severity stage classifications for hypertension?

Answer 2

Stage 1:
BP = 140/90
ABPM = 135/85

Stage 2:
BP = 160/100
ABPM = 150/95

Stage 3 :
BP = 180/110

Question 3

What is the aetiology for primary hypertension?

Answer 3

Primary = 90% and is no cause/unknown

Likely causes:

• Genetic susceptibility
• Excessive sympathetic
• Na/K membrane or RAAS defect

Other factors:

• Body weight
• Male 2x
• AGE
• Diabetes
• Cigarette
• LVH

Question 4

What is the aetiology for secondary hypertension?

Answer 4

Secondary = 5to10% and has a cause

Either: 
Renal = 
-renal artery stenosis 
-Kidney disease
-Fibromuscular dysplasia 

Endocrine =

• Conns syndrome
• Acromegaly
• Cushings disease
• Hyper/po thyroidism

Vascular =
-Coarctation of aorta

Sleep apnea

Drugs:

• Corticosteroids
• Oral contraceptives
• NSAIDS

Question 5

What are examples of end organ damages of HT?

Answer 5

Brain = Haemorrhage, stroke
Eye = retinopathy
Vessel = Peripehral Vascular disease
Heart = LVH, CHD, MI 
Kidney = Renal failure, Dialysis, transplantation

Question 6

What are the clinical symptoms of hypertension?

Answer 6

Asymptomatic 
End organ damage/2ndary cause = 
-Angina 
-Headache 
-Blurred vision 
-Palpitations

Question 7

What are the clinical signs of hypertension?

Answer 7

Retinopathy
Proteinuria
Cardiomegaly
Uraemia

Question 8

What are examples of investigations?

Answer 8

FBC
Urea + electrolyte test 
Fasting glucose 
ECG
ABPM
Renal US

Question 9

What does the diagnosis of HT involve?

Answer 9

Use ABPM + BP to assign to classification then assess risk: smoker/diabetes/stroke

Assess end organ damage through investigation
Screen for treatable causes like:
Conns, Sleep apnea, Stenosis