Hypertension: primary and secondary

Question 1

Define hypertension

Answer 1

When blood pressure is greater than 140/90 mmHg. This has to be on two different readings on two separate occasions

Question 2

Describe the epidemiology of hypertension

Answer 2

• More common in males

- Rate increases dramatically at 75+ years

Question 3

What are the two types of hypertension?

Answer 3

1. ) Primary (essential) hypertension

2. ) Secondary hypertension (caused by an underlying disease)

Question 4

Describe the risk factors for developing hypertension

Answer 4

• Smoking
• Obesity
• Dyslipidaemia
• Family history
• Old age
• Low birthweight
• Afro-Caribbean

Question 5

Describe the causes of hypertension

Answer 5

• Primary: genetics and lifestyle (95% of cases)
• Secondary diseases that can cause hypertension:
• Endocrine: e.g. Hyperthyroidism, hyperparathyroidism
• Renal: e.g. CKD, nephrotic syndrome
• Coarctation of the aorta (birth defect where aorta is narrower than normal)
• Pre-eclampsia
• Drugs: NSAIDS/oestrogen containing oral pill

Question 6

What are the signs of hypertension?

Answer 6

• Dyspnoea
• End organ damage
• Retinopathy

Question 7

What are the symptoms of hypertension?

Answer 7

• Dysponoea
• Headache
• Generally is symptomless

Question 8

Describe the investigations for hypertension

Answer 8

• Blood pressure is measured: measure using an ABPM. If ABPM shows:
  1. ) 135/85 = normal/no treatment
  2. ) 135/85 = treatment given is high risk of cardiac disease
  3. ) 150/95 = treat
• Remember: if any end organ damage is present then treat HTN regardless
• 12 lead ECG for LV hypertrophy
• Bloods for: serum creatinine/eGFR and glucose
• Urinalysis to check kidneys (e.g. protein)

Question 9

Describe the treatments for hypertension

Answer 9

1. ) Lifestyle advice: reducing weight/regular exercise/healthy diet
2. ) Medications:
   - First line: ACE inhibitor e.g. Ramipril (ARB e.g. candesartan if person gets cough or Ca2+ channel blocker e.g. amlodipine is=f they’re black)
   - Second line: ACE inhibitor + CCB
   - Third line = ACE-inhibitor + CCB + diuretics e.g. Bendroflumethiazide/furosemide
   - Fourth line = ACE inhibitor + beta blocker (e.g. bisoprolol) + CCB + diuretics

Question 10

What are some of the complications for hypertension?

Answer 10

• Retinopathy
• Risk of stroke is increased
• Risk of MI is increased

Question 11

Describe the pathophysiology of hypertension

Answer 11

• Vascular changes: accelerated atherosclerosis + causes thickening of media of muscular arteries
• Heart: major risk factor for IHD
• Nervous system: intracerebral haemorrhage
• Kidneys: reduced size
• Malignant: raised diastolic BP and progressive renal disease

Question 12

Overview of malignant hypertension

Answer 12

• Symtoms: headache and visual disturbance
• Signs: severe hypertension (e.g. greater than 200/130 mmHg) and bilateral renal haemorrhage
• Complications: hypertensive emergencies e.g. acute kidney injury and HF
• Treatment: sodium nitroprusside