KCP: Hypertension

Question 1

64 year-old White Scottish female presenting with abdominal pain

• high blood pressure for at least 10 years
• kidney failure on dialysis
• tender in right iliac fossa; fever; appendix abscess on CT
• blood pressure 50/20 mmHg (usually 150/90 mmHg)

What do you think happened to her next?

Why was her blood pressure so low?

Answer 1

• Blood pressure low because she was septic (total body infection)
• When you have an infection blood flow increases in order to get more white blood cells to the area of infection, if you have a systemic infection then blood flow is increased everywhere and
• Leads to Kidney failure as it needs 60 systolic in order to function. Lead to fainting. Eventually cardiac arrest.
• Antibiotics
• Fluids to raise blood pressure
• Adrenaline to constrict arterioles and cardiac output therefore increasing pressure

Question 2

Describe the RAAS )renin-angiotensin-aldosterone system)

Help:
Liver
Kidneys
Angiotensinogen
Angiotensin 1
Renin
Lungs
ACE
Angiotensin 2
Aldosterone

Answer 2

Question 3

Which parts of the water tower analogy for blood pressure correspond to which body parts?

Answer 3

Question 4

70 year-old White Scottish male referred to the renal clinic with high blood pressure

• high blood pressure for at least 10 years
• prescribed (and taking) four blood pressure medications
• blood pressure 172/96 mmHg despite all of these
• started on a fifth medication (lisinopril, an ACE inhibitor) and then his kidney function got rapidly worse…

What is happenning to her and what is the treatment?

Answer 4

Renal Stenosis

Question 5

Treatments for high blood pressure if under 55, or have diabetes type 2?

Answer 5

ACE Inhibitors

Common ones:
enalapril
fosinopril

Or Angiotensn 2 receptor blockers (ARBs)

Question 6

Treatments for high blood pressure if over 55 or african/caribean decent without diabetes type 2

Answer 6

Calcium channel blockers

(could also consider alpha blockers)

Question 7

Why are people over 55 or of afro/caribean origin often not offered ACE inhibitors?

Answer 7

Less sensitive to renin

Question 8

What is renal artery stenosis?

Answer 8

One or both of the arteries leading to the kidneys becomes narrowed, preventing adequate blood flow to the kidneys

Question 9

How does the sympathetic nervous system affect blood pressure?

Answer 9

Releases noradrenaline causing vaso constriction

Question 10

When do you sense blood pressure?

Answer 10

• Carotid barro receptors
• Kidney barro receptors

Question 11

Where do the carotid barro receptors feed into?

Answer 11

Medula and activate sympathetic nervous system

Question 12

Where do the kidney barro receptors feed into?

Answer 12

RAAS

Question 13

Things that can increase blood pressure

Answer 13

• Sensors confused
• Sympathetic activated
• RAAS activated
• Kidneys can’t excreet salt/water
• Cardiac output increased

Question 14

How does renal artery stenosis affect blood pressure?

Answer 14

If the blood supply to the kidneys is impaired then the kidney barro receptors will think you have low pressure even though it is normal in the rest of your body. This then activates the RAAS causing blood pressure to rise.

Question 15

Why does HBP affect the vision?

Answer 15

It forces blood out out the capillaries in the eyes

Question 16

Lift of things HBP can lead to?

Answer 16

• Stroke
• MI
• Heart failure
• Atrial fibrillation
• Kidney failure
• Retinopathy
• Encephalopathy

= disability
= death

Question 17

What is the best way to diagnose hypertension?

Answer 17

24h ambulatory blood pressure measurement

This prevent missreadings due to short term factors affect BP