L7 Hypertension

Question 1

Explain why Hypertension is such an important condition

Answer 1

• Biggest single contributor to global disease burden and mortality
• Chronic
• Risk factor for CVD
• Asymptomatic
• Expensive (for soceity and individual)
• Treatable

Question 2

Types of Hypertension?

Answer 2

Types of Hypertension

Systemic hypertension (“hypertension”)

Portal hypertension: increase in blood pressure within the portal venous system in e.g. (cirrhosis of the liver)

Pulmonary hypertension: increase in blood pressure within the right side of the heart and pulmonary arteries (congenital heart disease)

Question 3

Hypertension defined by what arbitrary cutoff point?

Answer 3

> 140 mmHg typical threshold of hypertension

Question 4

Diagnosis of Hypertension?

Answer 4

24 Ambulatory testing gold standard -> home testing prefered

Question 5

Systolic BP increases with age until __________

Answer 5

Systolic BP increases with age until the 8th decade of life

Question 6

Diastolic BP increases with age until _________

Answer 6

Diastolic BP increases with age until 50yr of age, then flattens or decreases

Question 7

Normal BP in morning, higher later in day

Answer 7

Masked Hypertension - Normal BP in morning, higher later in day

Question 8

Pathophysiology of HTN?

Answer 8

Sodium/ Fluid balance - Kidneys key

Peripheral resistance - Increased arterial resistance hallmark of HTN

Genetics - Polygenic

Question 9

Explain the difference between primary (“essential”) and secondary HTN

Benign vs. Malignanat?

Answer 9

Primary (“essential”): Genetic Cause

Secondary: Acquired due to lifestle

Benign – BP remains stable or rises slowly over years.

Malignant – BP rises rapidly (more likely attributable to a cause)

Question 10

Causes of Secondary Hypertension

Answer 10

Causes of Secondary HTN

• Oral contraceptives, glucocorticoids
• Primary aldosteronism: Overexcretion from adrenal cortex => increased retention of Na => increased BP
• Renal artery stenosis: decreased blood flow to kidney, thinks BP is low, leads to retention of Na and increased BP
• Obstructive sleep apnea
• Pheochromocytoma: Tumor of adrenal medulla –> increase adrenaline secretion –> hypertension, sweating and anxiety
• Cushing’s syndrome: Excessive secretion of Corticosteroids –> retention of sodium/water –> increased BP
• Coarctation of the Aorta

Question 11

Renovascular Causes of Hypertension?

Answer 11

Renal artery stenosis: decreased blood flow to kidney, thinks BP is low, leads to retention of Na and increased BP

Question 12

__________: Overexcretion from adrenal cortex => increased retention of Na => increased BP

Answer 12

Primary aldosteronism: Overexcretion from adrenal cortex => increased retention of Na => increased BP

Question 13

______________: Tumor of adrenal medulla –> increase adrenaline secretion –> hypertension, sweating and anxiety

Answer 13

Pheochromocytoma:

Tumor of adrenal medulla –> increase adrenaline secretion –> hypertension, sweating and anxiety

Question 14

______________: Excessive secretion of Corticosteroids –> retention of sodium/water –> increased BP

Answer 14

Cushing’s syndrome:

Excessive secretion of Corticosteroids –> retention of sodium/water –> increased BP

Question 15

_______________:

Ascending and descending portions of the aorta don’t properly form

=> _______ and improper blood flow downstream

=> Blood pressure_____________________

=> kidneys ____________

=>increased blood pressure

Answer 15

Coarctation of the Aorta:

Ascending and descending portions of the aorta don’t properly form

=> stenosis and improper blood flow downstream

=> Blood pressure downstream of the COARTATION drops

=> kidneys retain more Na

=>increased blood pressure

Question 16

Pathological changes to Vessels induced by HTN?

Answer 16

Small Vessels

• Hyaline Arteriosclerosis (arteriolar narrowing)
  
  • Common in BENIGN HTN and diabetes
  • Homogenous, pink, hyaline thickening of arteriolar walls
  • Narrowing => Ischemia (often of kidneys )
    
    • Hypertension causes sclerosis and loss of glomeruli in tubules
• Hyperplastic Arteriosclerosis (thickening of vessel wall)
  
  • Common in MALIGNANT hypertension
  • Onion-like thickening of arterial wall
  • Hyperplasia and Hypertrophy of VSMC
  • Fibrinoid deposits & Necrosis of vessel wall

Large Vessels => accelerates atherosclerosis

Question 17

_________________________:

• Common in BENIGN HTN and _________
• Homogenous, pink, hyaline thickening of arteriolar walls
• Narrowing=> Ischemia (often of kidneys )
  
  • Causes ______________________

Answer 17

Hyaline Arteriosclerosis (arteriolar narrowing):

• Common in BENIGN HTN and DIABETES
• Homogenous, pink, hyaline thickening of arteriolar walls
• Narrowing => Ischemia (often of kidneys )
  
  • Causes sclerosis and loss of glomeruli in tubules

Question 18

_________________________:

• Common in MALIGNANT hypertension
• Onion-like thickening of the arterial wall
• Hyperplasia and Hypertrophy of VSMC
• Fibrinoid deposits & Necrosis of vessel wall

Answer 18

Hyperplastic Arteriosclerosis (thickening of vessel wall)

• Common in MALIGNANT hypertension
• Onion-like thickening of arterial wall
• Hyperplasia and Hypertrophy of VSMC
• Fibrinoid deposits & Necrosis of vessel wal

Question 19

Complications of Hypertension are Secondary to _________

Answer 19

Complications of Hypertension are Secondary to Vascular Disease

Question 20

Cardiac Complications of Hypertension?

Answer 20

Cardiac Complications:

Coronary atherosclerosis; Worsened by HTN

Left ventricular hypertrophy: Has to do more work, requires more O2

Left ventricular failure: More O2 required as supply diminished

Question 21

CNS Complicaitons of Hypertenion?

Answer 21

CNS Complications

Strokes: Hypertension is the most important treatable risk factor in stroke!!!

Cerebral infarction- blockage of artery

Intracerebral Hemorrhage - Bleed damages surrounding tissue

Dementia: Hypertension is the most important modifiable risk factor for the development and progression of cognitive decline and dementia!!!!

Question 22

Most important treatable risk factor in stroke?

Answer 22

Hypertension

Question 23

Most important modifiable risk factor for the development and progression of cognitive decline and dementia?

Answer 23

Hypertension

Question 24

____________ is caused by hemorrhages or exudates (_______) in the eye

Answer 24

Hypertensive Retinopathy is caused by hemorrhages or exudates (fatty deposits) in the eye

Question 25

What are the main causes of Chronic Kidney Disease?

Answer 25

Hypertension (and diabetes) are the main causes of chronic kidney disease

Question 26

Benign versus Malignant Nephrosclerosis?

Answer 26

BENIGN Nephrosclerosis:

Characteristics of long-term BENIGN hypertension

Hyaline arteriosclerosis

Kidneys symmetrically atrophic

Granular surface

Glomerular sclerosis

MALIGNANT Nephrosclerosis:

Characteristic of MALIGNANT hypertension

Hyperplastic arteriosclerosis

Kidneys normal sized

Hemorrhages on the surface - Mottled red

Fibrinoid necrosis (necrotizing arteriolitis)

Question 27

Lifestyle Changes to reduce Hypertension

Answer 27

Lifestyle changes

Healthy dietary pattern

Reduced sodium intake

Reduced body fat

Increased exercise

Question 28

Drug Therapy for Hypertension

Answer 28

Angiotensin-converting enzyme (ACE) inhibitors reduce blood pressure by relaxing blood vessels

Calcium channel blockers keep calcium from entering the muscle cells of the heart and blood vessels

Diuretics flush excess water and salt from the body through urine

Beta-blockers make heart beat more slowly and with less force