Lecture 29: Hypertension

Question 1

Determinants of arterial pressure equation

Answer 1

MAP = CO x TRP

Question 2

Arterial pulse wave

Answer 2

Systolic pressure at top, pulse pressure is systolic-diastolic pressure, diastolic pressure at bottom

Question 3

Systemic resistance: the balances what?

Answer 3

Constrictors (alpha agonists, etc) vs dilators (beta 2 antagonists)

Question 4

What happens when aorta/large arteries get stiffer?

Answer 4

Larger pulse pressure/systolic pressure

Question 5

Normal BP

Answer 5

Less than 120/80

Question 6

High-normal

Answer 6

120-139 / less than 90

Question 7

White coat hypertension

Answer 7

Clinic >140/90, home or day less than 135/85

Question 8

Masked hypertension

Answer 8

Clinic less than 140/90, home or day >135/85

Question 9

Sustained hypertension

Answer 9

Both clinic and home elevated

Question 10

Resistant hypertension

Answer 10

Clinic and home elevated >140/90 despite adequate treatment of 3+ drugs

Question 11

What three factors play a role in converting pre-hypertension to hypertension?

Answer 11

Age, weight gain, high salt intake

Question 12

By the time someone is 90 years old, what % has HT?

Answer 12

90%

Question 13

What two fatal diseases is HT associated with?

Answer 13

Stroke and ischemic heart disease

Question 14

What are other consequences of HT

Answer 14

Cardiac disease (CHD, LV hypertrophy, CHF, arrhythmias, SCD); impaired renal function; atherosclerotic pathology; aorta dissection; vascular dementia

Question 15

What do you consider when evaluating a hypertensive patient?

Answer 15

Average BP (clinic, home); risk factors (smoking, lipids, diabetes); target organ damage indicators; identifiable causes (rare)

Question 16

Identifiable common HT causes (2)

Answer 16

Obesity, sleep-apnea syndrome (these are associated)

Question 17

Identifiable less common HT causes (3)

Answer 17

Renal artery stenosis, primary aldosteronism, chronic renal disease

Question 18

Identifiable rare HT causes (5)

Answer 18

Drugs (diet pills, cocaine), genetic syndromes (Liddle’s), Cushing’s syndrome, Pheochromocytoma, polycystic kidney disease

Question 19

What is the physical finding for renal artery stenosis?

Answer 19

Bruit in upper abdomen

Question 20

Genetic disease causing HT: describe. Is it frequent? Name of disease?

Answer 20

Gain of function mutation of Na+ channel in collecting duct leading to increased # channels –> too much Na+, K+ excreted –> high BP; very rare; Liddle’s Syndrome

Question 21

HT treatment: lifestyle improvement

Answer 21

Weight reduction and lower salt intake via diet and exercise; smoking cessation, stress reduction

Question 22

Take home message about lifestyle improvement

Answer 22

Most with sustained hypertension will benefit from drug treatment; life style improvement is helpful, but rarely enough

Question 23

Drug classes approved for HT treatment (6)

Answer 23

1. Diurects; 2. RAS blockers (ACE-I, AII receptor blockers, direct renin inhibitors); 3. Ca2+ channel blockers; 4. Catecholamine receptor blockers (alpha/beta receptor blockers); 5. Direct vasodilators; 6. Centrally acting agents

Question 24

T/F: Hypertensive medication is not very effective

Answer 24

False! They work well, often in combination. Reduce stroke and MI, even if very old patients