Pathology of hypertension

Question 1

Define hypertension

Answer 1

disorder in which the level of sustained arterial pressure is higher than expected for the age, sex, and race of the individual

Question 2

What do WHO classify as hypertension?

Answer 2

140/90would be accepted as hypertension

Question 3

What is the aetiology of hypertension?

Answer 3

Cardiac failure

Question 4

What is hypertension a risk factor for?

Answer 4

Cerebral haemorrhage
Atheroma
Renal failure
Sudden cardiac death

Question 5

What is CO determined by?

Answer 5

HR
Contractility
Blood volume

Question 6

What is primary hypertension caused by?

Answer 6

No obvious cause

• genetic factors
• salt intake
• protein intake
• RAAS
• sympathetic activity

Question 7

What increased dietary salt cause?

Answer 7

Salt sensitive hypertension

Question 8

Is there a genetic component to Salt sensitive hypertension?

Answer 8

yes

polymorphisms

Question 9

What is implicated in secondary hypertension?

Answer 9

Underlying disease

• renal disease
• endocrine disease
• aortic disease
• renal artery stenosis
• drug therapy

Question 10

What are the renal causes of secondary hypertension?

Answer 10

• renal artery stenosis
• acute or chronic glomerulonephritis
• chronic pyelonephritis
• cystic disease
• interstitial nephritis

reduced renal blood flow, excess renin release, salt and water overload

Question 11

What are some endocrine causes of secondary hypertension?

Answer 11

Adrenal gland hyperfunction/ tumours

conn’s syndrome- excess aldosterone

cushings syndrome- excess corticosteroid

phaeochromocytoma- excess noradranline

Question 12

What are some other causes of secondary hypertension?

Answer 12

Coarctation of the aorta- congenital narrowing of segments

drugs- corticosteroids

Question 13

What is benign hypertension?

Answer 13

Asymptomatic, incidental finding due to other pathology

Question 14

What does benign hypertension cause?

Answer 14

• LVH
• Congestive Cardiac Failure
• Increases atheroma
• increased aneurysm rupture (aortic dissection, berry aneurysms)
• renal disease

Question 15

What does left ventricular hypertrophy result in?

Answer 15

Increased LV load
Poor perfusion
Interstitial fibrosis
Micro-infarcts
Diastolic dysfunction

Question 16

What is the aetiology of LVH?

Answer 16

Sudden cardiac death (Arrythmia and poor perfusion)
Cardiac failure
affects outcome of other disease

Question 17

What is a subarachnoid haemorrage?

Answer 17

Bleeding in the brain
Can be caused by a berry aneurysm rupture
1

Question 18

In benign hypertension every –mmHg of diastolic pressure above 85 ——- the risk of MI

Answer 18

10

doubles

Question 19

In benign hypertension every -mmHg of diastolic pressure above 85 ——- risk of stroke

Answer 19

8

doubles

Question 20

What is microvascular injury?

Answer 20

Blood vessel wall changes- small arteries and arterioles

Question 21

Where might microvascular injury occur?

Answer 21

Retina and kidney

Question 22

What are the histological changes of microvascular injury?

Answer 22

Thickening of media (smooth muscle) and hyaline arteriosclerosis- plasma proteins forces into vessel wall (cf ageing)

Question 23

What is malignant hypertension defined as?

Answer 23

Diastolic pressure > 130-140

Question 24

What is the aetiology of malignant hypertension?

Answer 24

Cerebral oedema
acute renal failure
acute heart failure
headache and cerebral haemorrhage
blood vessels show fibrinoid necrosis end endarteritis proliferans of their walls

Question 25

How common is pregnancy associated hypertension?

Answer 25

10% of pregnancies

Question 26

What is the aetiology of pregnancy associated hypertension?

Answer 26

Pre-eclampsia

hypertension and proteinuria

Question 27

What is pregnancy associated hypertension thought to be a result of?

Answer 27

Secondary to silent renal or systemic disease