Pathology of Hypertension

Question 1

Definition of 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 does WHO accept as a high level of blood pressure?

Answer 2

>140/90 mmHg

Question 3

White coat hypertension?

Answer 3

High blood pressure at the Doctors office that returns to a normal level in other environments like home. Thought to be caused by stress of seeing doctor or could be indicative of future long term problems.

Question 4

Labile Hypertension?

Answer 4

Unexpected changes in blood pressure

Question 5

What does hypertension cause?

Answer 5

Cardiac failure

Question 6

What is hypertension a risk for?

Answer 6

Atheroma Renal failure Cerebral haemorrhage Sudden cardiac failure

Question 7

Brief epidemiology of Hypertension?

Answer 7

Varies between countries Higher in back population Lower in south pacific Familial tendency Rises with age

Question 8

Classification of hypertension in respect to A) Aetiology B) Clinicopathology

Answer 8

A) Primary or secondary B) Benign or malignant

Question 9

Equation for BP

Answer 9

Cardiac output x peripheral resistance

Question 10

Factors to consider for cardiac output?

Answer 10

Heart Rate Contractility Blood volume

Question 11

Factors to consider for peripheral resistance?

Answer 11

Constrictors (Angiotensin 2, catecholamines) Dilators (Nitric oxide, prostoglandins

Question 12

Most common type of hypertension?

Answer 12

Primary hypertension

Question 13

Primary hypertension?

Answer 13

No obvious cause Due to genetic factors Salt intake Protein intake RAAS

Question 14

What does an increase in dietary salt lead to?

Answer 14

Increased BP

Question 15

Salt sensitive hypertension?

Answer 15

It is some cases of primary hypertension Controlled by reduced dietary salt In renal diseases secondary hypertension is usually salt sensitive

Question 16

Underlying diseases with secondary hypertension?

Answer 16

Renal disease Endocrine Aortic Renal artery stenosis Drug therapy

Question 17

Why renal diseases are associated with secondary hypertension?

Answer 17

Reduced renal blood flow Excess renin release Salt and water overload

Question 18

Endocrine causes of secondary hypertension?

Answer 18

Adrenal gland hyperfunction Conn’s syndrome- XS aldosterone Cushing’s syndrome- XS corticosteroid Phaeochromocytoma- XS noradrenaline

Question 19

Benign hypertension is not a cause of serious life threatening morbidity. True or False?

Answer 19

FALSE. Cause of serious life threatening morbidity

Question 20

What does benign hypertension eventually cause?

Answer 20

Left ventricular hypertrophy Congestive cardiac failure Increases atheroma Increases aortic aneurysm rupture Renal disease Aortic dissection

Question 21

Hypertension and the heart?

Answer 21

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

Question 22

Outcomes of left ventricular hypertrophy?

Answer 22

Sudden cardiac death

Cardiac failure

Question 23

Hypersensitive heart picture

Answer 23

Question 24

Whats this?

Answer 24

Complicated atheroma

Question 25

What doubles the risk of MI?

Answer 25

Every 10mmHg of diastolic pressure above 85mmHg

Question 26

Every _mmHg of diastolic pressure above __ doubles risk of _____.

Answer 26

8mmHg

85

Stroke

Question 27

Malignant hypertension?

Answer 27

Serious life threatening condition- Rare

Diastolic pressure >130-140

Can develop from benign primary or secondary

Needs to be treated urgently

Question 28

What does malignant hypertension cause?

Answer 28

Cerebral oedema

Acute renal failure

Acute heart failure

Headache and cerebral haemorrhage

Blood vessels show fibrinoid necrosis and endarteritis proliferans of their walls

Question 29

Hypertension is usually asymptomatic? True or False?

Answer 29

True