PBL 6 - hypertension Flashcards
what is classified as hypertension at home vs in office?
home = >130/85 office = > 140/90
why are out of office BP measurements recommended to confirm the diagnosis of hypertension?
- can be a big difference in office and home BP measurements
- white coat syndrome
- monitor the quality of BP control
- reduce chances of misdiagnosing anxious people and treating them with unnecessary drugs
does smoking affect BP?
smoking itself does not raise BP, but the combination of high BP and smoking is lethal — accelerates atherosclerosis
does BP change as you age?
increases naturally as you get older
what level of alcohol intake is associated with an elevation of BP?
male > 28 units a week
female > 21 units per week
what is the definition of hypertension?
an increase in peripheral vascular resistance when the cardiac output is normal
an increase in BP increase the risk of what?
ishcaemic heart disease
what is primary (essential) hypertension and what % of cases are primary?
- hypertension when it is not a result of a medical condition or drug (doesn’t have a known secondary cause)
- 98%
name some medical conditions which cause secondary hypertension
- chronic kidney disease
- primary hyperaldosteronism
- renovascular disease
- chronic steroid therapy
- cushing’s syndrome
- aortic coarctation
- thyroid or parathyroid disease
- sleep apnea
- pheochromocytoma (tumour from chromaffin cells — make adrenaline and noradrenaline, found in adrenal gland)
describe primary hyperaldosteronism (Conn’s Syndrome)
- excess production of aldosterone from adrenal gland — more Na+ retention and hence H2O retention — increases BP
- can cause secondary hypertension
- low prevalence
- 30% caused by adrenal adenoma
- adenomata commoner in women and rare in children
- 70% caused by adrenal hyperplasia — both adrenal glands are overactive
- rarely adrenal carcinoma
- extremely rare glucocorticoid suppressible aldosterone so (autosomal dominant) — only seen in specialist clinics
describe renovascular disease
- fibromuscular dysplasia of the renal artery — often in very young patients, teenagers and early 20s
- renal artery stenosis in older patients due to atherosclerosis
- both can be cured with angioplasty and stenting (although in renal artery stenosis the patients have to be highly selective)
what is the most likely cause of primary hypertension?
autonomic neural dysfunction — over active SNS in combination with an under active PNS
name 7 environmental factors that contribute hypertension
- inactivity
- stress
- obesity
- tobacco
- age
- salt
- alcohol
name 3 characteristics of hypertension
- increased peripheral vascular resistance
- normal cardiac output
- damage to vital organs
how does hypertension cause LV hypertrophy?
heart has to beat against the increased vascular resistance — increase in workload — hypertrophy of the LV
