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Cardiovascular system > The aetiology and pathophysiology of hypertension > Flashcards

The aetiology and pathophysiology of hypertension Flashcards

1
Q

how does an increase in blood pressure of 2mmHg increase your risk of mortality from ischaemic heart disease?

A

by 7%

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2
Q

how does an increase in blood pressure of 2mmHg increase your risk of mortality from a stroke?

A

10%

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3
Q

what are the complications of hypertension in the brain?

A

haemorrhage, stroke, cognitive decline, Alzheimer’s,

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4
Q

what are the complications of hypertension in the eyes?

A

retinopathy

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5
Q

what are the complications of hypertension in the peripheries?

A

peripheral vascular disease: peripheral blood vessels block, narrow or spasm.

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6
Q

what are the complications of hypertension on the kidneys?

A

renal failure
dialysis
transplantation
proteinuria

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7
Q

what are the complications of hypertension on the heart?

A

coronary heart disease
myocardial infarction
left ventricular hypertrophy
congestive heart failure

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8
Q

what is congestive heart failure?

A

Inability of the heart to keep up with the demands on it, with failure of the heart to pump blood with normal efficiency.

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9
Q

what are the general types of stress which can cause hypertension?

A

mental and physical

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10
Q

how does the risk of cardiovascular disease and strokes change with increasing blood pressure?

A

it is an exponential increase

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11
Q

what also plays a part in the risk of cardiovascular disease and stroke with hypertension?

A

age

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12
Q

what is the general consensus for the bp at which a patient is hypertensive?

A

140/90

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13
Q

what is the optimum bp that must be aimed for in hypertensives?

A

<120/<80

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14
Q

what is ABPM and what is its advantage over clinical blood pressure?

A

ambulatory blood pressure monitoring. it provides a more accurate measure of blood pressure as blood pressure measured in the clinic tends to be higher than normal

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15
Q

what is clinical bp for type 1 hypertension?

A

140/90 mmHg or higher

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16
Q

what is the ABPM for type 1 hypertension?

A

daytime average of 135/85 mmHg or higher

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17
Q

what is the clinical bp for type 2 hypertension?

A

160/100 mmHg or higher

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18
Q

what is the ABPM in type 2 hypertension?

A

daytime averge of 150/95 or higher

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19
Q

what is the clinical bp for severe hypertension?

A

180/110 or higher

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20
Q

what is primary hypertension?

A

hypertension with no underlying cause

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21
Q

what is secondary hypertension?

A

hypertension with an underlying cause

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22
Q

what are some causes of secondary hypertension?

A

chronic renal disease
renal artery stenosis
endocrine disease (cushngs, Conn’s syndrome, phaechromocytoma, GRA [Glucocorticoid remediable aldosteronism]

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23
Q

what other factors apart from increases in blood pressure can cause an increase in morbidity from hypertension?

A
  • Cigarette smoking
  • Diabetes mellitus
  • Renal disease
  • Male
  • Hyperlipidaemia
  • Previous MI or stroke
  • Left ventricular hypertrophy
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24
Q

a hypertensive patient who smokes will have a morbidity risk the same as a hypertensive with of a bp of what?

A

20/10 mmHg greater than the smoker’s

25
Q

how does having diabetes mellitus affect the risk of MI in a hypertensive?

A

5-30 times increase

26
Q

what is the increased risk of morbidity due to hypertension of a male compared to a female?

A

2 times

27
Q

patients with left ventricular hypertrophy will have an increased risk of…?

A

2 times that hypertensive of same bp without the condition

28
Q

what is the risk of morbidity of a hypertensive patient who smokes and has diabetes

A

much higher than the two risks combined as diabetes and smoking work synergistically to increase risk of morbidity from hypertension

29
Q

what are the two prime contributors to blood pressure?

A 
cardiac output (stroke volume and heart rate)
total peripheral resistance
30
Q

what are the mechanisms that the sympathetic system increases blood pressure?

A

vasoconstriction
increased cardiac output
reflex tachycardia

31
Q

what are the three functions of the renin-angiotensin aldosterone system?

A

maintenance of sodium balance
control of blood pressure
control of blood volume

32
Q

how does angiotensin II increase blood pressure?

A

it is a vasoconstrictor
it is an anti-natriuretic peptide
it stimulates aldosterone release from the adrenal glands
it is a potent hypertrophic agent which stimulates myocytes and smooth muscle hypertrophy in the arterioles

33
Q

what does aldosterone do to increase blood pressure?

A

it causes sodium and water to be rebsorbed

34
Q

if hypertensive patients have hypertrophy of smooth muscle and myocytes what happens to their prognosis?

A

it is poorer

35
Q

what are the two most likely causes of hypertension?

A
  • increased reactivity of the resistance vessels

- a sodium homeostatic effect

36
Q

what causes an increase reactivity of the resistance vessels in hypertensives?

A

a result of hereditary defect of the smooth muscle lining arterioles (this causes an increased TPR),

37
Q

what causes hypertension in patients with a sodium homeostatic problem?

A

the kidneys are unable to excrete appropriate amounts of sodium for any given BP as a result sodium and fluid are retained and BP increases

38
Q

what are some other factors that can cause hypertension?

A 
age
genetics and family history
environment
weight
alcohol intake
race
salt intake
39
Q

how does BP change with increasing age? and why is this though to happen?

A

it increases, though to be because arteries become more inelastic and compliance decreases

40
Q

how should hypertension in the elderly be treated, compared to younger people?

A

just as aggressively, however blood pressure may be kept a little higher to prevent syncope

41
Q

between which family member’s does the closest correlation between hypertension exist?

A

siblings

42
Q

what environmental factors increase the risk of hypertension?

A

mental and physical stress

43
Q

can hypertension presist after stress is removed?

A

yes

44
Q

does decreasing salt intake help to reduce BP?

A

yes

45
Q

what quantities of alcohol increase blood pressure?

A

large quantities

46
Q

what is the average fall in bp after reducing alcohol intake?

A

5/3 mmHg, very small

47
Q

does weight loss cause decrease in BP in hypertensives?

A

yes, it can produce large decrease and so is the most important non-pharmacological treatment of the condition
(9kg loss can cause fall of 19/18 in non-medicated and 30/21 in medicated)

48
Q

how does birth weight affect the likelihood of developing hypertension in later life?

A

the lower the birthweight the higher the likelihood of hypertension in later life

49
Q

which races are most susceptible to hypertension?

A

black populations, reasons are unclear

50
Q

what renal diseases can cause secondary hypertension?

A

chronic pyelonephritis
fibromuscular dysplasia
renal artery stenosis
polycystic kidneys

51
Q

what is chronic pyelonephritis?

A

inflammation and fibrosis of the kidneys associated with repeated infections

52
Q

what is fibromuscular dysplasia?

A

abnormal growth within the arteries which is non arthrosclerotic and non-inflammatory

53
Q

what are the drug induced causes of secondary hypertension?

A

NSAIDS
oral contraceptive
corticosteroids

54
Q

what condition in pregnant women causes hypertension?

A

pre-eclampsia

55
Q

which endocrine disorders can cause hypertension?

A 
Conn's syndrome
Cushing's disease
pheochromocytoma
hypo and hyperthyroidism
acromegaly
56
Q

what is pheochromocytoma?

A

a tumour of the adrenal tissue that causes overproduction of adrenaline and noradrenaline

57
Q

what is acromegaly?

A

pituitary gland produced too much growth hormone in adulthood

58
Q

what vascular disease can causes hsecondary hypertension?

A

coarctation of the aorta

59
Q

what sleep condition can cause secondary hypertension?

A

sleep apnoea

Cardiovascular system (40 decks)

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