The Aetiology, Pathophysiology and Treatment of Hypertension Flashcards
What are some of the results of end-organ damage that hypertension can cause?
Brain haemorrhage Stroke Cognitive decline Peripheral vascular disease Renal failure Retinopathy Left ventricular hypertrophy Congestive heart failure Coronary heart disease
At what blood pressure is a blood patient hypertensive?
140/90 mmHg
What are some risk factors for hypertension?
Smoking Diabetes mellitus Renal disease Male Hyperlipidaemia Previous MI or stroke Left ventricular hypertrophy
Want accounts for second to second blood pressure control?
The sympathetic nervous system
What is very important in long term blood pressure control?
The renin-angiotensin-aldosterone system
What is the RAAS responsible for?
Maintenance of sodium balance
Control of blood volume
Control of blood pressure
Conserve salt and water to maintain circulatory volume
How does the RAAS work?
Renin converts angiotensinogen to angiotensin I which is then converted to angiotensin II by angiotensin enzyme (ACE)
What stimulates the RAAS?
Fall in blood pressure
Fall in circulating volume
Sodium depletion
What does angiotensin II do?
Vasoconstriction
Anti-natriuretic peptide
Stimulates aldosterone release from the adrenal glands
It is a potent hypertrophic agent that stimulates myocyte and smooth muscle hypertrophy in the arterioles
What is aldosterone?
A potent antinatrieretic and antidiuretic peptide
What does myocyte and smooth muscle hypertrophy indicate in a patient with hypertension?
A poor prognosis
What are key targets in the treatment of hypertension?
The sympathetic nervous system and the RAAS
What are the likely causes of hypertension?
- Increased reactivity of resistance vessels with a resultant increase peripheral resistance as a result of a hereditary defect of the smooth muscles lining the arterioles
- The failure of the kidneys to provide sufficient sodium for ay given blood pressure (essential hypertension)
Describe the affect of genetics on hypertension
A history of hypertension tends to run in families with the closest correlation existing between siblings
What factors affect blood pressure?
Mental and physical stress Sodium intake and diet Alcohol consumption Weight Birth weight Race
What are some causes of secondary hypertension?
Renal disease Drug induced Pregnancy Endocrine diseases Vascular diseases Sleep apnoea
What renal diseases cause secondary hypertension?
Chronic pyelonephritis
Fibromuscular dysplasia
Renal artery stenosis
Polycystic kidneys
What drugs can induce secondary hypertension?
NSAIDs
Oral contraceptive
Corticosteroids
What endocrine diseases cause secondary hypertension?
Conn's syndrome Cushing disease Phaeochromocytoma Hypo and hyperthyroidism Acromegaly
What vascular disease cause secondary hypertension?
Coarctation of the aorta
Which race has high blood pressure?
Black populations have a higher blood pressure than caucasians in the same environment
How does birth weight affect risk of hypertension?
The lower the birth weight the greater the risk of developing hypertension in the long term
