The Aetiology, Pathophysiology and Treatment of Hypertension

Question 1

What are some of the results of end-organ damage that hypertension can cause?

Answer 1

Brain haemorrhage 
Stroke 
Cognitive decline 
Peripheral vascular disease 
Renal failure 
Retinopathy 
Left ventricular hypertrophy 
Congestive heart failure 
Coronary heart disease

Question 2

At what blood pressure is a blood patient hypertensive?

Answer 2

140/90 mmHg

Question 3

What are some risk factors for hypertension?

Answer 3

Smoking 
Diabetes mellitus 
Renal disease 
Male 
Hyperlipidaemia 
Previous MI or stroke 
Left ventricular hypertrophy

Question 4

Want accounts for second to second blood pressure control?

Answer 4

The sympathetic nervous system

Question 5

What is very important in long term blood pressure control?

Answer 5

The renin-angiotensin-aldosterone system

Question 6

What is the RAAS responsible for?

Answer 6

Maintenance of sodium balance
Control of blood volume
Control of blood pressure
Conserve salt and water to maintain circulatory volume

Question 7

How does the RAAS work?

Answer 7

Renin converts angiotensinogen to angiotensin I which is then converted to angiotensin II by angiotensin enzyme (ACE)

Question 8

What stimulates the RAAS?

Answer 8

Fall in blood pressure
Fall in circulating volume
Sodium depletion

Question 9

What does angiotensin II do?

Answer 9

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

Question 10

What is aldosterone?

Answer 10

A potent antinatrieretic and antidiuretic peptide

Question 11

What does myocyte and smooth muscle hypertrophy indicate in a patient with hypertension?

Answer 11

A poor prognosis

Question 12

What are key targets in the treatment of hypertension?

Answer 12

The sympathetic nervous system and the RAAS

Question 13

What are the likely causes of hypertension?

Answer 13

1. 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
2. The failure of the kidneys to provide sufficient sodium for ay given blood pressure (essential hypertension)

Question 14

Describe the affect of genetics on hypertension

Answer 14

A history of hypertension tends to run in families with the closest correlation existing between siblings

Question 15

What factors affect blood pressure?

Answer 15

Mental and physical stress 
Sodium intake and diet
Alcohol consumption 
Weight 
Birth weight 
Race

Question 16

What are some causes of secondary hypertension?

Answer 16

Renal disease 
Drug induced 
Pregnancy 
Endocrine diseases
Vascular diseases
Sleep apnoea

Question 17

What renal diseases cause secondary hypertension?

Answer 17

Chronic pyelonephritis
Fibromuscular dysplasia
Renal artery stenosis
Polycystic kidneys

Question 18

What drugs can induce secondary hypertension?

Answer 18

NSAIDs
Oral contraceptive
Corticosteroids

Question 19

What endocrine diseases cause secondary hypertension?

Answer 19

Conn's syndrome 
Cushing disease 
Phaeochromocytoma 
Hypo and hyperthyroidism 
Acromegaly

Question 20

What vascular disease cause secondary hypertension?

Answer 20

Coarctation of the aorta

Question 21

Which race has high blood pressure?

Answer 21

Black populations have a higher blood pressure than caucasians in the same environment

Question 22

How does birth weight affect risk of hypertension?

Answer 22

The lower the birth weight the greater the risk of developing hypertension in the long term