W.5: Hypertension

Question 1

Definition of hypertension

Answer 1

Pressure on arterial walls exceeding a defined threshold

Question 2

Values normotension

Answer 2

Less than 120/80

Question 3

Values pre-hypertension

Answer 3

Sys: 120-139 or dia: 80-89

Question 4

Values stage I hypertension

Answer 4

Sys: 140-159 or dia: 90-99

Question 5

Values stage II hypertension

Answer 5

Sys: above 160, or dia: above 100

Question 6

Isolated systolic hypertension

Answer 6

Sys: above 140 AND dia: up to 90

Question 7

Cause of essential (idiopathic) hypertension, % of all patients with hypertension?

Answer 7

No clear etiological factor (cause) can be identified, 80-90% of all hypertensive patients.

Question 8

Cause of secondary hypertension, % of all patients with hypertension?

Answer 8

Clear etiological factor, 10-20% of all hypertensive patients.

Question 9

How can we get increased intravascular volume? Response?

Answer 9

Eg. from eating lots of NaCl - Response will be increased sodium excretion (and increased BP)

Question 10

Main effects of angiotensin II

Answer 10

Vasoconstriction, stimulation of aldosterone secretion, stimulation of vessel wall smooth muscle proliferation

Question 11

Effect of aldosterone

Answer 11

Stimulation of Na-reabsorption

Question 12

RAS pathway

Answer 12

Angiotensinogen (+renin)-> Angiotensin I (+ ACE-kinase II) -> Angiotensin II -> AT1 and AT2 receptor -> Aldosterone

Question 13

What is the function of the baroreflex?

Answer 13

To smoothen the fluctuations in arterial pressure

Question 14

alpha1 receptor

Answer 14

smooth muscle contraction, vasoconstriction

Question 15

alpha2 receptor

Answer 15

presynaptic membrane, negative fb

Question 16

beta1 receptor

Answer 16

heart, increases frequency and contractility

Question 17

beta2 receptor

Answer 17

smooth muscle, vasodilation

Question 18

Alteration in compliance when atherosclerosis is present?

Answer 18

Decreases the elasticity of the vessel wall, narrowing

Question 19

One vasodilator

Answer 19

Nitric oxide

Question 20

One vasoconstrictor

Answer 20

Endothelin

Question 21

Manifestations of hypertrophy on the heart

Answer 21

• LVH
• Congestive heart failure (CHF)
• Coronary heart disease (CHD)

Question 22

Disease of what organ is the most frequent causative factor in secondary hypertension?

Answer 22

Kidney disease

Question 23

Important early detection laboratory test of kidney disease

Answer 23

Albuminuria

Question 24

Causes of renal hypertension

Answer 24

• Parenchymal (chronic kidney disease)

- Renovascular (atherosclerosis)

Question 25

Causes of endocrine hypertension

Answer 25

• Primary aldosteronism
• Cushing syndrome
• Pheochromocytoma
• Hyperthyroidism
• Acromegalia

Question 26

Causes of drug induced hypertension (what drugs)

Answer 26

• Estrogen/androgen hormone supplementation
• NSAIDS
• Chronic alcohol intake
• Antidepressants
• Immunosupressive agents (cyclosporins, tacrolimus)

Question 27

Selected laboratory tests upon initial diagnosis of hypertension: Kidney function

Answer 27

• Urine sediment
• Urine albumin
• Urine sodium/potassium ratio
• Serum creatinin

Question 28

Selected laboratory tests upon initial diagnosis of hypertension: Endocrine

Answer 28

• Serum sodium
• Potassium
• Calcium
• TSH

Question 29

Selected laboratory tests upon initial diagnosis of hypertension: Metabolism

Answer 29

• Fasting blood glucose
• Total cholesterol
• HDL
• LDL-cholesterol
• Triglyceride

Question 30

Therapy for essential hypertension

Answer 30

Target:

1. Intravascular volume: Diuretics, ACE-inhib., aldosterone antagonists
2. Contractility: beta-blocker
3. Vessel wall function: Alpha1-blocker, alpha2-agonist, calcium-channel inhib.
4. Vessel wall structure: Cholesterol lowering agents