Week 3: Hypertension

Question 1

Define blood pressure.

Answer 1

-systolic: pressure in the arteries when the heart contracts
-diastolic: pressure in the arteries when the heart is relaxed and not contracting
bp=CO x tpr

Question 2

List perturbation sin the determinants of blood pressure that result in hypertension.

Answer 2

• stress–>sympathetic nervous overactivity
• renin-angiotensin excess–>functional constriction, structural hypertrophy
• reduced nephron #–>renal Na retention
• excess Na intake–>increased fluid volume
• factos that increase CO or peripheral resistance

Question 3

Identify risk factors for essential hypertension.

Answer 3

1. obesity: assoc. with increased CO, intravascular volume, SNS activity, increased RAS activity
2. tobacco: increase bp
3. caffeine: increases bp, but tolerance develops
4. alcohol: no more than 2 drinks a day
5. mineral metabolism: decreased Ca, K, Mg intake and increased Ca excretion assoc. with increased bp

Question 4

Identify common target organs affected by hypertension.

Answer 4

1. cardiac: LV hypertrophy, heart failure, myocardial infarct.
2. cerebrovascular: stroke
3. renal: chronic kidney disease, end stage renal disease
4. aorta and peripheral vasculature: aorta aneurysm/dissection, claudification.
5. retinopathy: arterial narrowing, hemorrhage, papiledema

Question 5

Describe history and physical findings associated with hypertension.

Answer 5

• need 2 measures separated by 2 minutes
• no nicotine or caffeine within 30 mins of measurement
• hx: previous hx of HTN, peripheral vascular disease, CAD, lipid abnormalities, renal disease, diabetes, cerebrovascular accidents
• family hx: HTN, heart disease, cerebrovascular accidents, DM
• medication hx
• symptoms suggestive of secondary hypertension

Question 6

Describe an evaluation of a patient for HTN.

Answer 6

1. hx
2. physical: bp measurements, ht, wt, fundoscopic exam, cardiac exam, abdomen exam for enlarged kidneys, bruits, pulsation/masses, diminished pulses in extremities, neuro exam
3. lab tests
   - blood chemistry
   - lipid profile
   - EKG
   - optional : TSH, HgA1C, serum uric acid, renin/aldosterone, echo, 24 hr ambulatory bp

Question 7

What are target blood pressure recommendations?

Answer 7

Age=60: <140/90

Question 8

Define resistant hypertension

Answer 8

failure to achieve goal blood pressure in patients who are adhering to full doses of an appropriate 3 drug regimen that includes a diuretic

Question 9

What are signs that patients are at risk for secondary hypertension?

Answer 9

• younger than 30 yo and older than 65 yo
• abrupt onset of HTN
• no family hx
• drug therapy (3+)
• hx or PE suggestive of secondary cause of HTN

Question 10

What are causes of secondary hypertension?

Answer 10

Apnea
Bruits : renal artery stenosis
Chronic kidney disease
Drugs
Endocrine disorders: primary aldosteronism, pheochromocytoma, Cushings, hyper/hypothryroidism