1. Hypertension

Question 1

What BP is indicative of stage 1 hypertension?

Answer 1

140/90

Question 2

What BP is indicative of stage 2 hypertension?

Answer 2

160/100

Question 3

What BP is indicative of stage 3 hypertension?

Answer 3

180/110

Question 4

How is BP calculated?

Answer 4

CO x peripheral resistance

Question 5

What factors control CO?

Answer 5

Na+, mineralocorticoids, ANP

HR and contractability

Question 6

Name 3 factors that influence vasoconstriction

Answer 6

a-adrenergic receptors
angiotensin
catecholamines

Question 7

Name 4 factors that influence vasodilation

Answer 7

B-adrenergic receptors
Prostaglandins
Kinins
NO

Question 8

What are the risk factors for hypertension?

Answer 8

High BMI
Salt intake
Alcohol, smoking
Inactivity
Genetics

Question 9

What is hypertension with an unknown cause called?

Answer 9

Essential hypertension

Question 10

Why does Cushing’s syndrome increase the risk of hypertension?

Answer 10

High cortisol increases sensitivity of blood vessels to adrenaline and noradrenaline, both of which are vasoconstrictors

Question 11

What are the functions of angiotensin 2?

Answer 11

Vasoconstriction and the release of aldosterone which causes Na retention

Question 12

Where is angiotensinogen produced?

Answer 12

Liver

Question 13

What enzyme converts angiotensinogen to angiotensin 1?

Answer 13

Renin

Question 14

Why does COVID-19 cause vasoconstriction?

Answer 14

Turns off ACE-2 which converts angiotensin 2 to angiotensin 1-7
Angiotensin 1-7 have the effects of vasodilation and increasing NO

Question 15

Why does Conn’s syndrome increase the risk of hypertension?

Answer 15

Increased aldosterone causes an increase in sodium retention

Question 16

What are the causes of secondary hypertension?

Answer 16

Renal 
Adrenal
Pituitary acromegaly eg. pregnancy
CV eg. coarctation of aorta
Alcohol and cocaine
Increased ICP (cushing's response)

Question 17

What are the adrenal causes of hypertension?

Answer 17

Excess aldosterone (conn's syndrome)
Catecholamine excess

Question 18

What causes Conn’s syndrome?

Answer 18

Hyperplasia or tumours of zona glomerulosa

Question 19

What type of tumour causes a catecholamine excess?

Answer 19

Phaeochromocytoma

Question 20

What type of hypertension is associated with phaeochromocytoma?

Answer 20

Paroxysmal

Question 21

What are the endocrine causes of hypertension?

Answer 21

Thyroid over or under function
Pituitary tumour
Pre-eclampsia

Question 22

What is pre-eclampsia and how does it cause hypertension?

Answer 22

Placental ischaemia causes the placenta to produce renin

Question 23

How can hypertension be investigated?

Answer 23

Urinalysis
Bloods: glucose, lipids, U&Es
Fundoscopy
ECG

Question 24

What is fundoscopy?

Answer 24

Examination of blood vessels of the retina

Question 25

What can be seen on an ECG in hypertension?

Answer 25

LV hypertrophy seen as a larger QRS complex

Question 26

What are the vascular consequences of hypertension?

Answer 26

Smooth muscle hypertrophy in media Fibrosis and loss of elastic tissue can cause dissection and rupture berry aneurysms Accelerated atherosclerosis Luminal narrowing in kidney causes renal impairment

Question 27

What is malignant hypertension?

Answer 27

>120 diastolic BP

Question 28

What does malignant hypertension cause?

Answer 28

Fibrinoid necrosis of vessels | This causes thrombosis and haemolytic anaemia (see forum)

Question 29

What are the consequences of malignant hypertension?

Answer 29

Acute renal failure Encephalopathy Increase ICP

Question 30

What are the cardiac consequences of hypertension?

Answer 30

``` LV hypertrophy (leading to an MI due to underperfusion) Sustained LV hypertrophy can cause dilatation which causes heart failure due to loss of pump function ```

Question 31

What are the renal consequences of hypertension?

Answer 31

Nephrosclerosis (risk increased with other small vessel diseases) Lack of perfusion triggers RAAS and worsens BP

Question 32

What are the cerebrovascular consequences of hypertension?

Answer 32

Stroke | Rupture of pre-existing berry aneurysm