23. Arterial Hypertension

Question 1

How is hypertension categorised?

Answer 1

• normal (<120/80 mmHg)
• prehypertension (120-139 / 80-89)
• stage 1 (140-159 / 90-99)
• stage 2 (≥ 160 / ≥ 90)

Question 2

How can you elevate blood pressure ?

Answer 2

• drugs
• volume
• vasoconstrictors (narrow vessels -> increase blood pressure)

Question 3

What is the definition for hypertension?

Answer 3

Definition for adults: persistent systolic blood pressure of ≥ 140 mm Hg and/or diastolic blood pressure ≥ 90 mm Hg

Definition for children < 13 years: blood pressure ≥ 95th percentile to < 95th percentile + 12 mm Hg OR systolic blood pressure ≥ 130 mm Hg and/or diastolic blood pressure ≥ 80 mm Hg (whichever is lower)

Question 4

What are the 2 types of hypertension?

Answer 4

• primary hypertension (genetics, risk factors) 85-95%

- secondary hypertension (renal, vascular, endocrine causes) 2-10%

Question 5

What are the risk factors for primary hypertension

Answer 5

Nonmodifiable risk factors:
Positive family history
Ethnicity
Advanced age

Modifiable risk factors:
Obesity
Diabetes 
Smoking, excessive alcohol or caffeine intake
Diet high in sodium, low in potassium 
Physical inactivity
Psychological stress

Question 6

What are the causes for secondary hypertension?

Answer 6

• renal hypertension
• endocrine hypertension
• coarctation of aorta
• obstructive sleep apnea
• medication: sympathomimetic drugs, corticosteroids, NSAIDs, oral contraceptives
• recreational drug use: amphetamines, cocaine, phencyclidine

Question 7

What are the symptoms of hypertension?

Answer 7

often asymptomatic until: complications or hypertensive crisis

non-specific symptoms:

• headaches, esp. early morning or waking headache
• dizziness, tinnitus, blurred vision
• flushed appearance
• epistaxis
• chest discomfort, palpitations
• strong, bounding pulse on palpation
• nervousness
• fatigue, sleep disturbances

Question 8

How will blood pressure be diagnosed?

Answer 8

blood pressure monitoring:
- repeated measurements on both arms : average blood pressure on at least
3 readings obtained on at least 3 separate visits needs to be elevated
- long-term measurement of blood pressure (24 hours)

Question 9

What are the next steps in the diagnostics after blood pressure monitoring proves hypertension?

Answer 9

Stratification of cardiovascular risk: fasting blood glucose, lipid profile (HDL, LDL, and triglycerides levels)

Evaluation of end-organ damage and underlying causes:
- complete blood count
- renal function tests: serum creatinine and eGFR
- serum Na+, K+, and Ca2+
- urinalysis
- TSH (= thyroid-stimulating hormone; test to detect hypo- or
hyperthyroidism)
- Electrocardiogram (ECG) (check for early electrical changes associated with
hypertensive heart disease)

Question 10

Which complications can arise in patients with hypertension?

Answer 10

cardiovascular system:

• Left ventricular hypertrophy, hypertrophic cardiomyopathy
• Congestive heart failure
• Coronary artery disease and myocardial infarction
• Aortic dissection
• Atherosclerosis

brain: stroke
kidneys: hypertensive nephrosclerosis
eyes: hypertensive retinopathy

Question 11

What is the treatment for hypertension?

Answer 11

• lifestyle changes (diet, weight loss, exercise, stop smoking & drinking)
• medication
• for secondary hypertension: treat underlying causes

Question 12

What is the pharmacological therapy?

Answer 12

in case BP ≥ 140/90 mm Hg

• antihypertensive medications: ACE inhibitors, angiotensin receptor blockers,
  thiazide diuretics, and calcium channel blockers.
• for pediatric patients and pregnant women: some of these drugs can no be
  used for example no betablockers for children due to their metabolic side
  effects)