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My LSS- CVS > CVS 15: Hypertension > Flashcards

CVS 15: Hypertension Flashcards

1
Q

Define hypertension and give the value which is considered abnormal

A

Abnormally elevated blood pressure

140/90 mmHg = abnormal

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2
Q

What does the updated guidelines state as the difference between ambulatory bp and office bp/ white coat bp?

A
  • Ambulatory (home bp) the threshold tends to be 5-10 mmHg lower than of that taken at a clinic
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3
Q

What happens to bp with age?

A
  • Systolic bp rises
  • diastolic bp plateaus into extreme old age and then begins to decline
  • PP increases (SBP- DBP)
  • Mean bp rises with age
  • almost everyone over 80yrs is hypertensive
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4
Q

What is the classification of hypertension?

A
  1. Primary/ essential (90-95% of cases): Unidentifiable cause
  2. Secondary (<5% of cases): Identifiable cause
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5
Q

Name some causes of secondary hypertension

A
  • RENAL DISEASE
  • Tumours secreting aldosterone (Conn’s)
  • Tumours secreting catecholamines
  • Oral contraceptive pill
  • Pre-eclamsia
  • Rare genetic causes
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6
Q

What could be some of the causes of primary hypertension?

A
  1. GENETICS
    • Monogenic- Liddle’s or mineralocorticoid excess
    • Complex polygenic
  2. ENVIRONMENT
    • dietary salt
    • obesity/ lack of exercise
    • alcohol
    • pre-natal environment
    • Pregnancy
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7
Q

Give an equation for Blood pressure

A

BP= CO x PVR

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8
Q

What are the haemodynamic properties associated with hypertension (think about the equation for BP)

A
  • increased TPR
  • reduced arterial compliance (higher PP)
  • normal cardiac output
  • Normal blood volume
  • central shift in blood volume- secondary to venous compliance
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9
Q

What causes elevated PVR in hypertension?

A
  1. Active narrowing of arteries- Vasoconstriction
  2. Structural Narrowing of arteries- Vasoconstriction accompanied by remodelling of the arteries, lumen gets smaller, resistance increases
  3. Loss of capillaries- Rarefaction= reduction in capillary density-> increase in resistance
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10
Q

What is isolated systolic hypertension? And which age group is it most common in?

A

SBP> 140 and DBP< 90

tends to occur in people over 60 because of divergence of SBP and DBP

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11
Q

What causes isolated systolic hypertension?

A
  • Increased stiffness of medium/ large arteries

- pulse wave reflected and is greater by the time it reaches the brachial artery

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12
Q

What is the treatment for this?

A
  • No drugs specific to this

- normal antihypertensives will reduce already normal DBP

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13
Q

What are the possible mechanisms causing primary hypertension?

A
  1. Kidney- key role in BP regulation, evidence mostly associated with salt intake
  2. Sympathetic Nervous system- high activity=> hypertension
  3. Endocrine/ paracrine factors => inconsistent evidence
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14
Q

Give 5 pieces of evidence for the kidney being the cause of hypertension

A
  • kidney regulates bp through regulation of Na+/ H2O and EC fluid volume
  • impaired renal function/ blood flow= commonest cause of hypertension
  • Monogenic causes of hypertension affect kidneys
  • Salt intake = high correlation with bp
  • excess salt intake in many animals ==> hypertension
  • in rats hypertension can be transplanted with the kidney
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15
Q

State some of the major risks caused by an increase in blood pressure

A
  • CHD
  • Stroke
  • Peripheral vascular disease/ atheromatous disease
  • Heart failure
  • Atrial fibrillation
  • Dementia/ cognitive impairment
  • Retinopathy
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16
Q

Hypertension can cause structural changes in the heart. Name the two changes it could cause

A
  • HYPERTROPHY of the left ventricle (increase in mass)

- Change in ventricular volume (REMODELLING)

17
Q

What is heart failure? By what factor does Hypertension increase the risk of CHF?

A
  1. The inability of the heart to adequately pump blood at normal filling pressures
  2. 2-3 fold increase
18
Q

What can hypertension cause in the large arteries?

A
  • hypertrophy of the large arteries
  • acceleration of atherosclerosis
  • dilation of large arteries (ANEURYSM)
  • THROMBOSIS or HAEMORRHAGE if the aneurysm ruptures
19
Q

What are Charcot- Bouchard Aneurysms? What are they normally associated with? and what can they cause?

A
  • Aneurysm of brain vasculature in small blood vessels
  • Associated with chronic hypertension
  • cause cerebral haemorrhage
20
Q

What are the signs of hypertension in the retina?

A
  • silver wiring and AV nipping (wall thickening)
  • Arteriolar narrowing
  • vasospasm
  • impaired perfusion
  • Haemorrhages (wall rupture)
  • Hard exudates (plasma leaks to surrounding tissue)
21
Q

What are the signs of hypertension in microvasculature?

A
  • Reduction in capillary density==> impaired perfusion and an increase in PVR
  • Elevated capillary pressure ==> damage and leakage
22
Q

What are the signs of hypertension in the kidneys?

A 
- microalbuminuria and macroalbuminuria
=> glomerular damage
=> Decline in GFR
- loss of nephrons and function in the kidney 
renal atrophy, cortical thinning

My LSS- CVS (21 decks)

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