Aetiology and Pathophysiology of Hypertension

Question 1

Organs that can be damaged by hypertension

Answer 1

Brain, heart, kidney, eyes (retinopathy), vessels (peripheral vascular disease)

Question 2

Hypertension damage to the heart examples

Answer 2

Coronary heart disease
Congestive heart failure
Left ventricular hypertrophy

Question 3

Hypertension definition

Answer 3

That blood pressure above which benefits of treatment outweigh the risks in terms of morbidity and mortality

Question 4

Effect of increased blood pressure on risk of stroke and cardiovascular disease

Answer 4

Increases exponentially

Question 5

Stage 1 hypertension blood pressure

Answer 5

140/90mmHg

Question 6

Stage 2 hypertension blood pressure

Answer 6

160/100mmHg

Question 7

Severe hypertension blood pressure

Answer 7

180/110mmHg

Question 8

Percentage of hypertension that is primary

Answer 8

90%

Question 9

Examples of causes of secondary hypertension

Answer 9

Chronic renal disease
Renal artery stenosis
Endocrine disease
Cushings
Drug induced
Pregnancy - preeclampsia
Vascular - coarctation of aorta
Sleep apnoea

Question 10

Hypertension indirectly and directly responsible for what percentage of deaths worldwide

Answer 10

> 20%

Question 11

Risk factors of hypertension

Answer 11

Cigarette smoking
Diabetes mellitus
Renal disease
Male
Hyperlipidaemia
Previous MI or stroke
Left ventricular hypertrophy

Question 12

Aetiology of primary hypertension

Answer 12

Age
Genetics and family history
Environment
Sodium intake and diet
Weight
Alcohol intake
Race
Birth weight

Question 13

Likely physiological causes of hypertension

Answer 13

Increase reactivity of resistance vessels = increase TPR

Sodium homeostatic effect - sodium and so fluid is retained

Question 14

Why does hypertension increase with age

Answer 14

Due to decrease arterial compliance

Question 15

Number of genes recognised as important to hypertension

Answer 15

> 30 genes

Question 16

White coat hypertension

Answer 16

People who are only hypertensive when they see their doctor

Question 17

Environmental factors that can cause stress

Answer 17

Mental and physical stress

Question 18

Most important non-pharmacological management of hypertension

Answer 18

Weight reduction

Question 19

Difference in blood pressure between Caucasians and black populations

Answer 19

Caucasians have lower blood pressure than black populations

Question 20

Methods to identify ‘true’ hypertension

Answer 20

Ambulatory blood pressure monitoring (ABPM)

Home blood pressure monitoring (HBPM)

Question 21

Nocturnal dip

Answer 21

When blood pressure is reduced at night

Question 22

Effect of nocturnal dip on risk of cardiovascular disease

Answer 22

Risk decreases

Question 23

Masked hypertension

Answer 23

Hypertensive but their blood pressure drops when they see the doctor, hiding it

Question 24

Guideline for treating someone with hypertension

Answer 24

Anyone with stage 1 hypertension and more than 10% risk of cardiovascular disease

Question 25

Target blood pressure for regular person who is hypertensive

Answer 25

<135/80-85mmHg

Question 26

Method of treatment of hypertension

Answer 26

Stepped approach - using low doses of several drugs

Question 27

Advantage of stepped approach

Answer 27

Minimises adverse events and maximises patient compliance

Question 28

Stepped approach

Answer 28

Adding new medication to current therapy until the target blood pressure is achieved

Question 29

Target blood pressure for elderly (over 80) who are hypertensive

Answer 29

<145/85mmHg

Question 30

Effect of ACE inhibitor

Answer 30

Inhibits the actions of angiotensin converting enzyme so angiotensin I is not converted to angiotensin II

Question 31

Contraindications to ACE inhibitors

Answer 31

Renal artery stenosis Renal failure Hyperkalaemia

Question 32

Adverse drug reactions of ACE inhibitors

Answer 32

``` Cough First dose hypotension Taste disturbance Renal impairment Angioneurotic oedema ```

Question 33

Effect of angiotensin II antagonists (ARB)

Answer 33

Competitively blocks the actions of angiotensin II at the angiotensin AT1 receptor

Question 34

Examples of calcium channel blockers

Answer 34

Amlodipine/Felodipine - vasodilators | Verapamil/Diltiazem - rate limiting

Question 35

Contraindications of calcium channel blockers

Answer 35

Acute MI | Heart failure, bradycardia

Question 36

Adverse drug reactions of calcium channel blockers

Answer 36

``` Flushing Headache Ankle oedema Indigestion and reflux oesophagitis Bradycardia Constipation ```

Question 37

Examples of thiazide type diuretics

Answer 37

Indapamide | Clortalidone

Question 38

Mechanism of thiazide type diuretics

Answer 38

Urinary excretion of sodium

Question 39

Adverse drug reactions of thiazide type diuretics

Answer 39

Gout | Impotence

Question 40

Example of alpha-adrenoreceptor antagonist

Answer 40

Doxazosin

Question 41

Mechanism of alpha-adrenoreceptor antagonist

Answer 41

Selectively blocks post synaptic alpha1 adrenoreceptors | Oppose vascular smooth muscle contraction in arteries

Question 42

Adverse drug reactions of alpha-adrenoreceptor antagonists

Answer 42

First dose hypotension Dizziness Dry mouth Headache

Question 43

Examples of centrally acting agents

Answer 43

Methyldopa | Moxonidine

Question 44

Mechanism of methyldopa

Answer 44

Converted to alpha methylnoradrenaline which acts on CNS alpha adrenoreceptors which decrease central sympathetic outflow

Question 45

Adverse drug reactions of methyldopa

Answer 45

Sedation and drowsiness Dry moth and nasal congestion Orthostatic hypotension

Question 46

Medication for hypertension during pregnancy

Answer 46

Nifedipine MR, methyldopa, atenolol, labetalol, thiazide diuretic, amlodipine

Question 47

Order of treatment for hypertensive patients under the age of 55 or Caucasian

Answer 47

ACE inhibitor, ARB, calcium channel blocker, Thiazide diuretic, extra other alternative (doxazosin, spironolactone)

Question 48

Order of treatment for hypertensive patients over the age of 55 or afrocaribbean or of child bearing age

Answer 48

Calcium channel blockers, ACE inhibitors or ARB, Thiazide diuretic, extra other alternative (doxazosin, spironolactone)