Aetiology of hypertension

Question 1

What is hypertension ?

Answer 1

Is that blood pressure at which the benefits of treatment with antihypertensive agents in reducing cardiovascular , cerebrovascular and peripheral vascular risk outweigh the risks of treatment

Question 2

When does someone have hypertension ?

Answer 2

140/90mmHg

Question 3

What is the number 1 cause of preventable morbidity and mortality ?

Answer 3

Hypertension

Question 4

What is the % increase risk mortality from IHD ?

Answer 4

7%

Question 5

What is the % increase risk mortality from stroke ?

Answer 5

10%

Question 6

What is the epidemiology of hypertension ?

Answer 6

affects 30-40% of the adult population

Prevalence >65% in persons over 60yrs

Question 7

What are the risk factors for hypertension ?

Answer 7

MI
HF
Stroke
CVD

Question 8

What does cigarette smoke do to BP ?

Answer 8

Adds 20/10mmHg

Question 9

How much more times are males at risk ?

Answer 9

2X

Question 10

How much more times are LVH at risk ?

Answer 10

2X

Question 11

What are the most common causes of death due to raised blood pressure ?

Answer 11

Ischemic heart disease and stroke

Question 12

What end organ damage is associated with hypertension ?

Answer 12

LVH, CHD, CHF, MI
Renal failure, dialysis, transplantation, proteinuria
Peripheral vascular disease
Retinopathy
Stroke

Question 13

What is the defined as stage 1 hypertension ?

Answer 13

Clinical BP is 140/90mmHg or higher

ABPM daytime average 135/85mmHg or higher

Question 14

What is defined as stage 2 hypertension ?

Answer 14

Clinic BP is 160/100mmHg or higher

ABPM daytime average 150/95mmHg or higher

Question 15

What is defined as stage 3 or severe hypertension ?

Answer 15

Clinic systolic BP is 180/120mmHg or higher

Question 16

What is primary hypertension ?

Answer 16

in 80-90% no cause can be found ?

Question 17

What is secondary hypertension ?

Answer 17

In 10-20% a cause can be found ?

Question 18

What are some of the causes of secondary hypertension ?

Answer 18

Chronic renal disease
Renal artery stenosis
Endocrine disease, Cushing’s

Question 19

How is BP controlled ?

Answer 19

By an integrated system

Question 20

What are the prime contributors to BP ?

Answer 20

Cardiac output
Stroke volume and heart rate
Peripheral vascular resistance
Each of these factors can be manipulated by drug therapy

Question 21

The sympathetic NS activation produces what ?

Answer 21

Vasoconstriction - increases resistance
Reflex tachycardia
Increased stroke volume - increased cardiac output

Question 22

What else does the sympathetic NS stimulate ?

Answer 22

Stimulates renin release which produces angiotensin II and aldosterone

Question 23

What is the renin-angiotensin-aldosterone system responsible for ?

Answer 23

Maintenance of sodium balance
Control of BP
Control of blood volume

Question 24

What is the renin-angiotensin-aldosterone system stimulated by ?

Answer 24

Fall in BP
Fall in circulating volume
Sodium depletion

Question 25

What is the aetiology of hypertension ?

Answer 25

``` Polygenic: - major genes - poly genes Polyfactorial: - environment - individual and shared ```

Question 26

What does increased reactivity of resistance vessels result in ?

Answer 26

Increase in peripheral resistance

Question 27

What is the sodium homeostatic effect ?

Answer 27

In hypertensive individuals the kidneys are unable to excrete appropriate amounts of sodium for any given BP, as a result sodium and fluid are retained and the BP increases

Question 28

How does age contribute to hypertension ?

Answer 28

BP rises with age possibly as a result of decreased arterial compliance We must be pragmatic, the elderly are more susceptible to adverse effects

Question 29

How does genetics and family history contribute to hypertension ?

Answer 29

A history of hypertension tends to run in families | Between siblings rather than parents and child

Question 30

How does environmental factors contribute to hypertension ?

Answer 30

Mental and physical stress both increases blood pressure | Removing stress does nor nescesaarlily return BP to normal values

Question 31

How does salt intake and diet contribute to hypertension ?

Answer 31

Reducing salt intake in hypersensitive individuals to <5gm/day or 1.5/day

Question 32

How does alcohol contribute to hypertension ?

Answer 32

Affects 1% of population Small amounts of alcohol decrease BP Large amounts of alcohol increase BP

Question 33

How does weight contribute to hypertension ?

Answer 33

Obese pateints have a higher BP | Up to 30% of hypertension is attributable in part of wholly to obesity

Question 34

How does race contribute to hypertension ?

Answer 34

Caucasians have lower BP than African populations