Arterial/Systemic Hypertension (HBP)

Question 1

Hence at what BP level do we say there is hypertension?
• Geoffrey Rose defined hypertension as a BP level ___________________________________________________ .

Answer 1

above which investigation and treatment will do more good than harm

Question 2

Definition of Hypertension Has evolved over years:
➢ JNC VII 2003, ESC-ESH 2018 and ISH 2020 : persistent elevation in clinic systolic BP ≥_____ mmHg and/or diastolic BP ≥ ____ mmHg following repeated measurement.

OR a 24-hr ABPM average of ≥ ____/____ mmHg or an HBPM average of ≥ ____/____ mmHg.
➢ ACC/AHA 2018: persistent systolic BP ≥ ____ mmHg and/or diastolic BP ≥ ____ mm Hg.
➢ JNC 8

Answer 2

140;90

130;80

135;85

130;80

Question 3

Epidemiology of Hypertension

• 1 in ____ males and 1 in ____ females adults are affected globally
• Higher prevalence in LMIC e.g Nigeria
• Has lower age of onset and poorer prognosis in ______ race.
• In Nigeria:
-overall prevalence is 25.1 -32.8%

Answer 3

4; 5

black

Question 4

Aetiology and types of
Hypertension
1. _________ hypertension (__________ hypertension)
2.__________ hypertension

Answer 4

Primary hypertension (essential hypertension)
2.Secondary hypertension

Question 5

Aetiology and types of
Hypertension
1. Primary hypertension
•accounts for _____% of cases:
•___________ cause
• Genetic predisposition and interplay with environmental factors/risk factors

Answer 5

95; no definite

Question 6

Primary hypertension

Examples of environmental/risk factors: A. ______________ : _____,_______,_____
B._________________

Answer 6

Non modifiable
- Aging
- Male gender
- Ethnicity/race

Modifiable

Question 7

Secondary hypertension
-accounts for about ____% of cases
- specific cause can be identified and is usually a complication of other conditions:

Answer 7

5

Question 8

Secondary hypertension

Kidney diseases

List 6

Answer 8

-Acute glomerulonephritis.
-Chronic nephritis.
- Polycystic disease.
- Diabetic nephropathy.
- Hydronephrosis.
- Renal artery stenosis.

Question 9

Secondary hypertension

Endocrine disorders

List 6

Answer 9

-pheochromocytoma
-Cushing syndrome
-congenital adrenal hyperplasia -hyperthyroidism
-hyperparathyroidism
-obesity

Question 10

Pregnancy can cause secondary hypertension

T/F

Answer 10

T

Question 11

Mechanism of Hypertension
• normal BP is dependent on the balance between _______________ and ___________.
BP =_____ x ______.

Answer 11

cardiac output (CO) and peripheral vascular resistance (PVR)

CO ; PVR

Question 12

The balance in CO and PVR is maintained by interplay of _______,_______,______, and ________ control systems.
• Derangement in any of these systems can affect cardiac and vascular homeostasis, therefore the

Answer 12

renal, neural, endocrine and vascular

Question 13

Mechanism of Hypertension
Renal Mechanism:

• the kidney controls BP homeostasis by regulating the pressure via the _______ relationship and the activity of the ———————— system.

• Perturbation in the renal physiology induced by impaired ____________ , elevation of renal inflammation and oxidative stress burdens stimulate adaptive changes that could lead to increased BP, if sustained.

Answer 13

natriuresis

renin– angiotensin (RAS)

renal blood flow

Question 14

Mechanism of Hypertension
Vascular mechanism:

•___________ and __________ vascular abnormalities either in the micro- or macro- circulation can lead to ______________ and increased _______________ . [increased vascular tone by sympathetic nervous system, humoral factors and local autoregulation can cause this]

Answer 14

Structural and functional

arterial stiffening

total peripheral resistance

Question 15

Mechanism of Hypertension
Neural Mechanisms:

• _______________ activation can induce HBP by causing peripheral vasoconstriction, potentiating cardiac contraction, reducing _________, and modulating _________ and ________________. (Increased SNS activity is associated with obesity/weight gain, hyperinsulinaemia/altered glucose metabolism, and obstructive sleep apnoea)

Answer 15

Sympathetic

venous capacitance

renal sodium and water excretion

Question 16

Mechanism of Hypertension
• Excess production of _____________ as in primary hyperaldosteronism
• Excess ______________ as in pheochromocytoma
•—————- hormone in thyrotoxicosis
•______________ in Cushing syndrome

Answer 16

mineralocorticoids

catecholamines

Thyroid

Glucocorticoids

Question 17

Mechanism of Hypertension
• Excess production of mineralocorticoids as in ___________________
• Excess catecholamines as in ________________
• Thyroid hormone in _____________
• Glucocorticoids in _________________

Answer 17

primary hyperaldosteronism

pheochromocytoma

thyrotoxicosis

Cushing syndrome

Question 18

Mechanism of Hypertension
Other mechanisms:
• Low birth weight (_____________________)
• Acute and chronic _______
• ___________

Answer 18

Barker’s hypothesis

Stress

Obesity

Question 19

Diagnosing Hypertension
• BP must be measured according to protocol.
• Measure in sitting, standing and lying positions.
• Use _________ at first visit and use the arm with ___________________ subsequently
• Elevated BP must be documented on at least _______ different occasions __________ apart.
• BP recording of ≥______/_____mmHg can be taken as hypertension.
• Screen for other CV risk factors – dysglycaemia, obesity, dyslipidaemia, (Hypertension as a

Answer 19

both arms ; higher measure

three; 1 to 4 weeks

180; 110

Question 20

Definition of common terms

• Severe hypertension – BP ≥ _____/____mmHg or ≥ _____/____mmHg

• Malignant hypertension- Markedly elevated BP > _____/____mmHg, with evidence of __________________________.

Answer 20

BP ≥ 180/110mmHg or ≥ 160/100mmHg

BP > 180/120mmHg ; acute progressive multi-organ damage.

Question 21

Accelerated hypertension –_______ significant (gradual or rapid?) increase over baseline BP that is associated with ______________

Answer 21

recent

rapid

target organ damage.