C23. Hypertension

Question 1

what is hypertension

Answer 1

high blood pressure. Medical condition characterized by persistently elevated pressure within large arteries

Question 2

what is BP measured in

Answer 2

mm of mercury

Question 3

how do you write BP

Answer 3

systolic over diastolic mm of mercury

Question 4

what is systolic pressure

Answer 4

maximum pressure within large arteries when the heart muscle contracts to propel blood through the body

Question 5

what is diastolic blood pressure

Answer 5

the lowest pressure within the large arteries during heart muscle relaxation between beating

Question 6

what are the determinants of blood pressure

Answer 6

Cardiac output
peripheral vascular resistance
Blood volume

Question 7

what is cardiac output

Answer 7

volume of blood pumped by the heart per minute

Question 8

what is peripheral vascular resistance

Answer 8

the resistance to blood flow in the peripheral blood vessels

Question 9

what are the determinants of hypertension

Answer 9

altered BP regulation
Genes
lifestyle
environment

Question 10

what numbers define hypertension

Answer 10

sustained SBP >140
sustained DBP >90

Question 11

what are the two types of hypertension

Answer 11

essential and secondary

Question 12

what is essential/primary hypertension

Answer 12

no clear single causes
complex genetic background and environmental factors
most common form of hypertension in adults

Question 13

what is secondary hypertension

Answer 13

specific underlying cause
5-10% of cases of adults
70-85% cases in children

Question 14

so the definition of essential Hypertension is…

Answer 14

“Essential Hypertension” is a persistently elevated blood pressure without an identifiable secondary cause

Question 15

what are some manual auscultatory devices used in practice

Answer 15

BP cuff, stethoscope

Question 16

what are some automated electronic devices used in practice

Answer 16

digital/electronic bp monitor

Question 17

in what environment would you measure BP and how would you have your patient

Answer 17

use a relaxed setting with a person quiet and seated

Question 18

what should you do before taking a BP reading

Answer 18

check the pulse if its irregular take the BP manually and ensure the device is validated and you are using the right sized cuff

Question 19

what is a ABPM

Answer 19

ambulatory Blood pressure monitor

Question 20

which method of taking blood pressure is the most accurate and useful and why

Answer 20

ABPM because it provides multiple readings in conditions that reflect the usual environment like daily activities and sleep

Question 21

so hypertension must be diagnosed with ABPM or……….

Answer 21

Home BP

Question 22

how many readings do you need an hour if you are using ABPM

Answer 22

at least two measurements per hour during the person’s usual waking hours (usually 14/day).

Question 23

how many measurements do you need if you are using a HBPM

Answer 23

two consecutive seated measurements 1 minute apart
BP is recorded x2 a day for min of 4 days and preferably a week

Question 24

when using HBPM which measurements are discarded

Answer 24

the first days measurements and then an average is used for the rest

Question 25

what is it called when BP goes up because it is being measured at the GP

Answer 25

white coat effect

Question 26

what is masked hypertension

Answer 26

having normal BP in clinic but elevated BP at home

Question 27

what could eb possible reasons for masked hypertension

Answer 27

young age, male, stress (ie in calm moments there bp could be almost normal )

Question 28

what are the stages of hypertension

Answer 28

1, 2 and severe

Question 29

what is stage one hypertension

Answer 29

office BP is 140/90 or higher ABPM/HBPM daytime average is 135/85 or higher

Question 30

what is stage 2 hypertension

Answer 30

office BP is 160/100 or higher ABPM/HBPM daytime average is 150/95 or higher

Question 31

what is severe hypertension

Answer 31

office SBP is 180/90 or higher office DBP is 110 or higher

Question 32

what tests should you do for hypertensive people to assess their organ damage

Answer 32

test urine for presence of proteins blood to measure glucose, cholesterol, electrolytes, creatinine arrange an ECG - (LVH?) examine fundi for hypertensive retinopathy

Question 33

what conditions can be developed due to prolonged HBP

Answer 33

Left Ventricular Hypertrophy - can lead to heart failure raised creatinine levels - kidney damage albumin present in urine - kidney damage retinopathy

Question 34

what are established vascular diseases linked to HPB

Answer 34

Ischaemic Heart Disease Cerebrovascular Disease PVD diabetes

Question 35

how do you asses someone for Hypertension

Answer 35

Medical history Family History Smoking Alcohol Sleep history CV examinations (pulses, bruits) ABPM ? HBPM examine Fundi

Question 36

what are the classes of retinopathy

Answer 36

Grade I, II, III, IV

Question 37

why do we check the fundi in hypertensive patients

Answer 37

Examining the fundi is crucial for detecting hypertensive retinopathy, which can indicate the severity and duration of hypertension. It helps in early detection, assessing the overall cardiovascular risk, monitoring progression, and preventing vision loss.

Question 38

what is secondary hypertension

Answer 38

Secondary hypertension is high blood pressure caused by another medical condition.

Question 39

what are some common causes of secondary hypertension

Answer 39

Obstructive sleep apnoea renal disease aldosteronism renovascular disease

Question 40

what are the more uncommon causes of secondary hypertension

Answer 40

Cushing's Hyperparathyroidism aortic coarctation