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CC: CVS and Blood vessels > HTN and vascular changes > Flashcards

HTN and vascular changes Flashcards

1
Q

What is the approximate BP at which a person is in HTN?

A

> 139/89mmHg

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2
Q

Is the safe cut off limit absolute – ie, is it the same no matter the circumstances of the individual patient?

A

No

Those with more CVS risk factors should aim for an even lower BP, along with other lifestyle changes

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3
Q

If HTN is left untreated, what is the major cause of mortality?

A

IHD (50% of cases) or congestive heart failure

1/3 die of stroke

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4
Q

How much of HTN is essential (idiopathic)?

A

Possibly as much as 90%

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5
Q

What are some renal causes of HTN?

A

Renal artery stenosis (usually by atheromatous plaque)

Renal vasculitis

Renin-producing tumour

Chronic renal disease

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6
Q

What are some major endocrine causes of HTN?

A

Adrenocortical hyperfunction (Cushings, primary aldosteronism etc)

Exogenous hormones (glucocorticoids, oestrogen, MAO inhibitors)

Phoechromocytoma

Hypo/hyperthyroidism

Pregnancy

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7
Q

What are some cardiovascular causes of HTN?

A

Increased intravascular volume

Increased CO

Rigidity or coarctation of the aorta

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8
Q

What are some neurological causes of HTN?

A

Increased intracranial pressure

Acute stress, including surgery

Psychogenic

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9
Q

What symptoms mark malignant, or severe HTN?

A

> 200/120 mmHg

Renal failure (hypertensive nephropathy)

Retinal haemorrhages and exudates with or without papilloedema

Hypertensive encephalopathy

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10
Q

What is the cause of hypertensive encephalopathy?

A

Cerebral oedema caused by severe and/or sudden rises in BP

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11
Q

What is the vascular response to a low to moderate increase in BP?

A

Arterial and arteriolar vasoconstriction maintains tissue perfusion and prevents pressure from being transmitted to the smaller, distal vessels

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12
Q

What happens when HTN proceeds beyond the ability of arteries and arterioles to vasoconstrict?

A

Smaller vessels and capillaries receive higher pressure, which leads to acute damage to the vessel wall

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13
Q

What are the three main systems that decide the blood pressure?

A

RAAS

Sympathetic nervous system

Plasma volume

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14
Q

What drugs can cause HTN?

A

Oral contraceptives (oestrogen -> angiotensinogen -> RAAS)

NSAIDs (COX-2 inhibition -> decreased Na excretion -> ^ plasma volume)

Methamphetamines, cocaine

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15
Q

How does chronic kidney disease cause HTN?

A

Relative resistance to atrial natriuretic peptide due to rapid degradation of cGMP leading to volume expansion

Increased activity of Na-K-ATPase in cortical collecting tubule but not other nephron segments, which normally powers the active sodium transport

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16
Q

When should you consider primary hyperaldosteronism as a cause of HTN?

A

When the patient has a triad of unexplained HTN, hypokalaemia and metabolic alkalosis

17
Q

Why do hypothyroidism patients have HTN?

A

Vasoconstriction due to reduced levels of vasodilatory mediators

^ in aldosterone

18
Q

How does HTN influence the structure of the heart?

A

Pressure overload can cause LVH

19
Q

What can LVH, from HTN, lead to?

A

Higher risk of IHD, stroke, sudden death, heart failure

20
Q

T/F HTN significantly increases the risk of CVA

A

T

21
Q

T/F HTN increases the risk of intracerebral haemorrhage

A

T

22
Q

What is the name of the renal disease caused by HTN?

A

Hypertensive nephrosclerosis

23
Q

How is HTN diagnosed?

A

BP measurement, or 24 hour BP measuring devices

24
Q

Over what time frame should HTN be measured before a definitive diagnosis can be made?

A

Ideally at least 3 measurements taken over a period of weeks to months

25
Q

What evaluations should be made in a person with HTN?

A

Extent of target-organ damage

CVS risk factors

Lifestyle factors, drugs and conditions that could be leading to HTN

26
Q

What investigations could you do with a patient with HTN?

A

Electrolytes and serum creatinine (to calculate eGFR)

Fasting glucose

Urinalysis

Lipid profile

ECG maybe, or TTE/TOE for LVH

27
Q

Should we immediately do investigations for secondary causes of HTN? Why?

A

No

Because they are quite rare, the tests can result in false positives

CC: CVS and Blood vessels (9 decks)

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