Hypertension

Question 1

At what number is someone considered hypertensive?

Answer 1

140/90 (135/85) mmHg (stage 1- mild

Question 2

What is accelerated hypertension?

Answer 2

Significant rise over short period of time and can cause damage to body

Question 3

What is the difference between secondary and primary hypertension?

Answer 3

Primary- essential - no known cause/multi factorial? May be genetic factors/ environmental

Secondary- as a result of something else- treat primary cause

Question 4

Give some examples of diseases that cause secondary hypertension?

Answer 4

Renovascular disease
Chronic renal disease
Hyperaldosteronism
Cushing’ syndrome

Question 5

How does renovascular disease cause secondary hypertension?

Answer 5

Occlusion of renal artery causes a fall in perfusion pressure in kidney

Decreased perfusion leads to increased renin production

Activation of RAAS

Vasoconstriction and Na+ retention at kidneys

Question 6

How can renal parenchymal disease cause secondary hypertension? (Chronic kidney disease)

Answer 6

Earlier stage may be loss of vasodilator substances

In later stage Na+ and water retention due to inadequate glomerular filtration

Increasing plasma volume-often called volume-dependent hypertension.

(Can cause small kidneys)

Question 7

How can adrenal issues cause secondary hypertension?

Answer 7

Conn’s syndrome- aldosterone secreting adenoma

Cushing’ syndrome- excess secretion of glucocorticoid cortisol (at high conc this will work on aldosterone receptors)

Tumour of the adrenal medulla- phaeochromocytoma- secretes catecholamines - noradrenaline and adrenaline (can produce dopamine as well)

Question 8

List some disease that are attributable to hypertension

Answer 8

Coronary heart disease 
Heart failure 
Stroke
Cerebral haemorrhage 
Chondrocytes kidney failure
Retinopathy 
Aortic aneurysm
L. V. Hypertrophy 
MI

Question 9

What are the possible methods for treating hypertension without drugs?

Answer 9

Exercise
Diet
Reduced Na+ intake
Reduced alcohol intake

*failure to implement lifestyle changes could limit the effectiveness of anti hypertensive therapy

Question 10

What treatments are there for treating hypertension that target the RAA system?

Answer 10

ACE inhibitors (prevent production of Ang I from AngII )

Ang II receptor antagonist ( resists the powerful vasoconstriction, and release of aldosterone caused by Ang II)-this has a diuretic and vasodilator effects

Question 11

What treatments are there for treating hypertension that target vasodilators?

Answer 11

L-type Ca channel blockers (reduce Ca entry to vascular smooth muscle cells, causes vascular smooth muscle contraction) lowers TPR

Could potentially use a1 receptor blockers to reduce sympathetic tone but this can cause postural hypotension

Question 12

What treatments are there for treating hypertension that cause water loss?

Answer 12

Diuretics!

Thaizide diuretics (acts on aldosterone to reduce circulation volume)- Inhibit Na/Cl co-transporter on apical membrane of cells in distal tubule

(Potential- aldosterone antagonists-spironolactone)

Question 13

What treatments are there for treating hypertension targeting the sympathetic NS ?

Answer 13

Beta blockers

Block B1 receptors in the heart and reduce the effect of sympathetic output- reduce heart rate and contractility - lowers CO

Can also be given for angina