Hypertension

Question 1

What is hypertension?

Answer 1

Sustained increase in blood pressure

Question 2

What are the stages of hypertension?

Answer 2

Stage 1
Stage 2
Severe

Question 3

What is stage 1 hypertension?

Answer 3

Blood pressure of 140/90mmHg or above

Question 4

What is stage 2 hypertension?

Answer 4

Blood pressure of 160/100mmHg or above

Question 5

What is severe hypertension?

Answer 5

Blood pressure of 180/110mmHg or above

Question 6

How does blood pressure measured at home differ to blood pressure measured in clinic?

Answer 6

Slightly lower at home

Question 7

What are the types of hypertension?

Answer 7

Primary hypertension

Secondary hypertension

Question 8

Which type of hypertension is more common - primary or secondary?

Answer 8

Primary by far

Question 9

What is another term for primary hypertension?

Answer 9

Essential hypertension

Question 10

What is the difference between primary and secondary hypertension?

Answer 10

Primary - unknown cause

Secondary - cause can be defined

Question 11

What factors contribute to primary hypertension?

Answer 11

Genetic factors - hypertension runs in families

Environmental factors

Question 12

What are some of the causes of secondary hypertension?

Answer 12

Renovascular disease

Chronic kidney disease

Hyperaldosteronism

Cushing’s syndrome

Question 13

How does renovascular disease lead to secondary hypertension?

Answer 13

Renal artery stenosis
fall in perfusion pressure of kidney
release of renin

Question 14

How does the release of renin lead to secondary hypertension?

Answer 14

Activation of RAAS
increases blood volume, TPR
and hence blood pressure

Question 15

How does renal parenchymal disease lead to secondary hypertension?

Answer 15

Early stage - loss of local vasodilators

Late stage - inadequate filtration, more Na+ and water retention

Question 16

How does loss of local vasodilators lead to secondary hypertension?

Answer 16

Vasoconstriction of afferent arteriole
Decreased GFR
Increased Na+ retention, water reabsorption
Increased blood volume, blood pressure

Question 17

What are the adrenal causes of secondary hypertension?

Answer 17

Conn’s syndrome

Cushing’s syndrome

Phaeochromocytoma

Question 18

How does Conn’s syndrome lead to secondary hypertension?

Answer 18

Adrenal adenoma

secretes aldosterone - hyperaldosteronism

Question 19

How does hyperaldosteronism lead to secondary hypertension?

Answer 19

Increased retention of Na+, water

Increased blood volume, blood pressure

Question 20

What else does Conn’s syndrome lead to? How?

Answer 20

Hypokalaemia

Aldosterone gives activation of apical K+ channel
K+ diffuses out, loss of K+

Question 21

How does Cushing’s syndrome lead to secondary hypertension?

Answer 21

Excess secretion of cortisol

binds to aldosterone receptors at high concs.

Question 22

How does phaeochromocytoma lead to secondary hypertension?

Answer 22

Secretes catecholamines - adrenaline and noradrenaline

Increased sympathetic activity

Question 23

What does hypertension lead to damage of?

Answer 23

Heart

Vasculature

Question 24

What are some of the complications of hypertension?

Answer 24

LV hypertrophy
MI
Heart failure

Aortic aneurysm
Coronary artery disease

Stroke

Retinopathy

Chronic kidney failure

Question 25

How does hypertension lead to LV hypertrophy?

Answer 25

Increased pressure in arteries, afterload LV has to contract harder, generate more pressure In order to push blood into arteries

Question 26

What can LV hypertrophy lead to? How?

Answer 26

Heart failure - diastolic Reduced filling of left ventricle Reduced EDV, SV, CO

Question 27

How does hypertension lead to myocardial ischaemia, infarction?

Answer 27

Increased pressure in arteries, afterload Heart has to contract harder, generate higher pressures To push blood into arteries Requires more oxygen Making it more susceptible to ischaemia, infarction

Question 28

How does hypertension lead to retinopathy, aneurysm, stroke, renal failure?

Answer 28

Arteries become damaged Are weakened More prone to atherosclerosis

Question 29

Why are arteries more prone to atherosclerosis with hypertension?

Answer 29

High pressure damages arterial walls Get inflammatory response Deposition of fat, calcium

Question 30

How is secondary hypertension treated?

Answer 30

Treat primary cause

Question 31

What are the two approaches to treating primary hypertension?

Answer 31

Non-pharmacological Pharmacological

Question 32

What does the non-pharmacological approach of treating primary hypertension involve?

Answer 32

Improving diet - reduce Na+, alcohol intake | Increasing exercise

Question 33

What is a disadvantage of non-pharmacological approaches to treating primary hypertension?

Answer 33

Limited effect

Question 34

What are the groups of drugs used to treat primary hypertension?

Answer 34

RAAS blockers Vasodilators Calcium ion channel blockers Beta blockers

Question 35

What are some examples of RAAS blockers?

Answer 35

ACE inhibitors Angiotensin 2 receptor antagonists

Question 36

How do ACE inhibitors work?

Answer 36

Prevent ACE converting angiotensin 1 into angiotensin 2 Prevent breakdown of bradykinin

Question 37

What are the effects of ACE inhibitors?

Answer 37

Vasodilation by bradykinin Reduced sodium, water reabsoprtion Reduced release of aldosterone from adrenal cortex

Question 38

What is an example of an ACE inhibitor?

Answer 38

Captopril

Question 39

What are the effects of angiotensin 2 receptor antagonists?

Answer 39

Reduced vasoconstriction Reduced sodium, water retention Reduced aldosterone release from adrenal cortex

Question 40

What are some examples of vasodilators?

Answer 40

Calcium ion channel blockers A1 receptor blockers

Question 41

How do calcium ion channel blockers cause vasodilation?

Answer 41

Prevent calcium ion entry into smooth muscle cells | Reduced smooth muscle cell contraction

Question 42

How do angiotensin 2 receptors antagonists work?

Answer 42

Prevent angiotensin 2 binding to its receptor

Question 43

How do A1 adrenoceptor antagonists cause vasodilation?

Answer 43

Prevent noradrenaline binding to A1 adrenoceptors on vascular smooth muscle cells and causing vasoconstriction

Question 44

What is a side effect of A1 adrenoceptor antagonists? Why?

Answer 44

Postural hypotension | block baroreceptor reflex from causing vasoconstriction

Question 45

What causes postural hypotension?

Answer 45

Standing up Gravity draws blood down to blood vessels in legs Reduced venous return, filling, SV, CO, maBP

Question 46

What responds to postural hypotension? How?

Answer 46

Baroreceptor reflex Increased sympathetic output Increases heart rate, force of contraction, SV, CO Peripheral vasoconstriction, increases TPR Increasing maBP

Question 47

What are some examples of diuretics?

Answer 47

Thiazide Aldosterone antagonists

Question 48

How do thiazide diuretics work?

Answer 48

Inhibit Na+ Cl- co-transporter on apical domain of cells | in distal tubule

Question 49

What is the effect of thiazide diuretics?

Answer 49

Reduced sodium and water retention | reduced blood volume, blood pressure

Question 50

What is an example of an aldosterone antagonist?

Answer 50

Spironolactone

Question 51

How do beta blockers work?

Answer 51

Block B1 adrenoceptors in heart | Reduce heart rate, force of contraction

Question 52

Are beta blockers commonly used to treat hypertension?

Answer 52

No

Question 53

When would beta blockers be used to treat hypertension?

Answer 53

Hypertension with a previous MI