Hypertension

Question 1

What is abnormal blood pressure?

Answer 1

140/90

Question 2

How does blood pressure change with age?

Answer 2

It increases but over a certain age, diastolic beings to fall, leading to a greater difference between systolic and diastolic

Question 3

What is the relationship between stroke and blood pressure?

Answer 3

Exponential - most people have stroke when blood pressure is controlled though

Question 4

How is hypertension classified?

Answer 4

primary - unknown cause (90-95%)

secondary - known cause

Question 5

What are some causes of hypertension?

Answer 5

• renal disease
• Conn’s syndrome
• tumours making catecholamines
• contraceptive (oral)
• pre-eclampsia
• genetic

Question 6

What are the environmental contributors to primary hypertension?

Answer 6

• salt
• alcohol
• obesity
• pregnancy
• pre-natal environment
• lack of exercise

Question 7

What are the genetic contributors to hypertension?

Answer 7

monogenic:

• Liddle’s syndrome (mutation in epithelial Na channel)
• Apparent mineralocorticoid excess (mutation in 11 beta hydroxysteroid dehydrogenase)

polygenic

Question 8

What are the haemodynamic consequences of hypertension?

Answer 8

• higher TPR
• reduced arterial compliance
• normal CO
• normal blood volume

Question 9

What causes the total peripheral resistance to increase in hypertension?

Answer 9

• Vasoconstriction
• structural narrowing of arteries
• loss of capillaries - rarefraction

Question 10

What is isolated systolic hypertension?

Answer 10

SBP> 140, DBP<90

Occurs in over 60 because they have stiff medium and large arteries. Pulse wave reflects and is high

Question 11

What are the risks associated with hypertension?

Answer 11

• Stroke
• coronary heart disease
• heart failure
• retinopathy
• dementia
• atrial fibrillation
• vascular disease

Question 12

What could cause primary hypertension?

Answer 12

• kidney
• sympathetic nervous system
• endocrine/paracrine

Question 13

What structural heart changes can hypertension result in?

Answer 13

• hypertrophy of ventricle wall

- remodeling of ventricular volume

Question 14

How does hypertension affect the risk of congestive heart failure?

Answer 14

• causes 25% of cases
• increases risk x2/3
• hypertension usually precedes heart failure

Question 15

How may hypertension affect large arteries?

Answer 15

can cause:

• hypertrophy
• atherosclerosis
• thrombosis
• hemorrhage
• aneurysm

Question 16

What are Charcot-Bouchard aneurysms?

Answer 16

Aneurysms in the brain in small vessel, associated with chronic hypertension and common cause of cerebral hemorrhage

Question 17

What can hypertension do to the retina?

Answer 17

• arteriolar narrowing
• AV nicking
• thickening of wall of small arteries
• increased exudates
• vasospasm
• hemorrhages
• impaired perfusion

Question 18

How does hypertension affect capillaries?

Answer 18

• reduced capillary density (high PR and affects perfusion)

- high pressure in capillary (damage/leaks)

Question 19

How can hypertension damage the kidneys?

Answer 19

• Can cause microalbuminuria and macroalbuminuria

- lead to nephron loss and decline in functioning

Question 20

What is microalbuminuria a sign of?

Answer 20

Microalbuminuria is a sign of a damaged glomerulus, so glomerular filtration rate declines (indicate kidney damage)