Hypertension

Question 1

Recall the stages of hypertension as well as their corresponding systolic parameters

Answer 1

1. Grade 1 - 140-159
2. Grade 2 - 160-179
3. Grade 3 - >180

Question 2

What is the main risk of Grade 3 hypertension?

Answer 2

Risk of precipitating malignant hypertension

Question 3

What blood pressure parameters are characteristic of hypertensive urgency?

Answer 3

Systolic BP > 180 or diastolic BP > 110

Question 4

Suggest 4 clinical symptoms that can be associated with hypertensive urgency

Answer 4

1. Epistaxis
2. Headache
3. SOB
4. Severe anxiety

Question 5

What is the difference between hypertensive urgency and a hypertensive emergency?

Answer 5

There is no end organ damage in hypertensive urgency

Question 6

Suggest 6 symptoms that can be associated with malignant hypertension

Answer 6

1. Chest pain
2. SOB
3. Back pain
4. Numbness/weakness
5. Visual changes
6. Difficulty speaking

Question 7

What is the pathophysiology of encephalopathy in malignant hypertension?

Answer 7

Elevate cerebral BP leads to cerebral oedema and in turn raised ICP

Question 8

What is the ‘QRISK’ calculator used for?

Answer 8

To estimate a patient’s 10 year risk of developing cardiovascular disease

Question 9

Recall the equation used for calculating cardiac output

Answer 9

CO = HR * SV

Question 10

Recall the equation that relates cardiac output and BP

Answer 10

BP = CO * PR

Question 11

Where in the body is angiotensinogen synthesised?

Answer 11

Liver

Question 12

What are the 2 main biochemical consequences of the release of Renin by the kidneys in response to a reduction in blood flow?

Answer 12

1. Conversion of angiotensinogen into angiotensin I

2. Induces secretion of aldosterone

Question 13

What are principle biochemical effects of aldosterone release?

Answer 13

Increased sodium and water reabsorption

Question 14

Outline the 3 main components of the body’s short term response to changes in blood pressure

Answer 14

1. Central nervous system response
2. Baroreceptors
3. Chemoreceptors

Question 15

From which sections of the spine to sympathetic vasomotor nerve fibres leave the spinal cord?

Answer 15

Thoracic and lumber spine

Question 16

Which vasomotor nerve fibres originate from the vasoconstrictor area?

Answer 16

Excitatory preganglionic vasoconstrictor neurons

Question 17

What is the function of the vasodilatory area of the brainstem?

Answer 17

Internal inhibition of the vasoconstrictor area

Question 18

The sensory component of the vasomotor area of the brainstem is supplied by which 2 cranial nerves?

Answer 18

1. Vagus

2. Glossopharyngeal

Question 19

Name 4 brain structures that influence the vasomotor centre

Answer 19

1. Reticular substance
2. Hypothalamus
3. Cerebral cortex
4. Cingulate gyrus

Question 20

Define myogenic tone

Answer 20

State of muscle tone from the muscle itself i.e. not mediated by the autonomic nervous system or a reaction to a hormonal process

Question 21

Compare the effects of activation of beta adrenoreceptors in the heart and in the peripheral vasculature respectively

Answer 21

1. Heart - increased contractility

2. Peripheral vasculature - reduced contractility

Question 22

Why is dobutamine used in the treatment of heart failure patients?

Answer 22

Preferential beta1-adrenoreceptor agonist, thereby increasing cardiac contractility more effectively than pan adrenoreceptor agonists such as adrenaline

Question 23

Describe the conduction pathway between the carotid baroreceptors and the brainstem

Answer 23

Hering’s nerve –> Glossopharyngeal nerve –> Tractus solitarius in the brainstem

Question 24

What is the consequence of arterial baroreceptors detecting an abnormal increase in blood pressure?

Answer 24

Stimulation of the tracts solitarius leads to inhibition of the vasoconstrictor centre and excitation of the vagal parasympathetic centre

Question 25

What happens in the atrial volume reflex?

Answer 25

1. Atrial stretching due to increased systemic BP leads to reflex dilation of renal afferent arterioles, thus increasing glomerular capillary pressure and increasing the rate of fluid filtration into the renal tubule. 2. Also leads to reduced secretion of ADH from the hypothalamus

Question 26

What are the 2 components of long term control of BP

Answer 26

1. Renin-aldosterone-angiotensin system | 2. Vascular remodelling and contractility

Question 27

Name the 3 cellular components of the juxtaglomerular apparatus

Answer 27

1. Macula densa 2. Juxtaglomerular cells 3. Extraglomerular mesangial cells

Question 28

Which cell type allows connection between the glomerular arterioles and the distal convoluted tubule?

Answer 28

The extraglomerular mesangial cells as part of the juxtaglomerular apparatus

Question 29

What are the 5 main actions of angiotensin II

Answer 29

1. Increased sympathetic activity 2. Increased reabsorption of Na and water + increased excretion of K 3. Stimulates the release of aldosterone from the adrenal cortex 4. Arteriolar vasoconstriction 5. Increased secretion of ADH from the posterior pituitary

Question 30

Name the 3 sections of the renal tubule that aldosterone acts on to increase absorption of Na +and excretion of K + and H +

Answer 30

1. Principle cells of the collecting tubules 2. Distal tubules 3. Collecting ducts

Question 31

Which biochemical imbalance is associated with primary hyperaldosteronism?

Answer 31

Hypokalaemic Alkalosis

Question 32

Outline the 2 main causes of primary hyperaldosteronism

Answer 32

1. Unilateral aldosterone producing adenoma | 2. Bilateral adrenal hyperplasia

Question 33

What is synacthen?

Answer 33

Synthetic ACTH used in the diagnosis of Addison's disease

Question 34

What is the systemic effects of adiponectin released by adipose tissue? (3)

Answer 34

1. Glucose regulation 2. Fatty acid breakdown 3. Dilation of small arteries

Question 35

Name 3 renal diseases that can cause secondary hypertension

Answer 35

1. Polycystic kidney disease 2. Glomerular disease 3. Renovascular disease

Question 36

Name 3 adrenal conditions that can cause secondary hypertension

Answer 36

1. Cushing's syndrome 2. Primary aldosteronism 3. Phaeochromocytoma

Question 37

Name 5 drug types that can cause secondary hypertension

Answer 37

1. Oral contraceptives 2. NSAIDS 3. Stimulants (cocaine, methylphenidate) 4. Calcineurin inhibitors 5. Antidepressants