Hypertension Pathophysiology, Presentation and Investigation Flashcards Preview

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1

What is hypertension?

The blood pressure above which the benefits of treatment outweigh the risks in terms of morbidity and mortality

2

According to NICE 2011 definitions, what is stage 1 hypertension?

Clinical BP of 140/90mmHg or higher
ABPM daytime average of 135/85mmHg or higher

3

According to NICE 2011 definitions, what is stage 2 hypertension?

Clinical BP of 160/100mmHg or higher
ABPM daytime average 150/95mmHg or higher

4

According to NICE 2011 definitions, what is severe hypertension?

Clinical systolic BP of 180mmHg or higher, or diastolic BP of 110mmHg or higher

5

In 95% of cases of hypertension, no cause can be found, what are these cases known as?

Primary hypertension

6

The 5-10% of cases of hypertension for which a cause can be found are known as what?

Secondary hypertension

7

What percentage of cases of hypertension are primary and what percentage are secondary?

95% primary
5-10% secondary

8

Does removal of the cause of secondary hypertension cure the hypertension?

No - removal of cause does not guarantee that the hypertension or associated risk will return to normal

9

What percentage of resistant hypertension is renal disease responsible for?

20%

10

What are some renal diseases that cause hypertension?

Chronic pyelonephritis
Fibromuscular dysplasia
Renal artery stenosis
Polycystic kidneys

11

What are some causes of drug-induced hypertension?

NSAIDs
OCP
Corticosteroids

12

What condition in pregnancy can cause hypertension?

Pre-eclampsia

13

What are some endocrine causes of hypertension?

Cushing's disease
Conn's syndrome
Phaeochromocytoma
Hypothyroidism
Hyperthyroidism
Acromegaly

14

What is a vascular cause of hypertension?

Coarctation on the aorta

15

Hypertension is the world's number one cause of preventable mortality and morbidity, and the UK's number one cause of premature morbidity and mortality. What is the risk of heart disease and stroke mortality with hypertension?

For a 2mmHg rise in BP there is a 7% increased risk of mortality from heart disease and a 10% increased risk of mortality from stroke

16

What are some of the factors which increase the risk from hypertension?

Cigarette smoking
Diabetes mellitus
Renal disease
Male
Hyperlipidaemia
Previous MI or stroke
Left ventricular hypertrophy

17

What are some factors that affect the development of hypertension?

Age
Genetics
Family history
Environment
Weight
Alcohol intake
Race

18

How does BP change with age?

Tends to rise with age

19

How should hypertension be treated in the elderly?

As aggressively as possible - studies show benefit from treating both systolic and diastolic hypertension

20

Why are genetics/family history considered to be risk factors for hypertension?

Hypertension tends to run in families with the closest correlation between siblings
Genes have been recognised as important in development of hypertension
Possible that environmental factors common to all members of a family have a role in the development of hypertension

21

How do mental and physical stress affect BP?

Both increase BP

22

How do people with white coat hypertension tend to respond to treatment?

Tend to be highly resistant to treatment

23

What effect can reducing salt intake in hypertensive individuals have?

Lowers BP

24

What salt reduction is necessary to lower BP?

Reducing salt intake to < 6 grams per day or to 1.5 gram/day

25

What is one of the most common causes of hypertension in young people?

Alcohol

26

What effect does alcohol have on BP?

Small amounts tend to decrease it but large amounts tend to increase it

27

What is the average fall in BP with alcohol consumption reduction?

Around 5/3 mmHg

28

How does weight affect BP?

Increases with weight
Obese patients have higher BP

29

What percentage of hypertension is attributable to obesity?

30%

30

What is the association between weight loss and BP reduction?

In non-medically treated patients, weight loss of 9kg has been reported to produce fall in BP of 19/18mmHg
In medically treated patients a fall of 30/21 mmHg has been reported