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Cardiovascular system SA > Hypertension – pathophysiology, presentation and investigation > Flashcards

Hypertension – pathophysiology, presentation and investigation Flashcards

1
Q

What is the definition of hypertension

A

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

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2
Q

Sustained hypertension is a contributing risk factor to

A

end-organ damage to blood vessels, heart and kidney

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3
Q

Increasing blood pressure is associated with a progressive exponentially increase in the risk of

A

Stroke

Heart disease

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4
Q

As well as increasing high blood pressure what also increases the risk of stroke and heart disease

A

Increasing age

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5
Q

What is normal blood pressure

A

systolic pressure of 120–129 mmHg or a diastolic pressure of 80–84 mmHg

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6
Q

What is stage 1 hypertension according to NICE

A

Clinic blood pressure is 140/90 mmHg or higher

ABPM daytime average 135/85 mmHg or higher.

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7
Q

What is stage 2 hypertension according to NICE

A

Clinic blood pressure is 160/100 mmHg or higher

ABPM daytime average 150/95 mmHg or higher.

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8
Q

What is severe hypertension according to NICE

A

Clinic systolic blood pressure is 180 mmHg or higher or diastolic blood pressure is 110 mmHg or higher.

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9
Q

What is Ambulatory Blood Pressure Monitoring (ABPM)

A

when your blood pressure is measured as you move around, living your normal daily life. It is measured for up to 24 hours

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10
Q

How is ABPM more efficient

A

Gives a more realistic blood pressure, as measured throughout the day rather than one reading

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11
Q

What is the two aetiologies of hypertension

A

Primary hypertension - no unknown cause

Secondary hypertension - underlying cause

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12
Q

What is the proportion of primary hypertension and secondary hypertension

A 
Primary = 90%
Secondary = 5-10%
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13
Q

What is the aetiologies of secondary hypertension

A 
Renal disease 
Drug induced 
pregnancy 
endocrine diseases 
Vascular diseases
sleep apnoea
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14
Q

What increases the risk of hypertension development

A 
Cigarette smoking		Adds 20/10 mmHg
Diabetes mellitus		5-30 X increase MI
Renal disease
Male				2X risk
Hyperlipidaemia		
Previous MI or stroke	
Left ventricular hypertrophy	2X risk
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15
Q

What are the prime contributors to blood pressure than can be manipulated by drug therapy

A

Cardiac output
-Stroke volume
-Heart rate
Peripheral vascular resistance

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16
Q

What controls blood pressure

A

An integrates system ( SNS + RAAS)

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17
Q

What system is needed in log term control of BP

A

Renin angiotensin aldosterone system

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18
Q

What is RAAS responsible for

A

maintenance of sodium balance
therefore controlling blood volume
which in turn controls blood pressure

19
Q

What is RAAS stimulated by

A

fall in BP
fall in circulating volume
sodium depletion

20
Q

what is the result of stimulated RAAS

A

Renin released from juxtaglomerular apparatus
Renin converts angiotensinogen to angiotensin I
Angiotensin I is converted to angiotensin II by angiotensin converting enzyme (ACE)

21
Q

What is the function of angiotensin II

A

vasoconstrictor
anti-natriuretic peptide
stimulator of aldosterone release from the adrenal glands

22
Q

What does it means that angiotensin is a potent hypertrophic agent

A

stimulates myocyte and smooth muscle hypertrophy in the arterioles

23
Q

What is the negative outcomes of angiotensin II being a potent hypertrophic agent

A

Arteries become narrower and cant dilate,
Unable to repsond to appropriate dilation
therefore more likely to split and become damaged

24
Q

What controls short term effect of blood pressure

A

Sympathetic NS

25
Q

What is the outcome to activation of the Sympathetic NS

A

vasoconstriction
reflex tachycardia
increased cardiac output

26
Q

What is the problem with the Sympathetic NS

A

can be prolonged to long and result in hypertension

27
Q

What is the pathologies of hypertension

A

Increased reactivity of resistance vessels and resultant increase in peripheral resistance (

A sodium homeostatic effect - Na cant be excreted, blood volume rises therefore BP increases

28
Q

What is the major polygenic and poly factorial factors in hypertension

A 
Age
Genetics and family history
Environment
Weight
Alcohol intake
Race
29
Q

Why does blood pressure increase with age

A

due to decreased arteriole compliance

30
Q

How does genetics affect hypertension

A

Hypertension runs in the family

Families live together under the same environment therefore are at the same risk

31
Q

What is the affect of reducing sodium intake in hypersensitive individuals

A

Reduces blood pressure

32
Q

What is the recommended maximum salt intake a day

A

< 6mg

33
Q

What is the affect of high and low alcohol intake on blood pressure

A

High -Increases BP

Low - Decrease BP

34
Q

How does obesity increase blood pressure

A

Obesity activated sympathetic nervous system
Obesity linked to sleep apnoea which increase BP
Obesity is also linked to IL6 which links to hypertension

35
Q

What is the most important non-pharmacological measure available

A

Weight reduction

36
Q

How is birth weight and hypertension linked

A

The lower the birth weight the higher the likelyhood of developing hypertension

37
Q

What is the possible reason for black populations to have a higher BP than caucasians

A

Black populations are genetically selected to be salt retainers and so are more sensitive to an increase in dietary salt intake or the environment

38
Q

In secondary hypertension what is the affect on hypertension if cause is removed

A

There is no guarantee that BP will return to normal

39
Q

What are examples of the renal diseases causing secondary hypertension

A

RENAL ARTERY STENOSIS

Further examples:
chronic pyelonephritis
- (destruction of renal tissue)

fibromuscular dysplasia
- (non-inflammatory disease of the blood vessels that causes abnormal growth within the wall of an artery)

polycystic kidneys
(abnormal cysts develop and grow in the kidneys)

40
Q

What is examples of drug induced secondary hypertension

A

NSAIDs
Oral contraceptive
Corticosteroids

41
Q

What is the name of the condition in pregnancy associate with high blood pressure

A

pre-eclampsia

42
Q

What is example of endocrine conditions resulting in secondary hypertension

A

Conn’s Syndrome
(excess production of the hormone aldosterone by the adrenal glands resulting in low renin levels)

Cushings disease
(tumour in the pituitary gland - vasoconstriction)

Phaeochromocytoma
(tumor of adrenal gland tissue - release to much epinephrine)

Hypo and hyperthyroidism
(over/under production of thyroid hormone = increase BP)

Acromegaly
(abnormal growth of the hands, feet, and face, caused by overproduction of growth hormone by the pituitary gland)

43
Q

What vascular condition can result in secondary hypertension

A

Coarctation of the aorta

44
Q

What respiratory condition can result in secondary hypertension

A

sleep apnoea

Cardiovascular system SA (43 decks)

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