Definition of hypertension?
Disorder in which the level of sustained arterial pressure is higher than expected for the age, sex and race of the individual
What does WHO accept as a high level of blood pressure?
White coat hypertension?
High blood pressure at the Doctors office that returns to a normal level in other environments like home. Thought to be caused by stress of seeing doctor or could be indicative of future long term problems.
Unexpected changes in blood pressure
What does hypertension cause?
What is hypertension a risk for?
Atheroma Renal failure Cerebral haemorrhage Sudden cardiac failure
Brief epidemiology of Hypertension?
Varies between countries Higher in back population Lower in south pacific Familial tendency Rises with age
Classification of hypertension in respect to A) Aetiology B) Clinicopathology
A) Primary or secondary B) Benign or malignant
Equation for BP
Cardiac output x peripheral resistance
Factors to consider for cardiac output?
Heart Rate Contractility Blood volume
Factors to consider for peripheral resistance?
Constrictors (Angiotensin 2, catecholamines) Dilators (Nitric oxide, prostoglandins
Most common type of hypertension?
No obvious cause Due to genetic factors Salt intake Protein intake RAAS
What does an increase in dietary salt lead to?
Salt sensitive hypertension?
It is some cases of primary hypertension Controlled by reduced dietary salt In renal diseases secondary hypertension is usually salt sensitive
Underlying diseases with secondary hypertension?
Renal disease Endocrine Aortic Renal artery stenosis Drug therapy
Why renal diseases are associated with secondary hypertension?
Reduced renal blood flow Excess renin release Salt and water overload
Endocrine causes of secondary hypertension?
Adrenal gland hyperfunction Conn's syndrome- XS aldosterone Cushing's syndrome- XS corticosteroid Phaeochromocytoma- XS noradrenaline
Benign hypertension is not a cause of serious life threatening morbidity. True or False?
FALSE. Cause of serious life threatening morbidity
What does benign hypertension eventually cause?
Left ventricular hypertrophy Congestive cardiac failure Increases atheroma Increases aortic aneurysm rupture Renal disease Aortic dissection
Hypertension and the heart?
Left ventricular hypertrophy -Increased LV load -Poor perfusion -Interstitial fibrosis -Micro-infarcts -Diastolic dysfunction
Outcomes of left ventricular hypertrophy?
Sudden cardiac death
Hypersensitive heart picture
What doubles the risk of MI?
Every 10mmHg of diastolic pressure above 85mmHg
Every _mmHg of diastolic pressure above __ doubles risk of _____.
Serious life threatening condition- Rare
Diastolic pressure >130-140
Can develop from benign primary or secondary
Needs to be treated urgently
What does malignant hypertension cause?
Acute renal failure
Acute heart failure
Headache and cerebral haemorrhage
Blood vessels show fibrinoid necrosis and endarteritis proliferans of their walls
Hypertension is usually asymptomatic? True or False?