Hypertension

• Fill in the gaps

  A) Angiotensinogen

  B) Renin

  C) Angio I

  D) ACE

  E) Angio II

  F) AT1

  G) Aldosterone

  H) Na+ reabsorption

  I) ECF volume

  
• What is 'low renin HTN'?

  Retain high Na+ -> more water reabsorption -> increased blood volume and BP

  High Na+ = increased vasoconstriction -> increased TPR and BP
• How can diabetes lead to HTN?

  High glucose/insulin = endothelial damage and oxidative stress
• Why may GFR decrease HTN?

  HTN = constriction of kidney vessels -> decrease blood flow, ischemia -> glomerulosclerosis -> further decrease BF = decrease GFR
• What are the two methods of measuring BP?

  Manual

  Automatic
• What can a difference in BP between arms indicate a hhigher risk of?

  Heart/stroke risks
• What could a difference in BP in each arm of over >10mmHg suggest?

  Aortic or subclavian artery disease
• Why may BP be different in each arm in a young person?

  Muscle compressing structure -> blocking arterial flow
• What conditions may cause BP to be different in each arm, in an elderly patient?

  Atherosclerosis

  Peripheral arterial disease

  Heart defects

  Cognitive decline

  Kidney disease

  Aortic dissection
• NHS health checks

  Who is it offered to?

  What is done?

  How often is it done?

  Who: 40-74 year olds

  What: Check for vascular/circulatory health, work out risk of developing CHD, DM, CKD, stroke

  How often: Every 5 years
• What organ systems can be involved in secondary HTN?

  Renal

  Endocrine

  Parathyroid

  Respiratory
• What are some renal causes of secondary HTN?

  Renal artery stenosis

  CKD
• How could renal artery stenosis/ CKD lead to secondary HTN?

  Decrease RBF -> triggers RAAS -> increase BP
• WHat are some adrenal causes of secondary HTN?

  Pheochromocytoma

  Cushing's disease

  Primary hyperaldosteronism
• What are some thyroid causes of secondary HTN?

  Hyper/hypothyroidism
• What are some complications of long term uncontrolled HTN?

  Stroke

  LV hypertrophy

  CHD

  Angina

  MI

  Arrythmias

  Aortic dissection

  Aneurism

  Atherome

  Hypertensive retinopathy
• How can HTN lead to a stroke?

  HTN can damage vessels -> narrowing/leak/rupture

  Increase risk of clot in artery -> block blood flow = stroke
• How can HTN lead to Left Ventricular Hypertrophy?

  High systemic BP/afterload -> LV overworks to push blood into the aorta -> LV increases mass to compensate
• Why can Coronary Heart Disease occur due to HTN?

  Damage to the blood vessels supplying the heart -> atherosclerosis and reduced blood flow to the heart muscle
• What is the most important RF for Aortic Dissection?

  Hypertension
• What are 3 vascular complications of uncontrolled HTN?

  Peripheral artery disease

  Aneurysm

  Atheroma
• Why can Peripheral Arterial Disease occour due to HTN?

  Atherosclerosis due to HTN can narrow arteries in limbs = pain and swelling
• What problem could uncontrolled HTN have on the eyes?

  Hypertensive retinopathy
• What is arteriovenous nicking?

  Arterioles compress veins due to sclerosis/hardening of artery
• What is phentolamine used for?

  HTN
• What is the MOA of phentolamine?

  Blocks alpha adrinergic receptors -> muscle relaxation and vasodilation = decreased BP
• What are 6 side effects of phentolamine?


  Dizzy

  N&V

  Change in HR

  Weakness

  Diarrhoea

  Headache
• What are some severe complications of phentolamine?

  Stroke

  Heart attack

  Severe chest pain

  Loss of consciousness (due to low BP)
• What key processes are involved in short term regulation of BP?

  Sympathetic nervous system

  Fight or flight response

  Catecholamine synthesis
• What key process is involved with long term regulation of BP?

  Kidney - RAAS, erythropoeitin
• What is stage 1 HTN?

  >140/90
• What is stage 2 HTN?


  >160/100
• What is stage 3 HTN?

  >180 systolic or >120 diastolic
• What is isolated systolic HTN?

  >160 systolic
• What is accelerated HTN?

  >180/120
• What is essential hypertension?

  No identifiable cause - often related to lifestyle factors
• What is secondary hypertension?

  Caused by underlying medical conditions e.g. kidney disease
• How can renal artery stenosis cause hypertension?

  Dec blood flow to kidneys = RAAS activation
• What is pheochromocytoma and how can it cause hypertension?

  Adrenal tumour -> produces excessive amount of adrenaline
• How can coarctation of the aorta cause hypertension?

  Narrowing of aorta -> inc resistance to blood flow -> heart works harder to pump blood