Facts on hypertension
- World’s number 1 cause of preventable and premature mortality and morbidity - A 2mmHg rise in BP causes a 7% increase of mortality from IHD and a 10% increased risk of mortality from stroke
What does hypertension greatly contribute to?
End organ damage
What conditions can be easily developed due to hypertension?
- IHD - Retinopathy - Peripheral vascular disease - Stroke - CHD - Heart failure - Renal failure - Proteinuria
How many times greater is your risk of stroke if you are hypertensive compared to normal blood pressure?
4-6 times greater
What ways can blood pressure vary throughout the day?
- Physical stress - Mental stress
What is the definition of clinical hypertension?
The blood pressure at which the benefits of treatment outweigh the risks in terms of morbidity and mortality
Describe what is shown here
Shows blood pressure distribution between different cultures
- Group 1 = island dwellers in the pacific where BP is lower
- Group 5 shows western european BP
- Notice all follow an equal distribution within their populations
How does age affect hypertension?
As age increases BP increases
What is the correlation between high BP and risk of stroke and CHD?
As BP increases the chances of developing these increases
Which age decade has the biggest increase in IHD mortality compared to average blood pressure at the beginning of that decade?
40 - 49 years
What is stage 1 hypertension?
- Clinical blood pressure > 140/90mmHg
- ABPM (ambulatory blood pressure monitoring) average of >135/85
What is stage 2 hypertension?
- BP > 160/100mmHg
- ABPM average > 150/95mmHg
What is severe hypertension?
- Systolic > 180
- Diastolic > 110
What other factors also increase the risk of hypertension?
- Smoking
- Diabetes
- Renal disease
- Being a bloke
- Hyperlipidaemia
- Previous history of MI or stroke
- Left ventricular hypertrophy (PHT)
What three ways is the renin-angiotensin-aldosterone system activated?
- Fall in BP
- Fall in circulating volume
- Lack of sodium in blood
What can angiotensin II also cause (instead of the release of aldosterone from the adrenal glands)?
Myocyte hypertrophy
What are the polygenic aetiologies of hypertension?
- Major genes (very rare)
- Poly genes
What is meant that hypertension is polyfactorial?
- Can be influenced by multiple environmental factors
- Can be individual or shared (people sharing the same diet etc may be both hypertensive)
What are example of individual hypertension aetiologies?
- Oral contraceptives
- Physical inactivity
- Stress
- Lower education
- Small family size
What are the most likely causes (endogenous) of hypertension?
- Increased reactivity of resistance vessels increase TPR
- Sodium homeostatic effect (kidneys unable to excrete appropriate sodium levels so sodium and fluid retained and BP increases
How should hypertension in the elderly be treated?
- Aggressively
- They have more to lose
- MUST REMAIN PRAGMATIC
Is hypertension hereditary?
- Yes
- Tends to run in the family (or in a hypertensive family no one runs haha haaaaaa)
- Closest correlation between siblings rather than parent to child
What special type of siblings very commonly both have hypertension or both don’t
- Monozygotic twins
- Dizygotic do show a correlation though not as strong
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Function of the CVS30
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Electrical Properties of the Heart44
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ECG 133
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The Cardiac Cycle33
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Embryology of the CVS - NOT COMPLETE36
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Regulation of SV and HR37
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Exchange and the Lymphatic System41
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Regulation of Arteriolar Resistance38
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Pressure and Flow in Arteries and Veins26
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Short Term Control of BP28
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Long Term Control of BP30
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Hypertension39
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Hypertension Therapy57
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Pathophysiology of Atheroma54
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SIHD and Angina61
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Pathophysiology of Thrombosis and Embolism45
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Pathophysiology of Ischaemia and Infarction35
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Valvular Heart Disease - INCOMPLETE30
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ACS and AMI23
