Hypertension

Question 1

What is blood pressure?

Answer 1

Driving force for blood to flow

Systolic: upper value as ventricles contracting

Diastolic: lower value as ventricles are not contracting but filling (resting)

Question 2

How do you calculate mean arterial pressure?

Answer 2

Diastolic + 1/3 pulse pressure

Question 3

What is the standard ‘physiological’ blood pressure?

Answer 3

120/80 mmHg

Question 4

What is ‘prehypertensive’ blood pressure?

Answer 4

SBP: 120-139 mmHg

DBP: 80-89 mmHg

Question 5

Label the diagram

Answer 5

Question 6

How do you measure/regulate blood pressure?

Answer 6

BP = cardiac output x total peripheral resistance (TPR)

Use a sphgmomanometer (blood pressure machine) with auscultation (stethoscope)

Question 7

Define essential hypertension

Answer 7

High blood pressure that doesn’t have a known secondary cause.

It has significant cardiovascular risk

It includes:

• obesity
• insulin resistance?
• excessive alcohol consumption
• genetics
• environment
• fetal programming?
• salt sensitivity
• age
• ethnicity

Question 8

What is white coat hypertension?

Answer 8

Good evidence that stress of visiting GP can increase blood pressure leading to false diagnosis

Question 9

What is isolated systolic hypertension?

Answer 9

When systolic blood pressure is higher than 130 but your diastolic blood pressure is under 80

Linked with aging (older people)

Aorta becomes stiffer - less recoil

Question 10

How does hypertension develop?

Answer 10

Question 11

What are the causes of secondary hypertension?

Answer 11

Renal disease

Renovascular disease

Conn’s syndrome

Cushing’s syndrome

Hyperthyroidism

Phaeochromocytoma

Pregnancy

Drugs

Question 12

State the consequences of essential hypertension

Answer 12

Risk of CVD doubles for every 20/10mmHg increase from 115/75mmHg

Left ventricular hypertrophy

Increased risk of myocardial infarction

Increased risk of stroke

Development of renal impairment

Development of chronic heart failure

Question 13

Identify the goals of treatment for hypertension

Answer 13

A reduction in blood pressure and when this involves drug treatment, this should be with as few side effects as possible.

NICE treatment targets:

• SBP < 140mmHg (<130 mmHg in diabetes)
• DBP < 90mmHg (<80mmHg in diabetes).

Specific goals are:

• Reduction in cardiovascular damage.
• Preservation of renal function.
• Limitation or reversal of left ventricular hypertrophy.
• Prevention of IHD.
• Reduction in mortality due to stroke and MIs.