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Questions and Answers
What two measurements are included in blood pressure readings?
What two measurements are included in blood pressure readings?
What is the definition of hypertension based on diastolic and systolic measurements?
What is the definition of hypertension based on diastolic and systolic measurements?
How many readings are typically required to diagnose hypertension?
How many readings are typically required to diagnose hypertension?
What blood pressure reading is considered to be in the normal range?
What blood pressure reading is considered to be in the normal range?
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What is prehypertension characterized by?
What is prehypertension characterized by?
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What is the systolic pressure range for mild hypertension (stage 1)?
What is the systolic pressure range for mild hypertension (stage 1)?
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Which type of hypertension accounts for 90-95% of cases and has no identifiable cause?
Which type of hypertension accounts for 90-95% of cases and has no identifiable cause?
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Which factor is NOT associated with the pathogenesis of primary hypertension?
Which factor is NOT associated with the pathogenesis of primary hypertension?
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At what age does the prevalence of essential hypertension increase significantly in women?
At what age does the prevalence of essential hypertension increase significantly in women?
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What systolic pressure defines severe hypertension (stage 3)?
What systolic pressure defines severe hypertension (stage 3)?
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Which of the following is a risk factor for developing high blood pressure?
Which of the following is a risk factor for developing high blood pressure?
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What role does renin play in the development of hypertension?
What role does renin play in the development of hypertension?
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Which racial group is noted to develop high blood pressure at an earlier age?
Which racial group is noted to develop high blood pressure at an earlier age?
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How does an increase in body weight affect blood pressure?
How does an increase in body weight affect blood pressure?
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What effect does physical inactivity have on heart rate and blood pressure?
What effect does physical inactivity have on heart rate and blood pressure?
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What is a potential consequence of consuming too much salt in the diet?
What is a potential consequence of consuming too much salt in the diet?
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Which of the following factors is associated with secondary hypertension?
Which of the following factors is associated with secondary hypertension?
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Which dietary component is linked to the regulation of sodium in the body?
Which dietary component is linked to the regulation of sodium in the body?
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What chronic condition is notably linked to increased risk of hypertension?
What chronic condition is notably linked to increased risk of hypertension?
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How might high stress levels affect blood pressure?
How might high stress levels affect blood pressure?
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What effect does smoking tobacco have on blood pressure?
What effect does smoking tobacco have on blood pressure?
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Which type of hypertension is characterized by severely elevated blood pressure along with evidence of end organ damage?
Which type of hypertension is characterized by severely elevated blood pressure along with evidence of end organ damage?
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What risk factor for cardiovascular disease is most directly associated with hypertension?
What risk factor for cardiovascular disease is most directly associated with hypertension?
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Which of the following medications is NOT commonly associated with causing or aggravating high blood pressure?
Which of the following medications is NOT commonly associated with causing or aggravating high blood pressure?
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Which symptom is most commonly associated with hypertensive complications?
Which symptom is most commonly associated with hypertensive complications?
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What term describes hypertension that does not have any noticeable symptoms, often referred to as a 'silent killer'?
What term describes hypertension that does not have any noticeable symptoms, often referred to as a 'silent killer'?
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What is the minimum systolic blood pressure measurement that defines a hypertensive crisis?
What is the minimum systolic blood pressure measurement that defines a hypertensive crisis?
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Which of the following complications is specifically related to the eyes as a result of hypertension?
Which of the following complications is specifically related to the eyes as a result of hypertension?
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Which of the following is NOT a common cause of high blood pressure?
Which of the following is NOT a common cause of high blood pressure?
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What condition arises due to excessive cortisol release from the adrenal cortex?
What condition arises due to excessive cortisol release from the adrenal cortex?
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Which of the following is a result of a tumor in the adrenal medulla?
Which of the following is a result of a tumor in the adrenal medulla?
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How does aldosteronism primarily affect kidney function?
How does aldosteronism primarily affect kidney function?
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Which of the following conditions causes high blood pressure due to a narrow part of the aorta?
Which of the following conditions causes high blood pressure due to a narrow part of the aorta?
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What mechanism does sleep apnea use to potentially increase blood pressure?
What mechanism does sleep apnea use to potentially increase blood pressure?
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Which hormone's excess causes hyperparathyroidism to affect blood pressure?
Which hormone's excess causes hyperparathyroidism to affect blood pressure?
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What is a common consequence of chronic corticosteroid therapy?
What is a common consequence of chronic corticosteroid therapy?
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Which factor does NOT contribute to secondary hypertension?
Which factor does NOT contribute to secondary hypertension?
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Study Notes
Blood Pressure Basics
- Blood pressure (BP) is the force exerted by blood against the walls of blood vessels.
- It's measured as systolic (maximum pressure during a heartbeat) over diastolic (minimum pressure between heartbeats).
- Measured in millimeters of mercury (mm Hg), for example, 120/80 mm Hg.
Hypertension: Definition and Diagnosis
- Hypertension is persistent high BP.
- Diagnosed when diastolic pressure is consistently above 90 mmHg and systolic pressure is above 140 mmHg.
- At least three readings above these thresholds on different occasions are usually required for diagnosis.
Blood Pressure Categories
- Normal BP: Below 120/80 mm Hg
- Prehypertension: Systolic pressure ranging from 120 to 139 mm Hg OR diastolic pressure ranging from 80 to 89 mm Hg.
Grading Hypertension
- Mild (Stage 1): Systolic pressure is 140-159 mmHg and diastolic pressure is 90-99 mmHg.
- Moderate (Stage 2): Systolic pressure is 160-179 mmHg and diastolic pressure is 100-109 mmHg.
- Severe (Stage 3): Systolic pressure is >180 mmHg and diastolic pressure is >110 mmHg.
Types of Hypertension
-
Primary (Essential) Hypertension: Accounts for more than 90-95% of cases.
- Unknown cause (idiopathic).
- Tends to be familial, likely resulting from interaction between genetics and environment.
- Prevalence increases with age.
- Factors potentially involved: increased sympathetic activity and increased renin secretion.
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Secondary Hypertension: Accounts for about 5-10% of cases.
- Occurs due to other medical conditions or medications (cause is known).
Primary Hypertension Pathogenesis
- Increased sympathetic activity: Leads to vasoconstriction and increased peripheral vascular resistance.
- Increased renin secretion: Leads to conversion of angiotensinogen to angiotensin I, then to angiotensin II, which causes vasoconstriction and aldosterone secretion, leading to salt and water retention.
Risk Factors for Hypertension
- Age: Risk increases with age, more prevalent in men until middle age (around 45), then women are more likely to develop it after 65.
- Race: More common among Black individuals, developing at an earlier age than in White individuals.
- Family History: Tends to run in families.
- Being overweight or obese: Greater weight necessitates more blood to supply oxygen and nutrients, increasing pressure on artery walls.
- Lack of physical activity: May increase heart rate, causing the heart to work harder and increasing strain on arteries.
- Tobacco use: Directly raises BP temporarily, and chemicals damage artery walls, narrowing them and increasing BP.
- High salt (sodium) intake: Causes the body to retain fluid, increasing BP.
- Low potassium intake: Potassium balances sodium levels, so insufficient potassium can lead to sodium build-up in the blood.
- Low vitamin D intake: May potentially affect an enzyme in the kidneys involved in blood pressure regulation.
- Stress: Can lead to temporary BP increases.
- Certain chronic conditions: Kidney disease, diabetes, and sleep apnea can increase risk.
- Alcohol consumption: Heavy drinking can damage the heart.
- Pregnancy: Pregnancy-induced hypertension (or pre-eclampsia) can occur.
Causes of Secondary Hypertension
-
Renal Causes:
- Renal Parenchymal Disease: Glomerulonephritis, Diabetic nephropathy, Polycystic kidney disease.
- Renovascular (renal artery stenosis) disease: Atherosclerosis, vasculitis, fibromuscular dysplasia, renal artery thrombosis or embolism.
-
Endocrine Causes:
- Cushing syndrome: Adrenal gland (cortex) hyperfunction leading to excess cortisol release.
- Aldosteronism: Tumor or hyperplasia in the adrenal gland (cortex) causes excess aldosterone production, leading to salt and water retention and potassium loss, elevating BP.
- Pheochromocytoma: Rare tumor in the adrenal gland (medulla) increases adrenaline and noradrenaline production, causing long-term high BP or short-term spikes.
- Thyroid problems: Both underactive (hypothyroidism) and overactive (hyperthyroidism) thyroid glands can lead to high BP.
- Hyperparathyroidism: Overproduction of parathyroid hormone increases blood calcium, triggering a rise in BP.
-
Miscellaneous causes:
- Coarctation of the aorta: Congenital disorder where a part of the aorta is narrow, forcing the heart to work harder, raising BP (particularly in arms).
- Sleep apnea: Repeated breathing cessation during sleep can reduce oxygen levels, damaging blood vessel walls and making them less effective in regulating BP. Can also cause nervous system overactivity and release of pressure-increasing chemicals.
- Pregnancy: Pregnancy-induced hypertension (or pre-eclampsia).
-
Medications and Supplements:
- NSAIDs, steroids, birth control pills, antidepressants, and post-transplant medications can contribute to high BP.
- Over-the-counter decongestants and some herbal supplements (ginseng, licorice, ephedra) can also have this effect.
- Many illegal drugs (cocaine, methamphetamine) increase BP.
Hypertension Symptoms
- Asymptomatic: Often referred to as a "silent killer" as most individuals are unaware of it due to lack of symptoms. Regular blood pressure checks are vital.
- Symptoms: Headache, tinnitus, dizziness, nosebleeds (epistaxis), and palpitations.
- Symptoms of complications: May occur if hypertension is not managed.
- Symptoms of the cause: If secondary hypertension, symptoms may relate to the underlying cause.
Hypertension Complications
-
Cardiovascular Complications:
- Major risk factor for atherosclerosis, leading to coronary heart disease, stroke, and peripheral vascular disease.
- Diastolic dysfunction of the left ventricle.
- Pressure overload on the left ventricle causes hypertrophy and eventually heart failure.
- Aortic dissection.
-
Cerebrovascular Complications:
- Cerebral atherosclerosis and thrombosis.
- Intracranial hemorrhage.
- Hypertensive encephalopathy.
-
Renal Complications:
- Renal failure.
-
Retinal Complications:
- Retinal ischemia and retinal infarction.
-
Blood Vessels:
- Widespread atheroma formation, especially if other risk factors are present (dyslipidemia, smoking, diabetes).
Hypertensive Crisis
- Severe hypertension: Systolic BP of 180 or diastolic BP of 110 mmHg.
-
Categorized as either:
- Hypertensive urgency: No evidence of end organ damage. BP lowered gradually using oral medications over 24-48 hours.
- Hypertensive emergency: Evidence of direct damage to one or more organs. Requires immediate medical attention.
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Description
This quiz covers essential concepts of blood pressure, including its measurement, classification, and the diagnosis of hypertension. Understand the differences between normal, prehypertension, and various stages of hypertension with multiple-choice questions designed to test your knowledge.
