Podcast
Questions and Answers
Which of the following complications is associated with hypertensive heart failure?
Which of the following complications is associated with hypertensive heart failure?
What is a characteristic feature of Grade IV retinal changes in hypertension?
What is a characteristic feature of Grade IV retinal changes in hypertension?
Which of the following investigation techniques is primarily used for cardiac complications in hypertension?
Which of the following investigation techniques is primarily used for cardiac complications in hypertension?
Which class of antihypertensive drugs directly promotes vasodilation?
Which class of antihypertensive drugs directly promotes vasodilation?
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What distinguishes hypertensive urgency from hypertensive emergency?
What distinguishes hypertensive urgency from hypertensive emergency?
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Which of the following lifestyle modifications is recommended for managing hypertension?
Which of the following lifestyle modifications is recommended for managing hypertension?
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Which condition is characterized by cerebral ischemia and thrombosis as a complication of hypertension?
Which condition is characterized by cerebral ischemia and thrombosis as a complication of hypertension?
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What is the primary aim of treatment for secondary hypertension?
What is the primary aim of treatment for secondary hypertension?
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What is classified as hypertension in adults?
What is classified as hypertension in adults?
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What is the age of onset typically associated with primary hypertension?
What is the age of onset typically associated with primary hypertension?
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Which of the following is a known cause of secondary hypertension?
Which of the following is a known cause of secondary hypertension?
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Which symptom is most commonly associated with hypertension?
Which symptom is most commonly associated with hypertension?
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At what stage is blood pressure reading considered Stage II hypertension?
At what stage is blood pressure reading considered Stage II hypertension?
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Which of the following is a characteristic of primary hypertension?
Which of the following is a characteristic of primary hypertension?
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What is a common consequence of long-term untreated hypertension?
What is a common consequence of long-term untreated hypertension?
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Which type of hypertension is often referred to as curable hypertension?
Which type of hypertension is often referred to as curable hypertension?
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Study Notes
Hypertension Definition
- Persistent high blood pressure greater than 140/90 mmHg
- Greater than 130/80 mmHg in patients with diabetes or kidney disease
- Requires at least two readings on separate occasions
Hypertension Classification
-
Optimal
- Systolic BP: 120 mmHg
- Diastolic BP: 80 mmHg
-
Normal
- Systolic BP: >130 mmHg
- Diastolic BP: >85 mmHg
-
Prehypertension
- Systolic BP: 130-140 mmHg
- Diastolic BP: 85-90 mmHg
-
Stage I
- Systolic BP: 140-160 mmHg
- Diastolic BP: 90-100 mmHg
-
Stage II
- Systolic BP: 160-180 mmHg
- Diastolic BP: 100-110 mmHg
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Stage III
- Diastolic BP: 110 mmHg
Types of Hypertension
-
Primary (Essential)
- Represents approximately 95% of all cases.
- No known cause (idiopathic).
- Usually develops between 35 - 55 years old.
- Positive family history.
- Predisposing factors: Genetics, Obesity, Stress, Salt over-intake, Smoking, Alcohol intake
-
Secondary (Curable)
- Represents approximately 5% of all cases.
- Hypertension with a known underlying cause.
- Onset: before 25 or after 55 years.
- Negative family history.
- Rapidly progressive hypertension with early complications.
Causes of Secondary Hypertension
-
Renal
- Parenchymal (e.g. Glomerulonephritis, diabetic nephropathy, pyelonephritis, polycystic kidney)
- Renovascular (e.g. renal artery stenosis)
-
Endocrine
- Pituitary: Acromegaly
- Thyroid: Hypothyroidism and Hyperthyroidism
- Parathyroid: Hyperparathyroidism
- Diabetes Mellitus
- Adrenal
- Conn’s syndrome
- Cushing syndrome
- Pheochromocytoma
-
Vascular
- Polyarteritis nodosa
- Polycythemia
- Coarctation of the aorta
-
Central Nervous System (CNS)
- Increased Intracranial Pressure (ICP)
-
Iatrogenic (Drugs)
- Contraceptive pills
- Cortisone and NSAIDs
- Sympathomimetic agents
- Calcium
Clinical Picture
-
Symptoms
- Asymptomatic in most cases.
- May be discovered accidentally.
- Headaches, usually occipital.
- Blurred vision, tinnitus, epistaxis, nausea, and vomiting.
- Complications of hypertension may be the first presentation.
-
Signs
- Blood pressure measurement: Persistent elevation > 140/90 mmHg.
- Auscultation of the heart:
- Accentuated S2
- S4
- Closed splitting S2
- Ejection systolic murmur
- Early diastolic murmur
Complications of Hypertension
-
Cardiac
- Ischemic heart disease: Caused by atherosclerosis and hypertrophy.
- Left Side Heart Failure: Caused by pressure overload.
- Right Side Heart Failure: Caused by hypertrophy of the left ventricle (LV) leading to a bulging of the septum into the right ventricle (RV), slightly impairing the filling of the RV.
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Cerebral
- Stroke: Cerebral ischemia and thrombosis (infarction) or cerebral hemorrhage
- Hypertensive encephalopathy:
- Increased cerebral blood flow leads to increased Intracranial Pressure (ICP), brain edema, coma, and convulsions.
-
Renal
- Renal Failure
-
Retinal
- Grade I Thickening of retinal arterioles (silver wire appearance)
- Grade II Kinking of retinal veins
- Grade III Hemorrhage and exudates
- Grade IV Papilledema
-
Vascular
-
Atherosclerosis
-
Aortic dissection
Investigations for Hypertension
-
For Complications
- Cardiac: X-ray, ECG, Echocardiogram.
- Cerebral: CT, MRI.
- Renal: Urine analysis, Renal function tests, Renal imaging.
-
For Cause
- When secondary hypertension is suspected or in cases of refractory hypertension.
Treatment of Hypertension
-
Non-Pharmacological (Lifestyle Modification)
- Lose weight if overweight.
- Reduce salt intake.
- Reduce dietary fat intake.
- Stop smoking.
- Regular exercise.
- Avoid stress.
-
Pharmacological
- Treatment of associated risk factors (e.g. hyperlipidemia).
- Treatment of the cause: In cases of secondary hypertension.
-
Antihypertensive Drugs
- Diuretics
- Sympathetic Blockers
- Vasodilators
- Calcium channel blockers
- Angiotensin-Converting Enzyme Inhibitors (ACE Inhibitors)
- Angiotensin II Receptor Blockers (ARBs)
Hypertension Urgency
- Rapid rise in blood pressure (> 220/130 mmHg).
- No associated target organ damage.
- e.g. renal failure, heart failure
Hypertensive Emergency
- Rapid rise in blood pressure (> 220/130 mmHg).
- Associated with target organ damage.
Malignant Hypertension
- Rapid rise in diastolic blood pressure (> 140 mmHg).
- Development of papilledema.
Accelerated Hypertension
- Similar to Malignant Hypertension but without papilledema.
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Description
This quiz covers the definitions, classifications, and types of hypertension. It emphasizes the importance of proper blood pressure readings and categorizes hypertension into various stages and types. Test your knowledge on the criteria for each classification and the factors contributing to hypertension.
