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Questions and Answers
What is the difference between systolic and diastolic blood pressure called?
What is the difference between systolic and diastolic blood pressure called?
What is the classification of blood pressure for an adult with a systolic blood pressure of 135 mm Hg and a diastolic blood pressure of 85 mm Hg?
What is the classification of blood pressure for an adult with a systolic blood pressure of 135 mm Hg and a diastolic blood pressure of 85 mm Hg?
What is the estimated global prevalence of hypertension?
What is the estimated global prevalence of hypertension?
Which of the following is NOT a secondary cause of hypertension?
Which of the following is NOT a secondary cause of hypertension?
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What is the estimated number of deaths per year related to hypertension?
What is the estimated number of deaths per year related to hypertension?
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Which of the following is NOT a factor that can contribute to the development of essential hypertension?
Which of the following is NOT a factor that can contribute to the development of essential hypertension?
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In the context of hypertension, what does the term 'RAAS' refer to?
In the context of hypertension, what does the term 'RAAS' refer to?
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What is the most common location for coarctation of the aorta, resulting in high blood pressure in the upper body and low blood pressure in the lower body?
What is the most common location for coarctation of the aorta, resulting in high blood pressure in the upper body and low blood pressure in the lower body?
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What type of tumor is responsible for pheochromocytoma, a condition often linked to high blood pressure?
What type of tumor is responsible for pheochromocytoma, a condition often linked to high blood pressure?
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Which of the following is NOT a potential symptom of coarctation of the aorta?
Which of the following is NOT a potential symptom of coarctation of the aorta?
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Study Notes
Hypertension
- Arterial blood pressure (BP) is the pressure in the arterial walls, measured in millimeters of mercury (mmHg).
- Systolic pressure is the peak pressure in arteries when blood is pumped during ventricular systole.
- Diastolic pressure is the lowest pressure in arteries when blood flows back into the vessels during ventricular diastole.
- Pulse pressure is the difference between systolic and diastolic pressure (normally 40 mmHg).
Hypertension: Definition
- Hypertension is persistent elevation in arterial blood pressure.
- A reading of more than 140/90 mmHg is considered hypertension.
Epidemiology of Hypertension
- Hypertension is a widespread condition contributing to significant morbidity and mortality, along with substantial direct and indirect costs.
- Globally, approximately 1 billion individuals are estimated to have hypertension.
- Approximately 7 million deaths annually are potentially linked to hypertension.
Classification of Blood Pressure (BP)
| BP Classification | Adult SBP (mmHg) | Adult DBP (mmHg) |
|---|---|---|
| Normal (normotensive) | Less than 120 | Less than 80 |
| Prehypertension | 120-139 | 80-89 |
| Stage 1 hypertension | 140-159 | 90-99 or both |
| Stage 2 hypertension | ≥160 | ≥100 or both |
Etiology of Hypertension
- Primary (essential) hypertension: Cause unknown in most cases (~90% of patients). It is managed, but not cured.
- Secondary hypertension: A specific cause exists (e.g., underlying medical conditions). If the cause is identified, it can often be treated, and potentially cured.
Secondary Causes of Hypertension
- Chronic kidney disease
- Cushing syndrome
- Coarctation of the aorta
- Obstructive sleep apnea
- Parathyroid disease
- Pheochromocytoma
- Primary aldosteronism
- Renovascular disease
- Thyroid disease
Pathophysiology of Primary Hypertension
- The pathophysiology of primary hypertension is diverse, but fundamentally involves effects on both:
- Cardiac output
- Peripheral resistance
- Multiple factors are involved in essential hypertension development including:
- Humoral factors (RAAS)
- Vasodepressor mechanisms
- Neuronal mechanisms
- Abnormalities in sodium, calcium, and natriuretic hormones
- Most antihypertensive drugs work by impacting these mechanisms.
Diagnostic Considerations
- Hypertension is often called the "silent killer" because many individuals don't experience symptoms.
- Diagnosis requires multiple BP measurements across multiple visits.
Diagnostic Evaluation of BP
- Establishing BP levels.
- Identifying potential secondary causes.
- Assessing overall cardiovascular risk.
- Ruling out potential treatable causes.
- The evaluation includes:
- Multiple BP measurements
- Medical history review
- Physical examination
- Lab/instrumental investigations
Measuring Blood Pressure
- Diagnosis typically relies on multiple BP measurements taken over time.
- Techniques include mercury sphygmomanometers and non-invasive devices (e.g., oscillometric or automated devices).
- Office-based measurements form a key reference for treatment.
Recommendations for Measuring BP
- Patients should refrain from caffeine and nicotine for 30 minutes before measurement.
- Patients should be seated, with feet flat on the floor and back supported.
- Appropriate cuff size is critical.
- A quiet and private environment is essential.
- A 5-minute rest period precedes the measurement.
Ambulatory and Self-BP Monitoring
- Useful in suspected white-coat hypertension to differentiate from actual hypertension.
- Helpful in monitoring patients with suspected drug resistance, hypotensive symptoms, episodic hypertension, and/or autonomic dysfunction, and identifying "non-dippers."
Normal Upper Limit for BP
- Office-based: 140/90 mmHg
- ABPM (24-hour average): <130/80 mmHg
- Daytime (awake): <135/85 mmHg
- Nighttime/sleep: <120/70 mmHg
- Self-BP measurement: 135/85 mmHg
Hypertensive Crises
- Hypertensive crises involve severely elevated BP, typically >180/120 mmHg.
- Emergencies: Accompanied by acute target organ damage.
- Urgencies: High BP without acute target organ damage.
Cardiovascular Risk and Blood Pressure
- Risk of stroke, myocardial infarction, angina, heart failure, and kidney failure is directly correlated with BP.
- Higher BP is associated with a higher risk of cardiovascular disease, doubling with a 20/10mmHg increase).
- Even prehypertension increases CV risk.
- Treatment with antihypertensives significantly reduces CV risks.
Hypertension-Associated Complications
- Atherosclerosis in major blood vessels.
- Coronary artery disease
- Myocardial infarction
- Chronic stable angina
- Ischemic stroke
- Transient ischemic attack
- Peripheral arterial disease
- Abdominal aortic aneurysm
- Other cardiovascular diseases
- Left ventricular dysfunction (heart failure)
- Chronic kidney disease
Risk Factors for Hypertension-Associated Complications
- Advanced age
- Smoking
- Obesity
- Physical inactivity
- Dyslipidemia
- Diabetes
- Kidney disease
- Microalbuminuria
- Lower estimated GFR
Benefits of Lowering BP
- Reduced rates of stroke, CAD events, vascular mortality, congestive heart failure (CHF), and left ventricular hypertrophy (LVH).
Goal Blood Pressure and Initial Drug Therapy
- Guidelines vary regarding target blood pressure and appropriate first-line medications based on patient characteristics.
- Factors such as age, comorbidities, and associated risk factors can influence treatment strategy.
Resistant Hypertension
- Defined as hypertension that remains uncontrolled despite use of three antihypertensive drugs (including a diuretic), at maximum tolerated doses.
- Several possible contributing causes including nonadherence, drug-interactions, and underlying conditions.
Diagnostic Algorithm for High Blood Pressure
- The algorithm outlines a process for diagnosis involving multiple BP readings across various settings.
- Decisions to initiate treatment, further testing, or referral are often based on this algorithm.
Clinical Evaluation (Cont'd)
- Once persistent hypertension is confirmed, an evaluation determines the extent of target organ damage, assesses overall cardiovascular risk, and rules out potentially curable causes.
Compelling Indications for Initial Hypertension Treatment.
- Heart failure
- Post-myocardial infarction
- Chronic kidney disease (CKD)
- Diabetes mellitus
- Coronary artery disease
- Recurrent stroke prevention
- Pregnancy
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Description
This quiz explores the key concepts of hypertension, including definitions, classifications, and epidemiology. Understand the importance of blood pressure measurements and their implications for health. Discover the global impact of hypertension and its significance in public health.
