Hypertension Overview

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Questions and Answers

Why is accurate blood pressure measurement important?

It is only important for people with cardiovascular disease

It helps to avoid overestimating or underestimating blood pressure (correct)

It is not important at all

It is only important for people with a family history of hypertension

What is a common characteristic of elevated blood pressure?

It is asymptomatic until target organ damage develops (correct)

It is only found in people with cardiovascular disease

It is always symptomatic

It is a rare finding

What is a potential harm of diagnosing and initiating treatment for hypertension?

It can cause physical harm to the patient

It can cause psychosocial harm to the patient (correct)

It can cause psychological harm to the patient

It can cause social harm to the patient

What is a potential benefit of home self-measurement of blood pressure?

It can help to avoid overdiagnosis due to the white coat effect Signup and view all the answers

What is the 'white coat effect' in hypertension?

The increase in blood pressure in up to 40% of patients due to anxiety caused by medical professionals Signup and view all the answers

What is ambulatory blood pressure monitoring (ABPM) used for?

To evaluate patients with suspected white coat hypertension, apparent drug resistance, or episodic hypertension Signup and view all the answers

Hypertension is considered a:

Modifiable risk factor Signup and view all the answers

What is the percentage of diagnosed hypertensive individuals who are adequately controlled in Sri Lanka?

22% Signup and view all the answers

What is the main factor that affects blood pressure according to the pathophysiology of hypertension?

All of the above Signup and view all the answers

What is the estimated prevalence of hypertension in the adult US population?

29% Signup and view all the answers

What is the projected number of hypertensive individuals by 2025?

1.56 billion Signup and view all the answers

Which of the following is a determinant of blood pressure?

Blood volume Signup and view all the answers

What is the main factor that regulates blood pressure through the sympathetic nervous system?

Vasoconstriction Signup and view all the answers

What is the relationship between blood pressure and risk of cardiovascular disease events?

Positive correlation Signup and view all the answers

What is the primary function of the renin-angiotensin system in regulating blood pressure?

Retains Na and H2O to increase blood volume and constricts blood vessels Signup and view all the answers

What percentage of hypertension is considered essential hypertension?

90% Signup and view all the answers

What is the primary cause of secondary hypertension?

Other diseases such as renovascular disease and obstructive sleep apnea Signup and view all the answers

What is the recommendation of the British Hypertension Society for blood pressure measurement?

All adults should have BP measured every 5 years Signup and view all the answers

What is the primary symptom of hypertension?

Mostly asymptomatic, but can be found on routine screening Signup and view all the answers

What is the importance of accurate blood pressure measurement?

It is crucial for diagnosing and managing hypertension Signup and view all the answers

What is the role of the kidneys in the renin-angiotensin system?

They respond to renin-angiotensin system and release aldosterone and antidiuretic hormone as needed Signup and view all the answers

What is a risk factor for hypertension?

Family history of hypertension Signup and view all the answers

Study Notes

Overview of Hypertension

Hypertension is a risk factor, not a disease, and is modifiable.
Lowering blood pressure (BP) decreases the risk of stroke, coronary events, cardiac failure, and renal impairment.

Prevalence and Incidence

More than 25% of the world's adult population is already hypertensive.
29% of the adult US population is hypertensive.
By 2025, 1.56 billion people will be hypertensive.
Prevalence is related to body mass index (BMI) and is higher in African Americans.
5% of the pediatric population has hypertension, and prevalence increases with age.
There is a strong positive relationship between blood pressure and the risk of cardiovascular disease (CVD) events.

Prevalence in Sri Lanka

The prevalence of hypertension in Sri Lanka is 18.8% in males and 19.3% in females.
Only 22% of diagnosed hypertensive patients are adequately controlled.
Only 6-15% of diagnosed hypertensive patients are adequately evaluated for risk factors for CVD and target organ damage.

Pathophysiology

Blood pressure is a function of cardiac output multiplied by peripheral resistance.
Atherosclerosis decreases the diameter of blood vessels, increasing blood pressure.

Determinants of Blood Pressure

Blood volume
Vascular resistance to pressure
Heart stroke volume

Vascular Resistance

Viscosity of blood
Width of vessels (constriction or dilation) controlled by muscle tone in vessel walls

Regulation of Blood Pressure

Sympathetic nervous system (SNS)
Renin-angiotensin system
Kidneys

Homeostatic Control of Blood Pressure

Short-term: sympathetic nervous system, vasoconstriction, and vasodilation
Long-term: fluid volume and renin-angiotensin system

Renin-Angiotensin Cascade

Redrawn from Guyton AC: Textbook of Medical Physiology, 8th edition, Philadelphia, 1991, WB Saunders.

Hypertension Aetiology

90% of hypertension is essential (cause unknown), and 10% is secondary to other diseases.

Causes of Secondary Hypertension

Renal parenchymal disease
Renovascular disease
Primary aldosteronism
Obstructive sleep apnea
Drug or alcohol-induced
Less common causes:
- Pheochromocytoma/paraganglioma
- Cushing's syndrome
- Hypothyroidism
- Hyperthyroidism
- Aortic coarctation (undiagnosed or repaired)
- Primary hyperparathyroidism
- Congenital adrenal hyperplasia
- Mineralocorticoid excess syndromes other than primary aldosteronism
- Acromegaly

Risk Factors for Hypertension

Algorithm content developed by John Anderson, PhD, and Sanford C. Garner, PhD, 2000.

Presentation of Hypertension to Primary Care

Usually asymptomatic
May be found on routine screening/incidental
Headache/visual disturbance
Symptoms of end-organ damage: LVH, TIAs, CVA, MI, angina, renal impairment, PVD, and retinopathy

Measurement of Blood Pressure

Screening: all adults should have BP measured every 5 years (British Hypertension Society)
If BP is 'high normal' (SBP 130-139 mmHg, DBP 85-89), BP should be checked annually
Screen any patient with known renal disease, atherosclerotic disease, diabetes as part of routine follow-up
Accurate BP measurement is important to confer substantial risk of cardiovascular disease and to detect and treat high BP before target organ damage develops

Home Self-Measurement (HSM) and Ambulatory BP Monitoring (ABPM)

HSM: consider for pts with white coat effect, avoiding overdiagnosis due to white coat effect
ABPM: consider for evaluating pts with suspected white coat hypertension, apparent drug resistance, episodic hypertension, and hypotensive symptoms on antihypertensive Rx

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Description

Learn about hypertension, a risk factor for various diseases, and its prevalence and incidence worldwide. Discover how it can be modified and the risks associated with it.