Hypertension Overview Quiz

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Questions and Answers

Which of the following is a non-modifiable risk factor for parenchymal hypertension?

Sedentary lifestyle

Obesity

Family history (correct)

Poor diet (high sodium)

What condition is associated with renovascular hypertension?

Renal artery stenosis (correct)

Diabetic nephropathy

Polycystic kidney disease

Glomerulonephritis

Which of the following contributes to increased intracranial tension (ICT) in neurogenic causes of hypertension?

Coarctation of the aorta

Toxaemia of pregnancy

Headache (correct)

Severe headache

Which symptom might indicate target organ damage in hypertensive patients?

Left ventricular hypertrophy Signup and view all the answers

Which of the following is categorized under miscellaneous causes of hypertension?

Toxaemia of pregnancy Signup and view all the answers

What is a common symptom in the asymptomatic phase of hypertension?

No symptoms at all Signup and view all the answers

Which drug class is known to potentially induce hypertension?

Oral contraceptives Signup and view all the answers

What type of symptoms are primarily associated with a hypertensive crisis?

Severe headaches Signup and view all the answers

What is often associated with severe anxiety in the morning?

Severe headache Signup and view all the answers

Which of the following symptoms can indicate encephalopathy?

Seizures Signup and view all the answers

What is a common symptom of chronic kidney disease (CKD)?

Proteinuria Signup and view all the answers

What does blurred vision generally indicate in the context of hypertension?

Hypertensive retinopathy Signup and view all the answers

Chest pain or angina in a hypertensive patient may suggest which condition?

Myocardial ischemia Signup and view all the answers

Which of the following symptoms could suggest a transient ischemic attack (TIA)?

Weakness or numbness in limbs Signup and view all the answers

What symptom may not typically be present in patients with hypertension?

Chest pain Signup and view all the answers

What can ringing in the ears indicate in the context of hypertensive symptoms?

Temporal arteritis Signup and view all the answers

What characterizes refractory hypertension?

Blood pressure of ≥140/90 mm Hg despite maximum doses of three different classes of drugs. Signup and view all the answers

Which type of hypertension is predominantly seen in the elderly?

Isolated Systolic Hypertension Signup and view all the answers

What is the hallmark of malignant hypertension?

Acute onset with very high DBP and evidence of vascular damage. Signup and view all the answers

Which blood pressure measurement is considered normal?

130/80 mmHg Signup and view all the answers

What is a characteristic of secondary hypertension?

It typically starts before the age of 25 years. Signup and view all the answers

Why is ambulatory blood pressure monitoring important?

To measure average blood pressure over extended periods. Signup and view all the answers

What does the term 'white coat hypertension' refer to?

High BP readings only in clinical settings with normal readings otherwise. Signup and view all the answers

Which apparatus is considered the gold standard for blood pressure measurement?

Mercury sphygmomanometer Signup and view all the answers

What is a common acute complication associated with hypertension?

Hemorrhagic stroke Signup and view all the answers

Which antihypertensive medication is typically preferred for pregnant women?

Methyldopa Signup and view all the answers

What is the primary goal of hypertension treatment?

Control blood pressure and manage associated risks Signup and view all the answers

Which medication group is used as first-line therapy for mild hypertension?

Diuretics or ACE inhibitors Signup and view all the answers

What is a key benefit of using combined antihypertensive therapy?

Improved patient compliance Signup and view all the answers

What investigation is typically performed to assess complications in cerebral hypertension?

MRI brain Signup and view all the answers

Which antihypertensive medication is categorized as a central alpha agonist?

Clonidine Signup and view all the answers

Which condition is NOT considered a complication of hypertension?

Peripheral artery disease Signup and view all the answers

Study Notes

Hypertension

Normal Blood Pressure: 140 mmHg systolic or greater and/or 90 mmHg diastolic or greater
Hypertensive Emergency (Crisis): Severe elevation in blood pressure with evidence of impending or progressive organ damage
Pre-hypertension: Blood pressure of 120-139 mmHg systolic and/or 80-89 mmHg diastolic. No drug therapy indicated, recommended lifestyle modifications.
Refractory or Resistant Hypertension: Blood pressure of ≥140/90 mm Hg despite three drugs from different classes at maximum approved doses, given at least 1 month to take effect.
Malignant Hypertension: Characterized by:
- Acute onset and rapid progression
- Very high diastolic blood pressure (>120 mmHg) with generalized vascular damage
- Papilledema
- Possible complications: micro-angiopathic hemolytic anemia, renal failure
- High risk of death from renal failure, cerebral hemorrhage or heart failure
- Hallmark: Fibrinoid necrosis
White Coat Hypertension: Blood pressure is high (>140/90 mmHg) in a clinic setting but normal during daytime ambulatory pressure readings

Staging of Office Blood Pressure

Measurement of Blood Pressure:
- Mercury sphygmomanometers: Considered the gold standard and most common.
- Aneroid sphygmomanometers: Alternative type.
- Automatic (Electronic/Digital) Sphygmomanometers: Convenient but may not be as accurate.
- Doppler sphygmomanometers: Used when traditional methods are difficult.
Ambulatory Blood Pressure Monitoring: Helpful for managing patients with:
- Resistant hypertension
- Medication-related hypotensive symptoms
- Stress-related (white coat) blood pressure increases
- Circadian rhythm in blood pressure

Types of Hypertension

Isolated Systolic Hypertension: Prevalent in the elderly, with a systolic blood pressure of 140 mmHg or greater and a diastolic blood pressure of 90 mmHg or lower.
Systolic and Diastolic Hypertension:
- Primary Hypertension: The most common type (95% of cases), without a known cause. Starts between 35-55 years old, often with a family history.
- Secondary Hypertension: About 5% of cases, with a known underlying cause. Often starts before age 25, with no family history, and progresses rapidly with early complications.

Causes of Secondary Hypertension

Renal Causes:
- Parenchymal: Glomerulonephritis, diabetic nephropathy, pyelonephritis, polycystic kidney disease, analgesic nephropathy
- Renovascular: Renal artery stenosis
Endocrine Causes:
- Hyperthyroidism
- Cushing's Syndrome
- Pheochromocytoma
- Hyperaldosteronism (Conn's syndrome)
Neurogenic Causes: Increase in Intracranial Pressure (ICT)
Vascular Conditions: Coarctation of the Aorta: A congenital narrowing of the aorta that increases resistance and raises blood pressure above the narrowing.
Miscellaneous Causes:
- Toxaemia of Pregnancy (Pre-eclampsia & Eclampsia Syndrome)
- Drug-Induced:
  - Oral Contraceptives
  - NSAIDs
  - Sympathomimetics

Risk Factors for Primary Hypertension

Non-Modifiable Factors: Age, family history, ethnicity
Modifiable Factors: Sedentary lifestyle, poor diet (high sodium), excessive alcohol consumption, smoking, stress, obesity

Clinical Picture of Hypertension

Asymptomatic Phase: Most patients are asymptomatic, but damage to organs can occur silently.
Symptoms of Elevated Blood Pressure:
- Headache, particularly in the occipital region (back of the head), often in the morning.
- Dizziness or lightheadedness
- Fatigue
- Nose bleeds (Epistaxis)
- Blurred vision or visual disturbances due to hypertensive retinopathy
- Tinnitus: Ringing in the ears
- Shortness of breath (Dyspnea)
- Chest pain or tightness, especially if hypertension has affected the heart.
Hypertensive Crisis Symptoms:
- Severe headache
- Severe anxiety or agitation
- Nausea and vomiting
- Confusion or changes in mental status
- Seizures
- Shortness of breath
- Chest pain or angina, may indicate myocardial ischemia or heart attack
- Weakness or numbness in limbs, could suggest stroke or transient ischemic attack (TIA)
Target Organ Damage Symptoms:
- Cardiovascular Symptoms:
  - Left ventricular hypertrophy, leading to heart failure.
  - Angina or myocardial infarction.
- Neurological Symptoms:
  - Stroke or transient ischemic attacks (TIAs)
  - Encephalopathy: Severe headache, confusion, seizures, and coma.
- Renal Symptoms:
  - Proteinuria, edema, and signs of kidney dysfunction or chronic kidney disease (CKD)
- Retinal Symptoms:
  - Hypertensive retinopathy: Blurred vision, double vision, or visual loss.
  - Hemorrhages or papilledema on retinal examination.
- Peripheral Vascular Disease:
  - Claudication: Pain in legs or arms due to poor blood flow.

Acute Complications of Hypertension

Cerebral stroke, hypertensive encephalopathy, subarachnoid hemorrhage
Heart complications: acute pulmonary edema, dissecting aneurysm, acute coronary syndromes
Acute renal failure
Epistaxis (Bleeding per nose)

Investigations of Hypertension

For Etiology: To detect secondary hypertension:
- Renal function tests
- Endocrine studies
- Neuroimaging (e.g., CT, MRI)
- Cardiac imaging (e.g., echocardiogram)
For Complications:
- Cardiac: ECG, chest x-ray, echocardiogram
- Cerebral: CT, MRI of the brain
- Renal: Urinalysis, renal function tests, renal imaging

Treatment of Hypertension

Goal of Treatment: To decrease blood pressure to a safe level, reduce the risk of complications, and improve quality of life..
Non-pharmacological (Lifestyle) Interventions:
- Weight loss
- Healthy dietary changes (e.g., DASH diet)
- Regular physical activity
- Sodium restriction
- Moderate alcohol consumption
- Smoking cessation
- Stress management
Causal Treatment: For secondary hypertension, treat the underlying cause.
Pharmacological Treatment:
- Associated Risk Factors: Address any underlying risk factors (e.g., diabetes, hyperlipidemia).
- Antihypertensive Drugs:
  - Diuretics: Thiazides, loop diuretics, potassium-sparing diuretics
  - Beta-adrenergic blockers: Atenolol, metoprolol
  - Alpha receptor blockers: Prazosin, terazosin
  - Central alpha agonists: Methyldopa, clonidine
  - Combined α and β adrenergic blockers: Carvedilol
  - ACE inhibitors: Captopril, enalapril
  - Angiotensin receptor blockers (ARBs): Losartan, valsartan
  - Calcium channel blockers: Amlodipine, nifedipine
  - Direct vasodilators: Hydralazine, minoxidil
Choosing Antihypertensive Medications:
- Mild Hypertension: Diuretics or ACE inhibitors are typically used as first-line therapy.
- Resistant Hypertension: Combination therapy with multiple drugs is often necessary.
- Specific Populations:
  - Elderly Patients: Calcium channel blockers or thiazide diuretics may be preferred.
  - Pregnant Women: Methyldopa or labetalol are generally preferred.
Rationale for Combined Therapy:
- Improved patient compliance (easier to take fewer pills)
- Allows for lower doses of individual drugs
- Fewer adverse effects
- Synergistic effects of multiple drugs working together

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Description

Test your knowledge on hypertension, its classifications, and related information. This quiz covers normal blood pressure, different types of hypertension, and associated complications. Improve your understanding of this critical health topic.