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Questions and Answers
What blood pressure reading typically indicates hypertensive urgency?
Which of the following is considered a non-modifiable risk factor for hypertension?
Which symptom might be associated with severe cases of hypertensive urgency?
What is a significant indicator of potential underlying vascular disease when measuring blood pressure between arms?
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Which of the following lab tests is NOT commonly performed to diagnose hypertension?
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What defines hypertension according to conventional standards?
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What percentage of patients are typically found with low-renin essential hypertension?
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What is one of the main causes of secondary hypertension?
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What characterizes a hypertensive emergency?
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Which of the following is NOT a typical classification for hypertension?
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What is a common risk factor that doubles cardiovascular disease risk with every 20/10 mmHg increase?
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Which mutation is associated with increased aldosterone secretion and salt and water resorption?
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Which of the following conditions is associated with increased cardiac output leading to hypertension?
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Study Notes
Definition of Hypertension
- Sustained increase in blood pressure greater than or equal to 140/90 mmHg.
- Leading risk factor for death worldwide.
- Increases risk of stroke, myocardial infarction, heart failure, renal failure, and dissecting aortic aneurysm.
- Cardiovascular disease risk starts at 115/75 mmHg and doubles with every 20/10 mmHg increase.
Pathogenetic Mechanisms of Hypertension
- Raised catecholamine levels.
- Increased blood volume (volume hypertension) and arteriolar constriction (vasoconstrictor hypertension).
- Increased cardiac output.
- Low-renin essential hypertension (20% cases) due to altered responsiveness to renin release.
- High-renin essential hypertension (15% cases) due to decreased adrenal responsiveness to angiotensin II.
Causes of Hypertension
- Primary hypertension (90-95%): Also known as essential hypertension, the cause is usually idiopathic.
- Secondary hypertension (5-10%): Caused by underlying conditions such as kidney disease, endocrine disorders, cardiovascular disease, neurological disorders, and medications.
- Medications that can cause secondary hypertension include NSAIDs, corticosteroids, vasopressin, and others.
Genetic Basis of Hypertension
- Gene defects in aldosterone metabolism can increase aldosterone secretion, leading to increased salt and water resorption and plasma volume expansion.
- Mutations in proteins involved in sodium resorption can lead to conditions like Liddle syndrome.
Clinical Classification of Hypertension
| Category | Systolic (mmHg) | Diastolic (mmHg) |
|---|---|---|
| Normal | < 120 | < 80 |
| Prehypertension | 120-139 | 80-89 |
| Hypertension: Stage 1 | 140-159 | 90-99 |
| Hypertension: Stage 2 | >160 | >100 |
| Isolated Systolic Hypertension | >140 | < 90 |
| Malignant Hypertension | >200 | >140 |
Hypertensive Crises
-
Hypertensive Emergency:
- Severe blood pressure increase (usually above 180/120 mmHg).
- Accompanied by acute target organ damage.
- Life-threatening and requires immediate medical intervention, often in a hospital setting.
-
Hypertensive Urgency:
- Significant elevation in blood pressure (typically >180/120 mmHg).
- Not accompanied by acute target organ damage.
- Requires prompt medical attention to prevent progression to a hypertensive emergency.
Risk Factors for Hypertension
-
Non-modifiable:
- Age
- Sex
- Family History
- Ethnicity
-
Modifiable:
- High dietary salt intake
- Diet high in fat and low in nutrients.
- Physical inactivity
- Obesity
- Alcohol consumption
- Tobacco use
- Stress
Symptoms of Hypertension
- Typically asymptomatic.
- Severe cases may present with headache, visual disturbances, or evidence of target organ damage.
- Consequences of target organ damage can affect the heart, eyes, kidneys, brain, and peripheral vasculature.
Diagnostic Tests for Hypertension
- Sphygmomanometer: Use a well-calibrated sphygmomanometer.
- Blood pressure measurements in sitting & standing positions: The arm should be supported at the level of the heart.
- Blood pressure measurements in both arms: If a difference of 20 mmHg is found, repeat measurements. Use the arm with the highest value for monitoring.
- Blood pressure differences between arms: A 15 mmHg difference may indicate underlying vascular disease and an increased risk of all-cause and cardiovascular mortality.
- Repeat readings: If the reading is >140/90 mmHg, confirm hypertension by ambulatory blood pressure monitoring (ABPM).
Lab Tests for Hypertension
- KFT (Kidney Function Test):
- LFT (Liver Function Test):
- Electrolytes:
- Other tests: ECG, Echo, eGFR
General Blood Pressure Targets
| Category | Clinic BP Target | ABPM/HBPM Target |
|---|---|---|
| People younger than 60 years | ||
| People 60 years and older |
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Description
This quiz explores the definition, pathogenesis, and causes of hypertension. Learn about the different types of hypertension, risk factors, and the physiological mechanisms behind elevated blood pressure. Test your knowledge on this critical health topic and its implications for cardiovascular disease.
