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Questions and Answers
What is one of the primary goals of hypertension treatment?
Which non-medical treatment may effectively manage hypertension?
Which of the following medications would be the first choice for a patient with hypertension and ischaemic heart disease?
What common side effect can occur with beta blockers?
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Which risk factor is most likely to contribute to the development of hypertension?
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What method is commonly used to measure blood pressure?
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What positive lifestyle change can help manage hypertension?
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Which dietary change is recommended for someone with hypertension?
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What defines hypertension regarding blood pressure readings?
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Which of the following is NOT a type of hypertension?
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Which of the following is considered a risk factor for developing hypertension?
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What is a common symptom of hypertension that may be experienced occasionally?
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What complication can arise due to untreated hypertension?
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Which of the following drugs is known to contribute to secondary hypertension?
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What characteristic differentiates essential hypertension from secondary hypertension?
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What physiological aspect does diastolic blood pressure specifically represent?
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What causes acute pulmonary edema?
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What immediate treatments can be administered for acute pulmonary edema?
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What does paroxysmal nocturnal dyspnoea indicate in patients with severe heart failure?
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Which condition can lead to right-sided heart failure?
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Which symptom is NOT typically associated with low cardiac output?
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What is a common treatment to improve long-term outcomes in heart failure?
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What is NOT a cause of right-sided heart failure?
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Which symptom suggests the presence of fluid overload in the body?
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Study Notes
Hypertension
- High blood pressure consistently over 139 mmHg (systolic) and/or 89 mmHg (diastolic)
- Normal blood pressure is ≤ 120/80 mmHg.
- Pre-hypertension is between 120/80 - 139/89 mmHg
- Systolic blood pressure is "top" number of blood pressure measurement, reflecting pressure generated during heart contraction.
- Diastolic blood pressure is the "bottom" number of blood pressure measurement, reflecting pressure during heart relaxation.
Types of Hypertension
- Essential hypertension: Has no identifiable cause, possibly due to genetics or environmental factors.
-
Secondary hypertension: Caused by an underlying disease.
- Drugs: NSAIDs, steroids, sympathomimetics, oral contraceptives.
- Endocrinological: Cushing disease, hyper/hypothyroidism, acromegaly.
- Kidney disorders
- Cardiovascular causes: Coarctation of the aorta
- Tumors: Phaeochromocytoma
- Catecholamines: Substances like dopamine and adrenaline, leading to vasoconstriction.
Risk Factors
- Family history
- Advancing age
- Smoking
- High salt intake
- Stress
- Overweight
- Hypercholesterolaemia
Symptoms
- Typically no symptoms present.
- Occasionally patients may experience:
- Epistaxis (nosebleeds)
- Mild headache
- Tiredness
- Chest pain
- Heart failure
- Blurred vision
- Confusion and convulsions
- Medical emergency: Hypertensive encephalopathy (severe headache, confusion, convulsions), chest pain, and shortness of breath require urgent hospital admission.
Diagnosis
- Suspected when blood pressure is high at any single measurement.
- Confirmed when blood pressure consistently elevated over 140 systolic or 90 mmHg diastolic.
Complications
- Cerebrovascular stroke
- Retinopathy (retinal damage)
- Paroxysmal nocturnal dyspnoea (sudden shortness of breath at night) due to fluid shifting from interstitial tissues to circulation in patients with severe heart failure.
- Acute pulmonary edema due to sudden rise of pressure in the left side of the heart leading to fluid moving from capillaries into alveoli.
- Low cardiac output symptoms causing fatigue, cold extremities, peripheral cyanosis, oligouria, and headache.
Treatment
- Goal: Decrease risk of complications
-
Non-medical:
- Lose weight if overweight.
- Exercise.
- Adjust diet: Decrease fat and sodium, increase fruits, vegetables, and fiber.
-
Medical:
- Diuretics, beta-blockers, calcium channel blockers, ACE inhibitors, ARBs, alpha-blockers.
Antihypertensive Drugs
- Diuretics: Thiazide & loop diuretics, side effects: Hypokalaemia, hyperuracemia.
- Beta-blockers: Atenalol, propranolol, side effects: Bradycardia (slow heart rate), bronchial asthma.
- Calcium channel blockers: Nifedipin, side effects: Lower limb edema.
- ACE inhibitors: Captopril, side effects: Dry cough, hyperkalemia
Choice of Antihypertensive Drugs
- Determined by patient's age, presence of ischemic heart disease or diabetes.
- Beta-blockers are the first choice for hypertension treatment if the patient has ischemic heart disease.
- NICE clinical guidelines provide an algorithm for choosing antihypertensive drugs based on age groups.
Blood Pressure Measurement
- Cuff wrapped around upper arm and inflated to stop blood flow in brachial artery.
- Auscultate with stethoscope over brachial artery to listen for blood pumping through the artery as the cuff is slowly deflated.
Heart Failure
-
Left-sided heart failure:
- Causes:
-
Coronary artery disease:
- Angina
- Myocardial infarction (heart attack)
-
Hypertension:
- Left ventricular hypertrophy
-
Valve disease:
- Aortic stenosis
- Mitral regurgitation
-
Cardiac tamponade:
- Fluid accumulation in the pericardial sac
-
Constrictive pericarditis:
- Thickening of the pericardium, restricting heart movement
-
Coronary artery disease:
- Causes:
Clinical Picture
- Dyspnea (shortness of breath)
- Orthopnea (difficulty breathing when lying flat)
- Paroxysmal nocturnal dyspnea (sudden shortness of breath at night)
- Pulmonary edema (fluid in the lungs)
- Fatigue
- Weakness
- Edema (swelling)
- Nocturia (frequent urination at night)
- Cough
- Wheezing
- Chest pain
- Palpitations (irregular heartbeats)
Principles of Treatment
-
Non-medical:
- Decrease salt, water, and NSAIDs intake.
-
Medical:
-
Treatment to improve acute symptoms (acute pulmonary edema):
- IV morphine
- IV frusemide (diuretics)
- Nitrate infusion if blood pressure is acceptable
- Dobutamine infusion (increase contractility in severe cases)
-
Treatment to decrease recurrence of symptoms and improve long-term outcome:
- ACE inhibitor
- Small dose spironolactone (potassium-sparing diuretics)
- Small dose beta-blocker
- Digoxin (to increase contractility)
-
Treatment to improve acute symptoms (acute pulmonary edema):
Right-Sided Heart Failure
-
Causes:
- Cor pulmonale: Right sided heart failure due to chronic lung disease causing pulmonary hypertension.
- Secondary to left-sided heart failure: Left-sided heart failure leads to chronic left atrial pressure elevation, pulmonary hypertension, followed by right-sided heart failure.
- Pulmonary embolism: From venous thrombosis of lower limb.
- Congenital pulmonary valve stenosis:
- Myocardial diseases: Myocardial infarction of right ventricle.
Clinical Picture
- Congested neck veins
- Enlarged, congested, painful, tender liver
- Lower limb edema, and later ascites occurs.
Congestive Heart Failure Definitions
- Heart failure: A condition where the heart cannot pump blood effectively enough to meet the body's needs.
- Congestive heart failure: A type of heart failure where fluid builds up in the body, often in the lungs, legs, and abdomen.
Summary of Key Points
- Hypertension is a major health concern with a wide range of potential complications.
- There are two main types of hypertension: essential and secondary.
- Risk factors for hypertension include family history, advancing age, smoking, high salt intake, stress, overweight, and hypercholesterolaemia.
- While usually asymptomatic, hypertension can cause severe symptoms in some cases.
- Treatment for hypertension involves lifestyle modifications and medications, and the choice of medication depends on various factors.
- Heart failure is another serious condition that can occur as a result of hypertension and other heart conditions.
- Heart failure can be left-sided or right-sided, and both types can lead to significant health issues.
- Management involves lifestyle changes and medical therapies aiming to improve heart function and decrease symptoms.
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Description
This quiz covers the key concepts of hypertension, including definitions, types, and causes. Learn about high blood pressure measurements, the distinctions between essential and secondary hypertension, and the impact of various contributing factors. Test your knowledge on this important health topic.
