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Hypertension


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When does BP rise to a maximum
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Rises to a maximum in systole- the systolic pressure

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When does BP rise to a maximum
Rises to a maximum in systole- the systolic pressure
How do you calculate BP and CO
BP = CO * TPR CO = HR * SV
When does BP rise to a minimum
Falls to a minimum in diastole- the diastolic pressure
What does stroke volume depend on ( what factors )
Preload → venous return Load → inherent pumping power ( contractility ) Afterload → = pressure against which the heart must pump ( pressure in the aorta )
What are the 2 mechanisms for control of Blood Pressure
Fast acting for immediate pressure changes Baroreceptor reflexes act on heart (CO) and blood vessels (TPR) via autonomics ( Sympathetic and Parasympathetic ) Slow acting long term responses act on RAAS (Renin Angiotensin Aldosterone System) via kidneys to regulate blood volume
What is the difference between primary and secondary hypertension
Primary hypertension --> Unknown cause , most common Secondary hypertension --> Defined cause, e.g. renal , endocrine or pregnancy
What are the 2 pathophysiology of hypertension in the heart
Muscle hypertrophy - Left ventricle works harder to combat high wall pressure - Due to muscle hypertrophy, there is higher demand of oxygen which could lead to LV ischemia and failure→ pulmonary congestion and oedema Atherosclerosis : - Endothelial damage in coronary arteries by atheroma which leads to loss of elasticity and hardening - Narrowing and reduced oxygen supply - Angina →infarction → heart failure
What are the 2 mechanisms of a stroke and TIA can be caused in the brain
Atherosclerotic plaques or thrombi in carotid or cerebral vessels which can embolize and block brain vessels Brain micro-aneurysms can rupture → hemorrhagic stroke
What are some causes of secondary hypertension
Renal : renal artery stenosis, glomerulonephritis Endocrine : Cushing syndrome adrenocortical hyperplasia Conn syndrome primary hyperaldosteronism Pheochromocytoma Thyroid dysfunction Mechanical : coarctation of the aorta Pregnancy : pre-eclampsia and hypertension
What can happen due to hypertension in the kidneys
Nephrosclerosis damages vessel walls of nephron Reduced blood supply leading to ischaemia Which can lead to atrophy of renal glomeruli and tubules Progressive renal failure
How would you diagnose hypertension
BP > 140/90 at clinic BP > 135/85 after ABPM or HBPM Also examine retina by fundoscopy, Femoral pulses and Renal bruit
What are some investigations for hypertension
ECG - for left ventricle hypertrophy Echocardiogram Blood --> U/E, cholesterol, glucose and steriods Urine --> Protein, blood Renal ultrasound
What is a hypertensive emergency
BP > 200/130 with evidence of organ damage Headache, visual disturbance Papilloedema + retinal haemorrhages Encephalopathy, heart failure, renal failure
What are some management strategies for hypertension
If it is secondary then treat the cause If primary then there are 2 ways Non-drugs --> Lifestyle changes Drugs --> Angiotensin blcokers ( ACEi/ARB ) , Calcium channel blockers , Diuretics and beta blockers Annual Review