Question

CASE STUDY B Essential Hypertension Ms. J., aged 48 years, has essential hypertension, diagnosed 4 years ago. She has not been taking her medication during the past 6 months because she has been feeling fine. Now she has a new job and has been too busy to enjoy her usual swimming and golf. She has decided to have a checkup because she is feeling tired and dyspneic and has had several bouts of dizziness, blurred vision, and epistaxis (nosebleeds) lately. On examination, her blood pressure is found to be 190/120, some rales are present in the lungs, and the retinas of her eyes show some sclerosis and several arteriolar ruptures. The physician orders rest and medication to lower the blood pressure, as well as an appointment with a nutritionist and urinary tests to check kidney function. 1. Describe the pathophysiology of essential hypertension. 2. Explain the possible problems associated with the high diastolic pressure. 3. Explain the significance of the retinal changes. 4. The doctor suspects mild congestive heart failure. Explain how this can develop from hypertension. 5. Give two other possible signs of CHF. 6. List two medications that are helpful in treating hypertension, and describe their actions.

Answer 1

1. Pathophysiology of essential hypertension

            * Genetic mutations and enviromental factors result in changes in pressure of blood which

               circulate throughout the body.

            * This changes in blood pressure directly or indirectly affect all body systems result in cardio,

                renal and cerebrovascular problems which alter the normal functioning of body.

2. Problems associated with high diastolic pressure.

                   * High diastolic pressure over a period of time result in elevation of systolic pressure.

                   * It result in cardiovascular problems like heart attack or chest pain.

                   * It result in aneurysms in abdominal aorta and leads to rupture of aneurysm which

                     produce severe life threatning complications.

                   * High diastolic pressure also affect cerebrovasular functions and leads to cognitive

                      impairements.

3. Significance of retinal changes

                   * Retinal changes commonly occur in late stage of hypertension so retinal changes

                      like sclerosis and arteriolar rupture shows patient in severe stage of hypertension

                      and required immediate treatment otherwise it result in retinal detachment and

                      optic neuropathy.

4. Congestive heart failure because of hypertension

                    * Hypertension result in high blood pressure in blood vessels result in fluid accumulation

                       in the lungs and chambers of heart result in reduction of pumping power of heart.

                    * This decrease in pumping action and increased pheripheral vascular resistance

                       due to hypertension result in ineffective functioning of heart leads to congestive

                        heart failure.

5.Other possible signs of congestive heart failure.

                      * Shortness of breath.

                      * Edema of ankles,arms and legs.

                      * Irregular heart beats.

                      * Wheezing with pink mucus secretion.

                      * Weakness.

6. Two medication help to treat hypertension.

                       * ACE inhibitors (Enalapril,captopril)

                       * Calcium channel blockers (Verapamil, nicardipine)

* ACE inhibitors

               * ACE inhibitors prevent the formation of angiotensin 2 which is a powerful vasoconstrictor

                and action of aldosterone (It raises BP) result in vasodilation and decreasing pheripheral

                vascular resistance leads to fall in blood pressure.

   * Calcium channel blockers

                Cacium channel blockers dilate arterioles result in decrease in pheripheral vascular

                 resistance which help to control hypertension.