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 ESSENTIALor PRIMARY HYPERTENSION ; The exaat pathologic underpinnings of primary hypertension remain to be established , any factor that produces an alteration in pherpheral vascular rsesistance , heart rate ,or stroke volume afect systemic arterial blood pressure . Four control sys tem plays major role in maintain the blood pressure (1)the arteral baroreceptors and chemoreceptors system(2) regulation of body fluid  volume (30 the renin angiotensine system and (4)vascular autoregulation . Hypothesis derived to explain the onset of primary hypertension in people at risk propose that a defect or malfuction must exist in some or all of these systems .Probably no single defect cause essential hypertension

2 lung diseases , arteriolar ruptures and renal diseases

3 Retinal vascular damaged caused by hypertension . usually it develop late in the diseases fluroscopic examination shows arteriolar constiction ,arteiovenous nicking , vasular wall changes,flame shape haemorrage , coton wool spots, yellow hard exudates and optic disk edema

4 Because of hypertension the blood vssels of heart becomes narrow, blood flow to the heart slow or stop.

5 shortness of breath , fatiue, activity limitation and demaor ankle swelling

6 Duretics; icreases the urination which reduces the sodium and fluids inthe body. that can reduce the BP because it lower the blood volume . eg FRUSEMIDE(2)Betablockers;reduce the BP by acting directly on the heart. it reduce the heart rate and force of pumping , as well as reduce the blood volume.eg ATENOLOL, LABETALOL   (3) ACE INHIBOTRS ; ANGIOTENSINE is a hormone in the body that c ause narrowing of blood vessels. the angiotensie converting enzyme inhibitors decrease the production f angiotensine and in turn that help to lower the blood pressure. eg RAMIPRIL,BENAZEPRIL