Question: 1. HypertensionFor this disease pathology, please provide the following information:What causes this disorder (pathology)? Are there any threats to life risks associated with this disease that you should watch out for, and why? (Not all terms will have life-threatening conditions associated with them)What types of lab work or diagnostic testing (ECG, X-ray, ultrasound, MRI, etc.) would you typically see ordered with this disease?What would you expect to see in the lab or diagnostic results?What are the most common treatments?Which treatments would be the most important or take priority?

Hypertension is defined as chronic elevation of systolic and diastolic blood pressure. High blood pressure is determined by cardiac output and systemic vascular resistance. It has been found that cardiac output is generally high in young patients. An increase in systemic vascular resistance is the main cause of high BP in elderly. Numerous physiological processes such as arterial baro- receptors, renin angiotensin aldosterone system, atrial natriuretic peptides, endothelin, glucocorticoids etc are responsible for maintaining the blood pressure. These complexes are known to maintain vasodilation and vasoconstriction in the systemic circulation, retention or excretion of sodium and water so that adequate systemic blood circulation can be maintained. I f there is imbalance or dysfunction in any of these processes that can lead to hypertension.Question 1: Causes/pathology of hypertension: Pathology of hypertension is complex and multifactorial. Several factors are known to modulate the blood pressure. Cause of the hypertension can either be primary (which is also known as idiopathic or essential) or secondary. Essential hypertension accounts for about 90-95% of cases Secondary hypertension is caused as a result of some other underlying diseases such as chronic kidney disease, endocrine disorders or due to narrowing of the aorta. Some risk factors that cause hypertension are: Smoking Obesity Sedentary life style Increased salt consumption Alcoholism Stress Family history Genetics Chronic kidney disease Adrenal and thyroid disorders Yes, persistent hypertension can lead to various life threatening complications in a patient. Cardiovascular complications of hypertension include coronary artery disease (CAD) and left ventricular hypertrophy. Left ventricular hypertrophy causes slowing of ventricular relaxation, impairs filling and diastolic functions. Chronic arterial blood pressure can lead to Coronary arterial diseases which can cause myocardial ischemia and myocardial infractions. Heart failure is another consequence of persistent high blood pressure. Initially it can cause diastolic dysfunction and eventually can cause cardiac congestion.Question 2: Diagnostic tests Ambulatory monitoring of blood pressure. In this test blood pressure will be monitored for 24 hours which provides details about change in blood pressure during day and night. Lab tests: Urine test, cholesterol test and blood test. Electrocardiogram (ECG or EKG) this test will measure electrical activity of heart, rate and rhythm of heart. Echocardiogram: Echocardiogram uses sound waves in order to produce image of the heart, which can be used to check signs and symptoms of hypertension. Question 3: Diagnostic tests findings: Urine analysis may reveal the presence of red blood cells or cells from kidney, which is an indication of kidney damage due to persistent high blood pressure. In case of hypertension there will be abnormalities in the reading of ECG. ECG readings will detect left ventricular hypertrophy in case if the patients have high blood pressure. Echocardiogram can detect all the hemodynamic changes which are caused due to elevated systemic arterial pressure. Blood tests including measurement of electrolyte, blood urea nitrogen levels, lipid profile test will show whether high blood pressure has affected any of these parameters .Common treatment: If age of patient is below 55 years ACE inhibitors and angiotensin 2 receptor blockers are usually prescribed. ACE inhibitors will lower blood pressure by relaxing the blood vessels. Examples: Enalapril, Lisinopril, Ramipril etc. Angiotensin 2 receptor blockers works in same way as ACE inhibitors works. Examples: Candesartan, Telmesartan, Olmesartan etc. If age of patient is above 55 years, calcium channel blockers are prescribed. Calcium channel blockers reduces blood pressure by causing widening of blood vessels, Examples: Amlodipine, Nifedipine, Felodipine etc. Diuretics are also prescribed in some cases of high blood pressure. Such drugs work by excreting excessive water and sodium from body through water. Examples: Indapamide, Furosemide etc. Beta blockers in high blood pressure work by slowing down the heart beat Examples: Atenolol, Propranolol etc. Priority treatment Lifestyle modification (physical activities, cut down of alcohol and smoking, losing weight, reducing caffeinated drinks), dietary restrictions (DASH diet, reducing amount of sodium in diet, having low fat diet) and medications must be given equal priority in management of hypertension.