Hypertension

What are the 2 blood pressure thresholds required across three separate visits to diagnose systemic hypertension?

systolic blood pressure 140 mmHg or higher, diastolic blood pressure 90 mmHg or higher

Clinical blood pressure measurements must be recorded to the nearest [...] mmHg.

2

The blood pressure cuff must never be inflated more than [...] mmHg above the estimated systolic pressure.

20

What specific clinical error is prevented by estimating a patient's systolic pressure via radial palpation before inflating the cuff?

missing an auscultatory gap

What measurement error occurs if an auscultatory gap is missed during manual blood pressure checking?

underestimation of systolic blood pressure

To minimize white-coat effects and eliminate uncalibrated gauge drift, what devices are preferred over aneroid manometers in the clinic?

validated oscillometric devices

List the 2 patient positioning requirements needed to ensure an accurate clinical blood pressure reading.

patient seated, cuff at level of the heart

Under what single clinical circumstance is it appropriate to order a urinary micro-albumin concentration for a hypertensive patient?

co-existing diabetes mellitus

What specific chest X-ray threshold confirms structural cardiomegaly from long-standing hypertensive pressure overload?

cardiothoracic ratio greater than 50 percent

Name the physical law that describes the structural relationship between myocardial wall tension, intra-chamber pressure, and wall thickness.

Law of Laplace

State the precise architectural orientation of newly synthesized sarcomeres in concentric left ventricular hypertrophy.

in parallel

State the precise architectural orientation of newly synthesized sarcomeres in eccentric left ventricular hypertrophy caused by fluid overload conditions.

in series

In vascular smooth muscle contraction, which second messenger triggers the immediate release of stored calcium from the sarcoplasmic reticulum?

inositol triphosphate

In vascular smooth muscle contraction, which second messenger activates long-acting sarcolemmal calcium channels to facilitate extracellular influx?

diacylglycerol

Which vascular endothelial vasodilator enzyme has its bioavailability drastically reduced by chronic hypertensive mechanical shear stress?

nitric oxide

Name the potent local autocrine/paracrine vasoconstrictor that is heavily upregulated following hypertensive endothelial injury.

endothelin-1

What specific clinical designation is given to a presentation pairing severe blood pressure elevation with acute target organ damage?

hypertensive emergency

Which fast-acting oral dihydropyridine medication formulation is strictly contraindicated in a hypertensive crisis due to severe reflex tachycardia risk?

immediate-release oral nifedipine

Which first-line antihypertensive drug class is completely contraindicated in patients presenting with active gout?

thiazide diuretics

What specific electrolyte transporter do low-ceiling thiazide diuretics target and inhibit in the distal convoluted tubule?

sodium-chlorine co-transporter

List the 4 primary serum electrolytes that are depleted as a direct result of standard thiazide diuretic therapy.

potassium, sodium, magnesium, zinc

Which psychiatric medication carries a high risk of acute systemic toxicity when co-administered with volume-depleting thiazide diuretics?

lithium

What is the most common localized peripheral side effect of amlodipine, and what is the maximum daily dose limit of simvastatin permitted when co-prescribed with it?

peripheral ankle edema, 20 mg/day

Which specific dietary inhibitor of the CYP3A4 enzyme system is completely forbidden for patients taking dihydropyridine calcium channel blockers?

grapefruit juice

Which inflammatory mediator accumulates during ACE inhibitor therapy to trigger a classic, intractable dry cough?

bradykinin

What is the safest alternative first-line drug class to prescribe when a patient develops an ACE-inhibitor-induced dry cough or angioedema?

Angiotensin II Receptor Blockers

List the 2 life-threatening or severe adverse class effects associated with prescribing ACE inhibitors like enalapril.

hyperkalemia, angioedema

List the 4 compelling cardiovascular comorbidities where beta-blockers are indicated as part of a patient's hypertensive regimen.

post-myocardial infarction, chronic heart failure, tachyarrhythmias, migraine prophylaxis

List the 2 absolute respiratory disease contraindications for prescribing a non-selective beta-blocker like propranolol.

asthma, chronic obstructive pulmonary disease

What critical clinical danger occurs when a patient with type 2 diabetes mellitus is prescribed a non-selective beta-blocker?

hypoglycaemia unawareness

Why are ACE inhibitors and Angiotensin II Receptor Blockers completely contraindicated across all trimesters of pregnancy?

strict teratogenicity causing fetal renal dysgenesis

What is the definitive first-line oral medication of choice utilized to manage gestational or pregnancy-induced systemic hypertension?

methyldopa

List the 2 major clinical side effects associated with long-term methyldopa therapy.

sedation, immune-mediated haemolytic anaemia

In the South African health system, limited access to trained specialists for invasive adrenal vein blood sampling dictates using which long-term medical therapy for suspected Conn's syndrome over surgery?

spironolactone

Which 2 classes of antihypertensive agents drastically increase the baseline fall risk in geriatric populations due to first-dose hypotension and vertigo?

alpha-1 blockers, central alpha-2 agonists

Name the advanced non-invasive investigation used to directly quantify aortic stiffness in high-risk young hypertensive patients.

aortic pulse wave velocity

List the 4 classic vascular changes visible on fundoscopic examination in a patient with advanced hypertensive retinopathy.

generalized arteriolar narrowing, silver or copper wiring, arteriovenous nicking, flame-shaped retinal hemorrhages

What are the 2 high-yield electrocardiogram (ECG) voltage and strain changes seen in advanced hypertensive left ventricular hypertrophy?

high R-wave amplitudes in leads V5 and V6 with deep S-waves in leads V1 and V2, asymmetric ST-segment depression with T-wave inversion in the lateral lead