Vascular Disease and Hypertension
Core concepts
Vascular disease and hypertension questions cover accurate blood pressure measurement, primary versus secondary hypertension, resistant hypertension, hypertensive emergencies, aortic dissection, peripheral artery disease, abdominal aortic aneurysm, and venous thromboembolism. Secondary causes include primary aldosteronism, renal artery stenosis, obstructive sleep apnea, thyroid disease, pheochromocytoma, and Cushing syndrome. Hypertensive emergency is severe BP with target-organ damage, not the number alone. Aortic dissection requires rapid blood pressure and impulse control and urgent imaging. PAD may be asymptomatic and is assessed with the ankle-brachial index.
Question traps
Do not diagnose resistant hypertension without adherence and proper technique. White-coat and masked hypertension matter. ACE inhibitors and ARBs can worsen renal function in bilateral renal artery stenosis. In dissection, lower heart rate and shear stress before aggressive vasodilation. Do not use thrombolysis for uncomplicated distal DVT routinely.
Worked example / rule of thumb
A 60-year-old with sudden tearing chest pain, unequal arm pressures, and a widened mediastinum needs immediate beta blockade and CT angiography. Rule: treat hypertensive emergency by target-organ damage, not by the absolute pressure alone.