8 - Hypertension Flashcards
What is the diagnosis of hypertension?
>140/90 mmHg
confirmed with ambulatory blood pressure monitoring
What is Hypertesive urgency?
>180/110 mmHg
No end organ damage
with symptoms: anxiety, epistaxis, headache, SoB
What is hypertensive (malignant) emergency?
> 180/110 mmHg
End organ damage present
Symptoms of chest pain, encephalopathy
What is stage 1 hypertension?
140/90 mmHg
What is stage 2 hypertension?
160/100 mm Hg
Whate is stage 3 hypertension?
> 180/110
Rules for staging of hypertension:
+20 mmHg systolic per increase in stage, starts ot 140mmHg
+ 10 mmHg diastolic per increase in stage, starts at 90 mmHg
What does QRISK scoring do?
predicts the risk of a cardiovascular event.
>10% = 20 mmHg atorvastatin prophylaxis
Previous CVA then 80 mmHg atorvastatin
What is Conns syndrome?
A form of primary hyperaldosteronism.
Symptoms: hypertension, headaches.
Look for: increases aldosterone: renin, hypernatremia and hypokalemia
Treatment: spirolactone (aldosterone antagonist)
What is Addisons disease?
Reduction in release of glucocorticoids and mineralcorticoids.
Symptoms: darkening of the skin, abdo pain, wieght loss
Look for hyponatraemia and hyperkaleamia
ACTH reactivity? Synacthen test
What is cushingoid sydrome?
Increased corticosteroid production
Symptoms: hypertension, cushingoid apperence
What is phaeochromocytoma?
Adrenal tumour releasing adrenalin and noradrenalin.
Triad of headache, palpitaiton and sweating.
Also orthostatic hypertension
How do you calculate Cardiac output?
CO = SV x HR
How is Blood pressure calculated (physiologically no clinically)?
BP = CO x PVR
What is Frank-starlings law of the heart?
Stoke volume is propotional to venous return.
The greater the left ventricular end-diastolic volume the greater the force of contraction of cardiac myocytes.
What is the action of angiotenis II?
ADH release
Increase sympathetic activity
Efferent arterial constriction
Aldosterone release
NaCl reabasorption
What stimulate the release of renin from macular densa cells?
Adrenalin (via A1 receptors)
Renal hypotension
Decreased Na in distal tubules
What is the management of hypertension?
A - ACEi
C - Calcium channel blockers
D - diuretics
What artifacts can you see in hypertensive retinopathy?
Hard exudates
Cotton wool spots
papillodema
Flame haemorrhage
How does LVH appear on an ECG?
> 35 mm = S wave of L1 + biggest R wave of L5 or L6
May also see:
ST and T waves abnormalities.
Causes of secondary hypertension?
Renovascular disease
Chronic kidney disease
Hyperaldosteronism (Conns)
Stress
Sleep apnea - due hypoxia and hypercapnia
hyper/hypo- thyroidism
Pheochromocytoma
coarctation of the aorta - increase RAAS and baroreceptor desensitisation
What is the mechanism of action of Furosemide, Bumetenide, Toresemide ?
inhibit Na/K/2C symporter in the thick ascending loop of henlé, water is retained in the nephron for excretetion.
SE: Gout attack hypotension, Hypokaleamia and metabolic alkylosis
What is the mechanism of action of bendroflumethiazide, idapamide?
Inhibits the Na/Cl antiporter in the distal tubules. These are the more diuretics common.
SE: increase blood sugar, hyponatreamia hypokaleamia, increase attacks of gout, impotence.
What is the mechanism of action of amlodapine?
Dihydropyridines: effects L type calcium channels however is more selective for vascular smooth muscles than cardiac myocytes.
SE: headaches, relfex tachycardia, hypotension, edema (ankle swelling).
What is the mechanism of action of Verapami?
Non-dihydropyridine: acts on L-type calcium channel and is more selective for cardiac myocytes than vascular smooth muscle.
For arrythmias
Causes bradycarida with ß-blockers
SE: headaches, relfex tachycardia, hypotension, edema.
What is the mechanism of action of atenolol, bisoprolol?
Antagonists of ß2 receptors leading to decrease in cardiac output and renin release.
SE: bradcardia, postural hypotension, AV block, heart failure.
Contraindicatied in non-dihydropyridine calcium channel blockers and asthma.
What is the mechanism of action of ramipril and lisinopril?
Angiontensin converting enzme inhbitor stopping the synthesis of angiotensin II in the RAAS.
SE: dry cough (use AB), hypotension, hyperkaleamia
Contraindicated in pregnancy and bilateral renal failure or stenosis.
What is the target BP when being treated for hyertension?
135/85 mmHg under 80 years old
145/85 mmHg over 80 years old
What are ACEi contraindicated in?
renal failure stenosis
Carry out eGFR 1 week after starting ACEi
What does an increase in renin and aldosterone?
2nd aldosteronism
What does low renin and raised aldosterone indicate?
Primary aldosteronism
Target blood pressure for +80 years?
<150/90 mmHg
Target blood pressure for diabetics?
< 130/80 mmHg
What medication can be used for blood pressure in pregnancy?
Nifedipine - CCB and mineralcorticoid blocker
Labetalol - ß blocker
Methyl dopa - reduces dopamine production (further metabolism for Nor/adrenalin)
What is this?
medial fibromuscular dysplasia
aneurysmal and stenosed renal artery secondary to hypertension.
