8 - Hypertension

Question 1

What is the diagnosis of hypertension?

Answer 1

>140/90 mmHg

confirmed with ambulatory blood pressure monitoring

Question 2

What is Hypertesive urgency?

Answer 2

>180/110 mmHg

No end organ damage

with symptoms: anxiety, epistaxis, headache, SoB

Question 3

What is hypertensive (malignant) emergency?

Answer 3

> 180/110 mmHg

End organ damage present

Symptoms of chest pain, encephalopathy

Question 4

What is stage 1 hypertension?

Answer 4

140/90 mmHg

Question 5

What is stage 2 hypertension?

Answer 5

160/100 mm Hg

Question 6

Whate is stage 3 hypertension?

Answer 6

> 180/110

Question 7

Rules for staging of hypertension:

Answer 7

+20 mmHg systolic per increase in stage, starts ot 140mmHg

+ 10 mmHg diastolic per increase in stage, starts at 90 mmHg

Question 8

What does QRISK scoring do?

Answer 8

predicts the risk of a cardiovascular event.

>10% = 20 mmHg atorvastatin prophylaxis

Previous CVA then 80 mmHg atorvastatin

Question 9

What is Conns syndrome?

Answer 9

A form of primary hyperaldosteronism.

Symptoms: hypertension, headaches.

Look for: increases aldosterone: renin, hypernatremia and hypokalemia

Treatment: spirolactone (aldosterone antagonist)

Question 10

What is Addisons disease?

Answer 10

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

Question 11

What is cushingoid sydrome?

Answer 11

Increased corticosteroid production

Symptoms: hypertension, cushingoid apperence

Question 12

What is phaeochromocytoma?

Answer 12

Adrenal tumour releasing adrenalin and noradrenalin.

Triad of headache, palpitaiton and sweating.

Also orthostatic hypertension

Question 13

How do you calculate Cardiac output?

Answer 13

CO = SV x HR

Question 14

How is Blood pressure calculated (physiologically no clinically)?

Answer 14

BP = CO x PVR

Question 15

What is Frank-starlings law of the heart?

Answer 15

Stoke volume is propotional to venous return.

The greater the left ventricular end-diastolic volume the greater the force of contraction of cardiac myocytes.

Question 16

What is the action of angiotenis II?

Answer 16

ADH release

Increase sympathetic activity

Efferent arterial constriction

Aldosterone release

NaCl reabasorption

Question 17

What stimulate the release of renin from macular densa cells?

Answer 17

Adrenalin (via A1 receptors)

Renal hypotension

Decreased Na in distal tubules

Question 18

What is the management of hypertension?

Answer 18

A - ACEi

C - Calcium channel blockers

D - diuretics

Question 19

What artifacts can you see in hypertensive retinopathy?

Answer 19

Hard exudates

Cotton wool spots

papillodema

Flame haemorrhage

Question 20

How does LVH appear on an ECG?

Answer 20

> 35 mm = S wave of L₁ + biggest R wave of L₅ or L₆

May also see:

ST and T waves abnormalities.

Question 21

Causes of secondary hypertension?

Answer 21

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

Question 22

What is the mechanism of action of Furosemide, Bumetenide, Toresemide ?

Answer 22

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

Question 23

What is the mechanism of action of bendroflumethiazide, idapamide?

Answer 23

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.

Question 24

What is the mechanism of action of amlodapine?

Answer 24

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).

Question 25

What is the mechanism of action of Verapami?

Answer 25

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.

Question 26

What is the mechanism of action of atenolol, bisoprolol?

Answer 26

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.

Question 27

What is the mechanism of action of ramipril and lisinopril?

Answer 27

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.

Question 28

What is the target BP when being treated for hyertension?

Answer 28

135/85 mmHg under 80 years old

145/85 mmHg over 80 years old

Question 29

What are ACEi contraindicated in?

Answer 29

renal failure stenosis

Carry out eGFR 1 week after starting ACEi

Question 30

What does an increase in renin and aldosterone?

Answer 30

2nd aldosteronism

Question 31

What does low renin and raised aldosterone indicate?

Answer 31

Primary aldosteronism

Question 32

Target blood pressure for +80 years?

Answer 32

<150/90 mmHg

Question 33

Target blood pressure for diabetics?

Answer 33

< 130/80 mmHg

Question 34

What medication can be used for blood pressure in pregnancy?

Answer 34

Nifedipine - CCB and mineralcorticoid blocker

Labetalol - ß blocker

Methyl dopa - reduces dopamine production (further metabolism for Nor/adrenalin)

Question 35

What is this?

Answer 35

medial fibromuscular dysplasia

aneurysmal and stenosed renal artery secondary to hypertension.