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Cardiovascular System > Aetiology and Pathophysiology of Hypertension > Flashcards

Aetiology and Pathophysiology of Hypertension Flashcards

1
Q

Organs that can be damaged by hypertension

A

Brain, heart, kidney, eyes (retinopathy), vessels (peripheral vascular disease)

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2
Q

Hypertension damage to the heart examples

A

Coronary heart disease
Congestive heart failure
Left ventricular hypertrophy

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3
Q

Hypertension definition

A

That blood pressure above which benefits of treatment outweigh the risks in terms of morbidity and mortality

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4
Q

Effect of increased blood pressure on risk of stroke and cardiovascular disease

A

Increases exponentially

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5
Q

Stage 1 hypertension blood pressure

A

140/90mmHg

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6
Q

Stage 2 hypertension blood pressure

A

160/100mmHg

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7
Q

Severe hypertension blood pressure

A

180/110mmHg

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8
Q

Percentage of hypertension that is primary

A

90%

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9
Q

Examples of causes of secondary hypertension

A 
Chronic renal disease
Renal artery stenosis
Endocrine disease
Cushings
Drug induced
Pregnancy - preeclampsia
Vascular - coarctation of aorta
Sleep apnoea
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10
Q

Hypertension indirectly and directly responsible for what percentage of deaths worldwide

A

> 20%

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11
Q

Risk factors of hypertension

A 
Cigarette smoking
Diabetes mellitus
Renal disease
Male
Hyperlipidaemia
Previous MI or stroke
Left ventricular hypertrophy
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12
Q

Aetiology of primary hypertension

A 
Age
Genetics and family history
Environment
Sodium intake and diet
Weight
Alcohol intake
Race
Birth weight
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13
Q

Likely physiological causes of hypertension

A

Increase reactivity of resistance vessels = increase TPR

Sodium homeostatic effect - sodium and so fluid is retained

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14
Q

Why does hypertension increase with age

A

Due to decrease arterial compliance

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15
Q

Number of genes recognised as important to hypertension

A

> 30 genes

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16
Q

White coat hypertension

A

People who are only hypertensive when they see their doctor

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17
Q

Environmental factors that can cause stress

A

Mental and physical stress

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18
Q

Most important non-pharmacological management of hypertension

A

Weight reduction

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19
Q

Difference in blood pressure between Caucasians and black populations

A

Caucasians have lower blood pressure than black populations

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20
Q

Methods to identify ‘true’ hypertension

A

Ambulatory blood pressure monitoring (ABPM)

Home blood pressure monitoring (HBPM)

21
Q

Nocturnal dip

A

When blood pressure is reduced at night

22
Q

Effect of nocturnal dip on risk of cardiovascular disease

A

Risk decreases

23
Q

Masked hypertension

A

Hypertensive but their blood pressure drops when they see the doctor, hiding it

24
Q

Guideline for treating someone with hypertension

A

Anyone with stage 1 hypertension and more than 10% risk of cardiovascular disease

25
Q

Target blood pressure for regular person who is hypertensive

A

<135/80-85mmHg

26
Q

Method of treatment of hypertension

A

Stepped approach - using low doses of several drugs

27
Q

Advantage of stepped approach

A

Minimises adverse events and maximises patient compliance

28
Q

Stepped approach

A

Adding new medication to current therapy until the target blood pressure is achieved

29
Q

Target blood pressure for elderly (over 80) who are hypertensive

A

<145/85mmHg

30
Q

Effect of ACE inhibitor

A

Inhibits the actions of angiotensin converting enzyme so angiotensin I is not converted to angiotensin II

31
Q

Contraindications to ACE inhibitors

A

Renal artery stenosis
Renal failure
Hyperkalaemia

32
Q

Adverse drug reactions of ACE inhibitors

A 
Cough
First dose hypotension
Taste disturbance
Renal impairment
Angioneurotic oedema
33
Q

Effect of angiotensin II antagonists (ARB)

A

Competitively blocks the actions of angiotensin II at the angiotensin AT1 receptor

34
Q

Examples of calcium channel blockers

A

Amlodipine/Felodipine - vasodilators

Verapamil/Diltiazem - rate limiting

35
Q

Contraindications of calcium channel blockers

A

Acute MI

Heart failure, bradycardia

36
Q

Adverse drug reactions of calcium channel blockers

A 
Flushing
Headache
Ankle oedema
Indigestion and reflux oesophagitis
Bradycardia
Constipation
37
Q

Examples of thiazide type diuretics

A

Indapamide

Clortalidone

38
Q

Mechanism of thiazide type diuretics

A

Urinary excretion of sodium

39
Q

Adverse drug reactions of thiazide type diuretics

A

Gout

Impotence

40
Q

Example of alpha-adrenoreceptor antagonist

A

Doxazosin

41
Q

Mechanism of alpha-adrenoreceptor antagonist

A

Selectively blocks post synaptic alpha1 adrenoreceptors

Oppose vascular smooth muscle contraction in arteries

42
Q

Adverse drug reactions of alpha-adrenoreceptor antagonists

A

First dose hypotension
Dizziness
Dry mouth
Headache

43
Q

Examples of centrally acting agents

A

Methyldopa

Moxonidine

44
Q

Mechanism of methyldopa

A

Converted to alpha methylnoradrenaline which acts on CNS alpha adrenoreceptors which decrease central sympathetic outflow

45
Q

Adverse drug reactions of methyldopa

A

Sedation and drowsiness
Dry moth and nasal congestion
Orthostatic hypotension

46
Q

Medication for hypertension during pregnancy

A

Nifedipine MR, methyldopa, atenolol, labetalol, thiazide diuretic, amlodipine

47
Q

Order of treatment for hypertensive patients under the age of 55 or Caucasian

A

ACE inhibitor, ARB, calcium channel blocker, Thiazide diuretic, extra other alternative (doxazosin, spironolactone)

48
Q

Order of treatment for hypertensive patients over the age of 55 or afrocaribbean or of child bearing age

A

Calcium channel blockers, ACE inhibitors or ARB, Thiazide diuretic, extra other alternative (doxazosin, spironolactone)

Cardiovascular System (27 decks)

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