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BDS3 Human Disease > Aetiology, pathology and treatment of Hypertension > Flashcards

Aetiology, pathology and treatment of Hypertension Flashcards

1
Q

What demographic are likely to have polypharmacy?

A

Older people

Over 75

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2
Q

What are complications of hypertension to the brain?

A

Haemorrhage

Stroke

Cognitive decline

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3
Q

What are the complications of hypertension to th eyes?

A

Retinopathy

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4
Q

What are the complications of hypertension to the blood vessels?

A

Peripheral vascular disease

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5
Q

Why is high BP bad for you?

A

Mechanical effect of sustained high BP directly affects arterial and capillary integrity

Esp. In heart, brain, kidneys and eyes

Regulatory dysfunction causing HTN may also have direct deleterious effects

E.g. direct catecholamines effect on heart

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6
Q

Effect of hypertension on the kidneys?

A

Renal failure

Dialysis

Transplantation

Proteinuria

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7
Q

Complication of hypertension on the heart?

A

LVH - left ventricle hypertrophy

CHD

CHF - congestive heart failure

MI

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8
Q

Reninopathy?

A

Bleeding at the back of the eye

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9
Q

What is the effect of 2mmHg rise in BP?

A

7% increase risk mortality from IHD

10% increase risk mortality from stroke

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10
Q

What BP is a pt hypertensive?

A

140/90

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11
Q

Normal BP?

A

<120/<80

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12
Q

Elevated BP?

A

120-129/<80

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13
Q

High normal BP?

A

130-139/80-89

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14
Q

Stage 1 hypertension?

A

140/90 in clinic or higher

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15
Q

Stage 2 hypertension?

A

160/100 mmHg or higher in clinic

ABPM daytime average 150/95 mmHg

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16
Q

Severe hypertension?

A

Systolic bp 180/120 mmHg

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17
Q

What is a more accurate way to measure BP?

A

ABPM Daytime average 135/85mmHg

Home monitor or given a monitor for a day

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18
Q

What BP does smoking add?

A

20/10 mmHg

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18
Q

What factors increase risk of hypertension?

A

Cigarettes
Diabetes
Renal disease
Male
Hyperlipidaemia
Previous MI or stroke
Left ventricular hypertrophy

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19
Q

How much does diabetes increase chance of MI?

A

5-30 times increase MI

20
Q

Are men more likely to have hypertension?

A

Yes 2 x more likely

21
Q

What controls bp?

A

Sympathetic

Renin angiotensin aldosterone systems

22
Q

Cardiac output?

A

Stroke volume x hr

23
Q

Prime contributors to BP?

A

Cardiac output

Peripheral vascular resistance

24
Q

What are the effects of the peripheral nervous system?

A

Vasoconstriction

Reflex tachycardia

Increased cardiac output

These all increase bp

25
Q

What stimulates Ras?

A

Fall in bp

Fall in circulating volume

Sodium depletion

26
Q

ACE inhibitor?

A

Ramipril

27
Q

What is a long term control of BP?

A

RAAS

28
Q

Describe the process of angiotensin II production

A

TheRAASisstimulatedby: – fall in BP
– fall in circulating volume – sodium depletion
* Anyoftheabovestimulatereninreleasefromthejuxtaglomerular apparatus which converts angiotensinogen to angiotensin I
* AngiotensinIisconvertedtoangiotensinIIbyangiotensinconverting enzyme (ACE)

29
Q

Can hypertension be genetic?

A

Yes, GRA gene turned on by endogenous steroid

30
Q

Factors affecting hypertension?

A

Age
Genetics and family history
Environment
Weight
Alcohol intake
Race
Birth weight
Sodium intake

31
Q

What are causes of secondary hypertension?

A

Chronic renal disease

Renal artery stenosis

Endocrine disease, Cushing, conn’s syndrome, GRA

32
Q

What is secondary hypertension?

A

5-10% of all hypertension has identifiable cause

Removal of the cause does not guarantee that the normal hypertension or risk will Truro to normal

Sustained hypertension produces end-organ damage to blood vessels, heart and kidney

33
Q

Drug induced secondary hypertension?

A

Nsaids
Oral contraceptive
Coricosteroids

34
Q

Endocrine system and hypertension?

A

Conn’s syndrome

Cushing disease

Hypo or hyperthyroidism

Acromegaly

35
Q

Vascular cause of secondary hypertension?

A

Coarctation of the aorta

36
Q

How to identify true hypertension?

A

ABPM ambulatory BP monitoring

Or HBPM home blood pressure monitoring

37
Q

How to assess risk of pt and hypertension?

A

Previous MI, stroke, IHD – Smoking
– Diabetes mellitus
– Hypercholesterolaemia
– Family history
– Physical Examination

38
Q

If it is difficult to assess risk of hypertension, wat do you use?

A

Assign risk calculator / Q risk

39
Q

What is teh target bp of a hypertensive pt?

A

<135/80-85 mmHg

40
Q

Why treat hypertension?

A

Reduce cerebrovascular disease by 40-50%

Reduce MI by 16-30%

41
Q

Teatment for a young person with high renin?

A

ACE inhibitor/ARB

42
Q

Treatment for elderly with low renin?

A

Calcium channel blocker

Thiazide - type diuretic

43
Q

Step 1 in tx if pt is under 55 years?

A

ACE1/ARB

44
Q

When do you not prescribe ACE1/ARB?

A

Afro-Caribbean
Women of child baring age

45
Q

Step 2 of tx for hy[ertension?

A

Add thiazide-type diuretic sch as inapamide to CCB or ACE1/ARB

46
Q

Step 3 or tx plan for hypertension?

A

Add CCB, ACE1, diuretic together

47
Q

Contraindications of ACE inhibitors?

A

Renal artery stenosis

Renal failure

Hyperkalaemia

BDS3 Human Disease (33 decks)

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