aetiology, pathology and treatment of hypertension Flashcards
whats the worlds number one cause of preventable morbidity and mortality?
hypertension
whats the UK number 1 preventable cause of premature mortality and morbidity?
hypertension
what are the compliations of hypertension (the affect on organs)?
brain:
haemorrhage, stroke, cognitive decline
eyes:
retinopathy
peripheral:
peripheral vascular disease
renal:
renal failure, dialysis, transplantation, proteinuria
heart:
coronary heart disease, congestive heart failure, left ventricular hypertophy
whta stresses effect blood pressure?
physical and mental
definition of hypertension?
That blood pressure above which the benefits of treatment outweigh the risks in term of morbidity and mortality
what is the BP and ABPM of a patient that is suffereing from stage 1 hypertension?
BP: 140/90
ABPM: 135/85
what is the BP and ABPM of a patient that is suffereing from stage 2 hypertension?
BP: 160/100
ABPM: 150/95
what is the BP and ABPM of a patient that is suffereing from severe hypertension?
systolic BP ois 180
diastolic BP is 110
how much of cases have not found a cause (primary hypertension?
90%
what are secondary hypertensions
a cause for hypertension for e.g.
chronic renal disease
renal artery stenosis
endocrine disease, cushings, conns syndrome,
what are risk factors of increasing the chnce of hypertension?
Cigarette smoking Diabetes mellitus Renal disease Male Hyperlipidaemia Previous MI or stroke Left ventricular hypertrophy
what controls blood pressure?
an integrated system
what are the prime contributers to blood pressures?
cardiac output- stroke volume, heart rate
peripheral vascular resistance
what does the sympathetic nervous system activation produce?
vasocontriction
reflex tachycardia
increased cardiac output
does the sympathetic nervous system activation increase blood pressure or decrease?
increase
what is The Renin-Angiotensin-Aldosterone System responsible for?
maintenance of sodium balance
control of blood volume
control of blood pressure
what is the RAAS stimulated by?
fall in BP
fall in circulating volume
sodium depletion
what does renin convert angiotensinogen to?
angiotensin I
what converts angiotensin I to angiotensin II?
angiotensin converting enzyme (ACE)
whats the function of angiotensin II?
vasoconstrictor
anti- natriuretic peptide
stimulator of aldosterone release from the adrenal glands
whats the aetiology of hypertension?
Increased reactivity of resistance vessels and resultant increase in peripheral resistance
A sodium homeostatic effect
Age Genetics and family history Environment Weight Alcohol intake Race
will removing the cause of hypertension decrease the risk or return back to normal?
not necessarily
causes for secondary hypertension?
Renal disease: 20% of resistant hypertension
Drug Induced
Pregnancy
Endocrine
Vascular
Sleep Apnoea
what things would be assessed when determining the risk of hypertension?
Previous MI, stroke, IHD Smoking Diabetes mellitus Hypercholesterolaemia Family history Physical Examination
Assess end organ damage
Screen for treatable causes
why do we treat hypertension?
reduce cerebrovascular disease by 40-50%
reduce MI by 16-30%
how do you treat stage 1 hypertension?
Offer antihypertensive drug treatment to people aged under 80 years with ABPM >135/85 with one or more of the following:
target organ damage
established cardiovascular disease
renal disease
diabetes
a 10-year cardiovascular risk equivalent to 20% or greater.
how do you treat stage 2 hypertension?
ABPM> 150/95
Offer antihypertensive drug treatment to people of any age with stage 2 hypertension.
whats the first step for choosing antihypertensive druug treatment?
Offer step 1 antihypertensive treatment with a calcium-channel blocker (CCB) to people aged over 55 years and to black people of African or Caribbean family origin of any age.
If a CCB is not suitable (oedema, intolerance), or if there is evidence of heart failure or a high risk of heart failure, offer a thiazide-like diuretic.
whats the second step for treatment for hypertension?
Add Thiazide-type diuretic such as clortalidone or indapamide to CCB or ACEI/ARB
step 3 for treatment of hypertension?
Add CCB, ACEI, Diuretic together
treatement of resistant hypertension
Consider further diuretic therapy with low-dose spironolactone (25 mg once daily) if the blood potassium level is 4.5 mmol/l or lower.
caution in people with a reduced estimated GFR because they have an increased risk of hyperkalaemia.
Consider higher-dose thiazide-like diuretic treatment if the blood potassium level is higher than 4.5 mmol/l. [new 2011]
what inhibits the actions of angiotensin converting enzyme?
RAMIPRIL
what is the function of angiotensin converting enzyme?
converts angiotensin I to active angiotensin II which is a potent vasoconstrictor and hypertetrophogenic agent
what plays a significant role in organ damage?
angiotensin II
what are the contraindications of angiotensin II?
Renal artery stenosis
Renal failure
Hyperkalaemia
what are the adverse reactions of angiotensin
cough first dose hypotension taste disturbance renal impairment angioneurotic oedema
what is the function of calcium channel blockers?
vasodilator and rate limiting
CCB work by…
blocking the L type calcium channels
selectivity between vascular and cardiac L type channels
relaxing large and small arteries and reducing peripheral
resistance
reducing cardiac output
who should you give CCBs to?
over 55years. women of child baring age Compliance is high, Benefit in the elderly patient with systolic Hypertension Rarely cause postural hypotension
what are contraindications of CCBs
Acute MI
Heart failure, bradycardia (rate limiting CCBs)
what are adverse drug reactions of CCBs
Flushing
Headache
Ankle oedema
Indigestion and reflux oesophagitis
what drug should you gibe to afro-caribbean?
thiazide
Indapamide, Clortalidone
whats the function of doxazosin?
Selectively block post synaptic 1-adrenoceptors
Oppose vascular smooth muscle contraction in arteries
what are the adverse reactions of doxazosin?
First dose hypotension
Dizziness
Dry mouth
Headache
what drug should you use for pregnant people?
METHYLDOPA
what are adverse reactions of methyldopa?
Sedation and drowsiness
Dry mouth and nasal congestion
Orthostatic hypotension
what is the treatment regime for hypertension if over 55 years?
If over 55years of age Start CCB No or incomplete effect Add Thiazide-type diuretic Incomplete effect Add ACE inhibitor Still incomplete effect Add Beta-blocker Still incomplete effect Add one of the less commonly used agents
what is the treatment regime for hypertension if young?
Start ACEI If child bearing age CCB or Beta Blocker No or incomplete effect Add Thiazide type diuretic Incomplete effect Add Calcium channel blocker Still incomplete effect Add Beta-blocker Still incomplete effect Add one of the less commonly used agents
what is the second most comon cause of maternal and fetal death?
hypertension
