Atherosclerosis and Hypertension Flashcards
Atherosclerosis is a progressive disease characterised by what?
Build up of plaque in arteries
What is atherosclerotic plaque formed from?
Fatty substances, cholesterol, cellular waste, calcium and fibrin
What is essential hypertension?
No underlying cause
What is secondary hypertension?
Underlying cause
What are clinical complications of atheroma?
Stenosis, thrombosis, embolism, aneurysm, dissection, ischaemia
What has to happen for atherosclerosis to form, and what gets exposed?
Endothelial injury- exposes collagen
Following endothelial injury, what accumulates and what is produced?
Lipids and macrophages accumulate and cell adhesion molecules are produced
Because of production of adhesion molecules, what attaches to endothelial cells?
Monocytes and T lymphocytes
What do macrophages do during formation of atherosclerosis?
Take up oxidised LDL
What is the last stage of atherosclerosis formation?
Migration of smooth muscle and increase in size
What are atheromatous plaques formed from?
Fatty substances, cholesterol, cellular waste, calcium, fibrin
As plaques increase in size, what happens?
Compromised blood flow and damage to the arterial wall
What is the progression of atheroma?
Fatty streak, fibrofatty plaque, complicated plaque, plaque rupture
What can even the presence of a plaque (before rupture) cause?
Angina, TIA, claudication
What does the rupture of a plaque cause?
MI, stroke, critical leg ischaemia
When is atheromatous narrowing of an artery likely to produce critical disease?
If it is the only artery supplying an organ/tissue
The artery diameter is small
Overall blood flow is reduced
What are 5 complications of atheroma?
Stenosis, thrombosis, embolism, aneurysm, dissection
What is arterial stenosis?
Narrowing of the arterial lumen with reduced elasticity
What does arterial stenosis cause?
Reduced flow in systole and tissue ischaemia
What is cardiac fibrosis?
Loss of cardiac myocytes and replacement by fibrous tissue
What does cardiac fibrosis cause?
Loss of contractility, elasticity and filling
What is an aneurysm?
Abnormal and persistent dilatation of an artery due to a weakness in its wall
What is an arterial dissection?
Splitting of the media by flowing blood leading to a false lumen filled with blood
What factors influence high blood pressure?
Age, sex and race
What is essential hypertension?
Rise in blood pressure of unknown cause
What is hypertension classed as?
> 140/90
What equation gives you BP?
CO x TPR
What is salt sensitive hypertension?
Increase in dietary salt leads to increase in BP
What is Conn’s syndrome?
Excess aldosterone
What is Cushing’s syndrome?
Excess corticosteroid
What is Pheochromocytoma?
Excess noradrenaline
In benign hypertension, every 10mmHg above 85 does what?
Doubles risk of MI and stroke
What does LVH lead to?
Increased LV load, poor perfusion, interstitial fibrosis, diastolic dysfunction
What is classed as malignant hypertension?
Diastolic pressure 130-140
What is pre-eclampsia?
Hypertension and proteinuria in pregnancy
What can pre-eclampsia lead to?
Eclampsia (seizures) which is a medical emergency
What should you offer if clinical BP is 140/90 or higher?
Ambulatory blood pressure monitoring to confirm diagnosis
What is stage 1 hypertension?
Clinic BP 140/90 or higher and ABPM/HBPM average is 135/85 or higher
What is stage 2 hypertension?
Clinic BP 160/100 or higher and ABPM/HBPM average is 150/95 or higher
What is severe hypertension?
Clinic systolic BP 180 or higher and clinic diastolic BP is 110 or higher
What is it known as when BP measures taken in clinic and at home are elevated?
Sustained hypertension
What is known as when BP measured as normal in clinic and elevated at home?
Masked hypertension
What is it known as when BP measured high in clinic and normal at home?
White coat hypertension
What intervention should be offered for stage 1 hypertension?
Lifestyle interventions and support on adherence and annual review
What intervention should be offered for stage 1 hypertension with target organ damage or high CV risk?
Offer drug treatment
What intervention should be offered for stage 1 hypertension aged < 40?
Consider specialist referral
What intervention should be offered for stage 2 hypertension?
Offer drug treatment
What is the target BP of a person under 80?
140/90
What is the target BP for a person aged 80+?
150/90
People with WCH and aged < 80 should aim for ABPM of?
below 135/85
People with WCH and aged 80+ should aim for ABPM of?
below 145/85
What is the definition of WCH?
A discrepancy of more than 20/10 between clinic and average ABPM at time of diagnosis
What are common causes of secondary hypertension?
Renal disease, obstructive sleep apnoea, aldosteronism
What are uncommon causes of secondary hypertension?
Cushing’s, pheochromocytoma, hyperparathyroidism, aortic coarctation, intracranial tumour
What are all the drugs which can be used for hypertension?
ACE inhibitor, ARB, Ca++ blocker, beta blocker, thiazide diuretic, spironolactone, alpha blocker
What should be done if a persons hypertension is not controlled by ACE inhibitor, Ca++ blocker and thiazide diuretic?
Consider further diuretic, beta blocker, alpha blocker or seek expert advice
What should be used for resistant hypertension?
Spironolactone
What is classed as resistant hypertension?
Hypertension not controlled by spironolactone
