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Year 3 - Medicine > Cardiology - Hypertension > Flashcards

Cardiology - Hypertension Flashcards

1
Q

What is stage 1 hypertension?

A

Clinic BP >140/90 mmHg

HBPM >135/85 mmHg

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2
Q

What is stage 2 hypertension?

A

Clinic BP >160/100 mmHg

HBPM >150/95 mmHg

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3
Q

What is severe hypertension?

A

Clinic BP >180/110 mmHg

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4
Q

If a patient presents with a blood pressure of:

a) 146/98 mmHg

b) 184/113 mmHg

what is the general management?

A

a) ambulatory monitoring or HBPM

b) commence treatment immediately

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5
Q

What are the symptoms of hypertension?

A

Usually asymptomatic finding, however in severe hypertension there may be symptomatic manifestations (e.g. headache).

Sweating, headache, palpitations and anxiety may indicate phaeochromocytoma.

Muscle weakness or tetany may indicate hyperaldosteronism.

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6
Q

What are the causes of hypertension?

A
  • idiopathic
  • Cushing’s syndrome
  • polycystic kidney disease
  • coarctation (radio-femoral delay)
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7
Q

How can hypertension be investigated?

A
  • HBPM or ABPM
  • urine sample (albumin:creatinine ratio, haematuria) to assess for kidney damage
  • bloods (U&Es, HbA1c and lipid profile)
  • 12-lead ECG
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8
Q

What are the target blood pressures for a patient who:

a) age <80yrs

b) has a history of diabetes, IHD or CKD

c) age >80yrs

A

a) <140/90 mmHg

b) <130/80 mmHg

c) <150/90 mmHg

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9
Q

What is the non-pharmacological management of hypertension?

A
  • weight reduction (if BMI >25kg/m2)
  • reduce salt intake
  • reduce alcohol intake
  • aerobic exercise
  • smoking cessation
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10
Q

What is the first line hypertension treatment in a patient:

a) aged 48yrs old, Caucasian

b) aged 58yrs old, Caucasian

c) aged 43yrs old, Afro-Carribean

d) aged 61yrs old, Afro-Carribean

A

a) ACEi (ramipril) or ARB (candesartan)

b) calcium channel blocker (amlodipine)

c) calcium channel blocker (amlodipine)

d) calcium channel blocker (amlodipine)

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11
Q

What is the second line hypertension treatment in:

a) aged 48yrs old, Caucasian

b) aged 58yrs old, Caucasian

c) aged 43yrs old, Afro-Carribean

d) aged 61yrs old, Afro-Carribean

A

a) ACEi or ARB + CCB or thiazide-like diuretic

b) CCB + ACEi or ARB or thiazide like diuretic

c) CCB + ACEi or ARB or thiazide like diuretic

d) CCB + ACEi or ARB or thiazide like diuretic

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12
Q

What is the third line hypertension treatment in:

a) aged 48yrs old, Caucasian

b) aged 58yrs old, Caucasian

c) aged 43yrs old, Afro-Carribean

d) aged 61yrs old, Afro-Carribean

A

a) ACEi or ARB + CCB + thiazide-like diuretic

b) CCB + ACEi or ARB + thiazide-like diuretic

c) CCB + ACEi or ARB + thiazide-like diuretic

d) CCB + ACEi or ARB + thiazide-like diuretic

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13
Q

What is the treatment of resistant hypertension?

A

Discuss adherence to treatment regime.

Confirm BP with ABPM or HBPM.

Consider seeking expert advice OR adding:

  • spironolactone if blood [K+] ≤4.5mmol/L
  • alpha-blocker or beta-blocker if blood [K+] >4.5mmol/L
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14
Q

What are some complications of hypertension?

A
  • ischaemic heart disease
  • cerebrovascular accident
  • hypertensive retinopathy
  • hypertensive nephropathy
  • heart failure
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15
Q

What is a hypertensive emergency?

A

An increase in blood pressure that, if sustained, will lead to irreversible end-organ damage.

Hypertensive emergencies are associated with a critical event, such as:
- encephalopathy
- pulmonary oedema
- AKI
- myocardial ischaemia

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16
Q

Name some fundoscopy signs that are suggestive of malignant hypertension?

A
  • silver wiring (walls of arterioles become sclerosed)
  • arteriovenous nipping (arterioles compress veins)
  • cotton wool spots (due to retinal ischaemia / infarct)
  • hard exudates (leaking lipids into the retina)
  • retinal haemorrhage (rupture of damaged vessels)
  • papilloedema (ischaemia to the optic nerve, resulting in optic nerve swelling and blurring of disk margins)
17
Q

How should a hypertensive emergency be managed?

A

Aim to reduce blood pressure to 110mmHg (diastolic) within 12 hours.

IV infusion of:
- sodium nitroprusside
- labetalol
- GTN
- esmolol

18
Q

What is hypertensive urgency?

A

An increase in blood pressure that, if sustained, will lead to irreversible end-organ damage.

Hypertensive urgency is NOT associated with a critical illness.

19
Q

How should a hypertensive urgency be managed?

A

Aim to reduce blood pressure to 100mmHg (diastolic) within 48 hours.

Oral regime of:
- nifedipine
- amlodipine

20
Q

What is a phaeochromocytoma?

A

A tumour of the adrenal glands, causing excessive release of adrenaline and noradrenaline.

These hormones agonise a1 receptors in the vasculature, causing vasoconstriction. This results in increase in TPR, thus BP increases.

They also agonise b1 receptors in the heart, increasing the inotropic contractility of the heart. This increases heart rate, thus increases cardiac output, thus increases BP.

21
Q

What are the symptoms of a phaeochromocytoma?

A
  • episodic headaches
  • sweating
  • tachycardia

Sustained or paroxysmal hypertension is the most common sign of phaeochromocytoma.

22
Q

What is the management of a phaeochromocytoma?

A

Surgical resection of adrenal tumour.

Pending surgery, a combined alpha- beta-adrenergic blockade (e.g. phenoxybenzamine) can be used to control hypertension.

23
Q

What is Cushing’s syndrome?

A

The over-secretion of cortisol by the adrenal glands, caused by either a functional pituitary adenoma or a tumour of the adrenal gland.

The excess cortisol has mineralocorticoid effects, increasing blood pressure.

24
Q

What are the symptoms / signs of Cushing’s syndrome?

A
  • apparent physical appearance
  • hypertension
  • hyperglycaemia
  • elevated 24hr urine cortisol excretion
  • low-dose dexamethasone suppression test confirms

Adrenal CT indicated if Cushing’s confirmed.

25
Q

What is primary hyperaldosteronism (Conn’s syndrome)?

A

A benign tumour of the adrenal glands, causing excess aldosterone release, causes a rise in blood pressure.

Aldosterone upregulates the expression of aquaporins, ENaC and ROMK in the collecting ducts of the kidneys, increasing water reabsorption and thus increasing blood pressure.

26
Q

What are the signs / symptoms of primary hyperaldosteronism?

A
  • low serum potassium and high sodium
27
Q

What are the signs / symptoms of primary hyperaldosteronism?

A
  • hypertension
  • hypokalaemia and hypernatraemia
  • morning aldosterone:renin (raised ratio, excessive negative feedback)
28
Q

What is hypertensive retinopathy?

A

Damage to the small blood vessels in the retina as a result of systemic hypertension (either chronic or malignant).

Year 3 - Medicine (33 decks)

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