Essential or secondary hypertension Flashcards
Give the broad definition of hypertension:
the persistent evaluation of blood pressure in the systemic arterial circulation
In which ethnic groups is hypertension most common?
black African and African Caribbean
Why is it that women have a lower blood pressure at all ages until menopause?
female sex hormones protect against raised blood pressure
What is systolic blood pressure?
the peak arterial pressure during cardiac contraction
What is diastolic blood pressure?
the lowest arterial pressure during cardiac relaxation
Describe how blood pressure should be taken in clinical practice (2):
1) take after 5 minutes of uninterrupted rest with the back supported and legs uncrossed
2) you should take 2 or more subsequent BP readings and calculate the mean or take the lowest of them
What is an ambulatory measure of blood pressure?
portable device that measures BP across 24 hour periods often at 30 minute intervals, giving a broader average
What is combined hypertension?
where both systolic and diastolic blood pressure are elevated
What is isolated systolic hypertension:
where systolic blood pressure is elevated but diastolic blood pressure is decreased
What is orthostatic hypotension?
a sustained fall in blood pressure within 3 minutes of assuming an upright position of more than 20mmHg systolic or 10mmHg diastolic
What is primary hypertension?
raised blood pressure with no singular identifiable cause (90% of hypertension cases)
What is secondary hypertension?
Elevated BP with a specific cause
Give the equation for blood pressure:
BP=CO x TPR
What is resistant hypertension?
uncontrolled blood pressure despite the use of at least three separate antihypertensives
Give 4 lifestyle causes of hypertension:
- High salt intake
- Lack of exercise
- Alcohol
- recreational drug use
Name 3 drugs that can cause hypertension:
1) oral contraceptive pill
2) NSAIDs
3) corticosteroids
Name 4 causes of secondary hypertension using ROPE:
1) R: renal disease (increase in circulatory volume)
2) O: obesity
3) P: pregnancy
4) E: endocrine disorders
Name and explain 4 endocrine causes of hypertension:
- Hyperaldosteronism (increases salt and water retention)
- Pheochromocytoma (increased adrenaline increases BP)
- Cushing’s syndrome (cortisol increased blood glucose which increases the circulatory volume
- Acromegaly - growth hormone increases blood glucose which increases circulatory volume
What is pre-eclampsia?
pregnancy-induced hypertension with the presence of proteinuria
what are 2 symptoms of pre-eclampsia?
- Seizures
- Pitting oedema
Name 5 groups of anti-hypertensive drugs:
1) ACE inhibitors
2) angiotensin II receptor blockers
3) beta blockers
4) calcium channel blockers
5) diuretics
Give an example of a thiazide diuretic:
indapamid
Give an example of a potassium sparing diuretic:
Spironolactone
How do beta blockers reduce BP?
They stimulate vasodilation through renin inhibition
How do calcium channel blockers help reduce BP?
they stimulate peripheral vasodilation
Give two examples of calcium channel blockers:
- Amlodipine
- verapamil
How do ARBs and ACEi help to reduce BP?
they reduce angiotensin II mediated vasoconstriction
Give an example of an angiotensin II receptor blocker:
losartan
Define essential hypertension:
blood pressure of >140/90mmHg with no secondary cause identified
What blood pressure reading is considered ‘severe’ hypertension?
180/110mmHg
what is malignant hypertension?
Short onset hypertension with a systolic pressure over approx 180mmHg
Name 5 symptoms of malignant hypertension?
- Headache
- Visual disturbances
- Sweating
- Palpitations
- Symptoms of end organ damage
Describe a histological finding associated with malignant hypertension:
fibrinoid necrosis in blood vessels
Give 6 retinal signs of hypertension that may be seen during fundoscopy:
1) arteriolar narrowing
2) haemorrhages (blot, dot and flame)
3) microaneurysm
4) cotton wool spots (white patches)
5) hard exudate
6) papilledema (swelling of optic disc)
Give a common cardiac manifestation of hypertension:
left ventricular hypertrophy
How may left ventricular hypertrophy be identified upon palpation?
thrusting apex beat
Give 2 investigations for hypertensive kidney disease:
1) GFR
2) dip stick albumin
Give 5 lifestyle changes that can help reduce blood pressure:
1) regular cardiovascular exercise
2) increased intake of fruits and vegetables and reduced intake of saturated fat
3) reduced alcohol intake
4) weight reduction
5) reducing dietary salt intake
Which anti-hypertensive drug are those 55+ or black African patients started on?
calcium channel blockers
What anti-hypertensive drug are those younger than 55 started on?
ACEi or ARBs
What is classified as hypertensive?
BP >140 systolic or >90 diastolic.
What is mild hypertension?
Mild – >140 systolic or >90 diastolic
What is moderate hypertension?
Moderate – >160 systolic or >100 diastolic
What is severe hypertension?
180 systolic or >110 diastolic
