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Cardiology > HTN > Flashcards

HTN Flashcards

1
Q

Define HTN

A

HTN is defined as high arterial BP >140/90mmHg with increased CVD risk.

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2
Q

Name three body systems/mechanisms that helps regulate BP

A
  1. Autonomic System
  2. RAAS
  3. Neurohuromal factors e.g. adrenaline

etc

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3
Q

RF for HTN? (5)

A
  1. Age (strongest RF)
  2. Gender - Male up to 65y, Females after 65y
  3. Ethnicity - African American have a higher risk
  4. Lifestyle - Smoking, Alcohol, high salt intake diet, obesity, lack of exercise
  5. Anxiety and emotional stress
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4
Q

Pathophysiology of Essential HTN

A
  1. Genetic/environmental factors (1.) impair Na excretion or (2.) increase vascular resistance
  2. Inadequate Na excretion where more Na is retained and thus water, resulting in a blood volume overload.
  3. Increased vascular resistance will increase pressure in the vessels. Increased resistance also reduces renal blood flow, thereby activating RAAS. This together inc BP.
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5
Q

Pathophysiology of Secondary HTN and examples of causes.

A
  1. Mechanism depends on aetiology e.g. renal causes, endocrine causes, medications etc.
    (a) Atherosclerosis, vasculitis will lower renal blood flow. This causes the kidneys to secrete renin to retain water –> inc blood fluid volume –> inc BP
    (b) Tumour excreting excess aldosterone that secretes renin –> overstimulation of RAAS system
    (c) Cushing’s Syndrome - elevated catecholamines and causes elevation in BP.
    (d) Hypothyroidism - less T3 available results in inc vascular resistance. This reduces renal blood flow and activates RAAS.
    (e) Drugs - alcohol, cocaine, amfetamine, antidepressants
    (f) Iatrogenic
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6
Q

What is accelerated (or malignant) HTN? RF? Signs? Mx?

A
  1. Abnormally high HTN often >220/120mmHg
  2. RF = Essential/secondary HTN, Drug use, Neuroendocrine tumours
  3. Signs = headache, retinal haemorrhage, papilloedema
  4. HTN emergency = accelerated HTN with evidence of end-organ damage requires same-day assessment
  5. HTN urgency = severe HTN without organ damage

Mx

  1. BP reduced slowly over 24hrs to prevent hypoperfusion
  2. IV drugs - nitroprusside, beta-blockers, CCB are used.
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7
Q

Complications of HTN if untreated?

A

HTN damages arterial wall causing it to weaken and lose of elasticity, this will:

  • Inc risk of thrombus formation
  • Inc risk of aneurysm, that may rupture

Can lead to end-stage disease:

  • End-stage renal disease
  • MI
  • Congestive heart failure
  • Stroke
  • Papillioedema
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8
Q

Signs and Symptoms of HTN (go through types)

A
  1. Essential HTN patients are usually asymptomatic
  2. Secondary HTN - associated with underlying cause
  3. Emergency HTN - end-organ damage, Confusion, drowsiness, chest pain, breathlessness
  4. Signs of end-organ damage:
    - Nausea and vomitting
    - Renal - Proteinuria
    - Heart - Chest pain, LVH, MI, Congestive heart failure
    - Brain - Headache
    - Eye - Retinopathy, papilledema (severe), visual disturbances
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9
Q

How is a diagnosis of HTN made?

A
  1. Diagnosis of HTN made via BP reading at clinic and ABPM/HBPM.
  2. If clinical BP is >140/90mmHg, offer ABPM or HBPM to confirm diagnosis of HTN
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10
Q

What is ambulatory BP monitoring (ABPM)?

A
  1. Monitor pt’s BP changes throughout the day at home for 24h
  2. Ensure at least 2 readings/hour is taken during pt’s usual waking hours
  3. Use average of 14 measurements
  4. If ABPM is unsuitable/not tolerated offer HBPM.
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11
Q

What is home blood pressure monitoring (HBPM)?

A
  1. Ensure 2 consecutive measurements are taken at least one minute apart with person seated
  2. BP is recorded twice daily, ideally morning and evening
  3. BP recording continues for at least 4d, ideally 7d
  4. Take average to confirm diagnosis
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12
Q

How would you measure BP in clinic?

A
  1. If HTN is suspected, BP in both arms are checked
  2. If difference in reading is more than 15mmHg, repeat
  3. If difference remains more than 15mmHg after second attempt, use the higher BP reading
  4. If BP measured is >140/90 mmHg
  5. Take a second measurement during consultation
  6. If second measurement is substantially different from first take a third measurement.
  7. record the lower of the last two measurement as the clinic BP
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13
Q

What is white coat effect HTN?

A
  1. Raised BP in clinical but normal elsewhere

2. Discrepancy of >20/10mmHg between clinical and ABPM/HBPM BP measurements.

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14
Q

What is masked HTN?

A
  1. Normal BP in clinic but higher ABPM/HBPM at home
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15
Q

What is normal BP?

A
  1. <120/80mmHg

2. This varies with age and person

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16
Q

What are the BP values for Stage 1, 2, 3 HTN

A
  1. Stage 1 HTN = >140/90mmHg
  2. Stage 2 HTN = >160/110mmHg
  3. Stage 3 HTN = >180/110mmHg
17
Q

Investigations for HTN (5)

A

Investigations for target organ damage
1. Urinalysis: haematuria, proteinuria, CKD?

  1. Blood:
    - U+E, creatinine, eGFR = test for renal damage
    - glucose = hyperglycaemia
    - cholesterol = High cholesterol can lead to the development of fatty deposits in blood vessels
  2. 12-lead ECG: Assess Cardiac function, LVH, CAD.
  3. Fundus Examination
  4. Assess 10y CVD risk via QRISK
18
Q

What is the rationale behind treatment?

A

Rationale = Prevent causes of premature morbidity and mortality, as HTN is major RF for stroke, MI, HF, CKD, cognitive decline, premature death.

Main goal is to lower BP and get it in the following ranges:

  • Below 140/90mmHg
  • Below 150/90mmHg if over 80 years old (due to frailty)
  • Below 130/80mmHg if DM (lower due higher CVD risk),
19
Q

What is the treatment and management for HTN? (not looking stepwise tx in this Q)

A
  1. Lifestyle: diet, exercise, weight loss, reduce caffeine, smoking, alcohol.
  2. Antihypertensive treatment, only offered if:
    (a. ) <80yr stage 1 HTN WITH: Target organ damage, Established CVD, Renal disease, Diabetes, 10y CV risk of >20%
    (b. ) Offered to stage 2 HTN regardless of age
  3. Referral if:
    - Clinic BP of stage 3, severe HTN with:
    - Signs of retinal haemorrhage, papilloedema (accelerated HTN) or
    - Symptoms: new onset confusion, headache, palpitations, pallor, abdominal pain, diaphoresis, chest pain, signs of HF, or AKI.
    - Therapeutic problems
    - HTN in pregnancy
  4. Medical emergency if clinical BP >180/110mmHg
20
Q

When is antihypertensive offered?

A

(a. ) <80yr stage 1 HTN WITH one of the following:
- Target organ damage
- Established CVD, Renal disease, Diabetes
- 10-year CV risk of >20%

(b.) Offered to stage 2 HTN regardless of age

21
Q

Antihypertensive stepwise approach for <55years, non-black African or Caribbean

A
  1. ACEi
  2. ACEi + CCB
  3. ACEi + CCB + Thiazide-like diuretic
  4. Fourth antihypertensive/Consider referral
22
Q

Antihypertensive stepwise approach for >55years, black African or black Caribbean

A
  1. CCB
  2. CCB + Thiazide-like diuretic
  3. CCB + Thiazide-like diuretic + ARB
  4. Fourth antihypertensive/Consider referral
23
Q

When would ACEi not be advised?

A
  1. Black african or caribbean origin as it is ineffective
  2. Pts >55 years
  3. Pt develops cough
  4. Impaired renal function.
  5. Pregnancy - due to teratogenic effect
  6. ARB can be offered instead (do not cause cough)
24
Q

What is resistant HTN? How would it be managed?

A

Pt is regarded having resistant hypertension when they have poor response to all 3 antihypertensive drugs.

  1. Low-dose spironolactone - if K <4.5mmol/L
  2. Alpha-blocker or beta-blocker - if K >4.5mmol/L
25
Q

What would be used to treat HTN in pregnancy?

A
  1. Labetalol (alpha-blocker)

2. Methyldopa

26
Q

What causes Iatrogenic HTN?

A
  1. NSAIDs, antidepressants, steroids, immunosuppressants, anti-TNFs, oestrogen containing oral contraceptives
  2. Stimulants (alcohol or amphetamines[CNS stimulants])
  3. Supplements (ginseng, liquorice)
27
Q

What risks are associated with isolated HTN in older people?

A
  1. MI
  2. HF
  3. Stroke

Cardiology (19 decks)

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