Hypertension 1

Question 1

Why is hypertension bad?

Answer 1

Its a preventable cause of morbidity and mortality

Question 2

What is hypertension a major risk factor for?

Answer 2

Stroke- ischaemic and hemorrhagic
Myocardial infarction
Heart failure
Chronic renal disease- kidneys control blood pressure through renal output- can cause 2ndary HT
Cognitive decline- brain has a very sensitive circulation- small vessel changes can cause chronic ischaemia
Premature death
also increases risk of atrial fibrillation

Question 3

When would it be suspected that someone has HT?

Answer 3

Clinical BP of 140/90 or higher

dont treat a single recording- need multiple

Question 4

What is ABPM and when is it used?

Answer 4

Ambulatory blood pressure monitoring
can confirm the diagnosis of HT
wear the cuff all the time- inflates every 30 mins
white coat HT= BP goes up in the clinic

Question 5

Difference between stages 1,2 and severe HT?

Answer 5

Stage 1:
BP of 140/90 & above in clinic, ABPM- 135/85
Stage 2:
BP of 160/100, ABPM- 150/95
Severe HT:
SBP- 180, DBP- 110

Question 6

What is primary hypertension? how is it treated?

Answer 6

There is no obvious cause of the HT- vast majority of patients
treatment:
lifestyle modifications
anti-hypertensive treatment

Question 7

What is secondary hypertension and what are its characteristics?

Answer 7

High BP is reflective of another issue 
indicative of:
endocrine disease (adrenal tumout)
cushings syndrome 
renal disease 
characteristics of the patient:
patient is young 
resistant BP- standard meds dont shift the BP
might have features of an underlying cause

Question 8

What are BP targets?

Answer 8

For under 80s= clinic BP of less than 140/90, ABPM of less than 135/85
issue with the elderly- have higher targets- because their arteries are less compliant- more stiff- systolic peak higher in these individuals- target slightly higher

Question 9

What are the mechanisms of BP control?

Answer 9

1. Cardiac output and peripheral resistance (arterial BP)- most people with HT have problems with peripheral resistance
2. Interaction between the RAAS and SNS
3. Local mediators- vasoconstriction and dilaton
   * majority of drugs effect RAAS-SNS

Question 10

How do you prevent angiotensin 2 causing vasoconstriction?

Answer 10

Renin inhibitors- inhibits conversion of angiotensinogen to angiotensin 1
ACE inhibitors- inhibits conversion of angiotensin 1 to angiotensin 2

Question 11

How does angiotensin 2 affect vascular growth?

Answer 11

Increases vascular growth

if you increase vascular mass- decrease the lumen and increase resistance

Question 12

What are other treatments for HT?

Answer 12

Beta-blocker- low priority in HT treatment
Alpha blockers- block alpha 1 receptors which cause vasoconstriction due to noradrenaline
can affect sympathetic nerves- centrally acting drugs

Question 13

How do renin levels differ in HT?

Answer 13

Some people- normal levels, others abnormally high

Afro-Caribbeans- low renin hypertension

Question 14

When are ACE inhibitors used, examples of drugs

Answer 14

HT
heart failure
diabetic nephropathy
ramipril, enalapril, perindopril, trandolapril

Question 15

What are ARBs, when are ARBs used, examples of drugs

Answer 15

ARBS are highly specific AT-1 receptor blockers
Use it in the same conditions youd use ACE inhibitors
HT, heart failure, diabetic nephropathy
drugs: candesartan, losartan, valsartan, irbesartan, telmisartan

Question 16

What are ARBs adverse effects

Answer 16

hypotension- especially in those who are volume depleted- esp heart failure- highly dependent on RAAS
hyperkalaemia
potential for renal dysfunction
rash
angio-oedema
NOT used in females who are childbearing age