Hypertension 1 Flashcards
What does it mean that cardiac disorders exist as a complex web?
They often lead to each-other
What are determinants of cardiovascular disorders?
- lifestyle
- genetics
how is blood pressure usually written?
systolic/diastolic
What is systolic blood pressure?
pressure while heart is contracting (maximum pressure)
What is diastolic blood pressure?
pressure while heart is filling (minimum pressure)
What is the pulse pressure?
Difference between systolic and diastolic pressure
What is hypotension and what could it be caused by?
decreased BP (could be caused by antihypertensive drugs acting too much)
What measurements do we use to quantify hypertension?
diastolic measurements
What are the different stages of hypertension?
- Stage 1, mild hypertension – 90-100 mmHg
- Stage 2, medium – 100-120 mm Hg
- Stage 3 – severe - >120 mm Hg
What is white code hypertension?
when someone is nervous about getting a blood pressure measurement and it goes up just because of presence of doctor
How are ambulatory blood pressure measurements carried out?
patient carries around a belt mounted device connected to cuff on their arm through the entire day giving measurements of blood pressure
How many hypertensive patients are adequately controlled and how many are at optimal blood pressure?
- 60% adequately controlled
- 10% at optimal blood pressure
Why is there an estimated 70 million untreated hypertensive patients in the world’s top 7 economies?
Maybe inadequate access to healthcare
Many people may not know they have hypertension – silent killer
What are primary and secondary hypertension?
- Primary (essential or idiopathic) hypertension – cause unknown
- Secondary hypertension – identified cause such as polycystic renal disease, renal artery stenosis and phaeochromocytoma (tumour of adrenal medulla – stimulates production of large quantity of adrenaline)
What may contribute to primary hypertension?
- Lifestyle contributors Obesity Insulin resistance High alcohol intake High sodium, low potassium intake Age - Genetic factors Up to 65% (twin studies) Around 10 genes identified that alter salt/water balance Other genes may affect obesity, alcohol use etc Epigenetics: maternal diet
What are consequences of hypertension?
- High sustained arterial BP increases mortality from:
Coronary artery disease
Stroke
Cerebral haemorrhage
Thrombosis (ischaemic) and thromboembolism
Heart failure (heart reacts to sustained increase in blood pressure by remodelling it’s muscle and becoming less efficient
What is the NICE care package for hypertension?
- Stage 1 hypertension (unless age>80, or organ damage)
Lifestyle interventions
Education, support, and annual monitoring
If under 40 get specialist referral - Stage 2 hypertension
Offer antihypertensive therapy in addition to lifestyle interventions
What are some lifestyle modifications that are suggested with hypertension?
- lose weight
- limit alcohol intake
- increase aerobic activity
- reduce sodium intake
- maintain K+ intake
- maintain Ca2+ and Mg2+ intake
- Stop smoking
- reduce dietary fat and cholesterol
What are first line and second line treatments?
- First line treatment: the drugs that are usually chosen as the initial treatment for a patient. If they don’t work then doctors will move on to second line treatments or may use adjunct treatments
- Second line treatments: What is tried next. If it is in addition to the first line treatment, then it is described as adjunct or adjuvant treatment
How do you work out blood pressure?
cardiac output x peripheral resistance
What is the basic principle in blood pressure control by drugs?
interfere with control mechanisms. But do not compromise cardiovascular reflexes
Are most patients taking one medication or more to treat hypertension?
More than one
What happened with the ASCOT trial?
(Anglo Scandinavian Cardiac Outcomes Trial)
- Compared amlodipine (+ perindopril) newish with atenolol (+ Bendroflumethiazide) older treatments
- Amlodipine – calcium channel blocker
- Perindopril – angiotensin converting enzyme inhibitor
- Atenolol – beta adrenoceptor antagonist
- Bendroflumethiazide – diuretic
- Two arms
1 arm – people were given amlodipine and supplemented with perindopril if needed additional help
2 arm – people were given atenolol and supplemented with Bendroflumethiazide if needed additional help
- Results
1. Blood pressure reduced in both arms of study
2. Reduced incidence of associated CV disease with amlodipine
3. Conclusion: Calcium channel blocker (+ ACE inhibitors) should replace ‘older’ treatments
Which trial underlies NICE recommendations?
ASCOT trial
What happened with the ALLHAT trials?
- Antihypertensive and Lipid-lowering treatment to prevent heart attack trial)
- Compared chlorthalidone (thiazide-like diuretic) with amlodipine or lisinopril (another angiotensin converting inhibitor)
- Results:
1. Blood pressure controlled in all three but chlorthalidone superior
2. Risk of heart attack similar with all three
3. Risk of some associated CVS lower with chlorthalidone
4. Conclusion: thiazide diuretic superior to calcium channel blockers or ACE inhibitors
What trial underlies American Association recommendations?
ALLHAT trial
What are the overall conclusions to do with the treatment of hypertension?
- Calcium channel blockers or ACE inhibitor or ATII antagonist or thiazide-like diuretic should be primary treatment
- May need to add in other drugs e.g. beta blocker
