Hypertension Flashcards
What is blood pressure?
It is the pressure of the blood exerted on the blood vessel walls
What is the name of the arterial sound which can be heard when measuring blood pressure indirectly?
Korotkoff sounds.
What is the definition of systolic and diastolic blood pressure?
Systolic: force of blood during contraction of the heart
Diastolic: relaxation of the heart, heart filling with blood in between beats
How do you find pulse using the systolic & diastolic pressure?
Difference between systolic & diastolic = pulse
What does BP = CO x TPR stand for?
Blood pressure = cardiac output x total peripheral resistance
What is the cut off reading for someone to be hypertensive?
> 140/90 mmHg
OR 150/90 mmHg if >80yrs
Why is hypertension known as a ‘silent killer’?
Because it is an asymptomatic condition, & symptoms only show when there is organ damage.
Volume & viscosity of the blood is an example of a determinant of blood pressure. What are some other determinants?
- Contraction of ventricles
- Resistance of arterial blood vessels
- Elasticity of arterial walls
What is the difference between Ambulatory BP Monitoring (ABPM), vs. Home BP Monitoring (HBPM)?
ABPM: measures BP for 24h on the arm using a small device.
HBPM: self-monitoring at home
How many stages are there for hypertension and what does this determine?
There are 3 stages. These stages determine which treatment the patient will receive.
What is white coat hypertension?
When a patients BP is only high when a health care professional is taking a reading.
What is pre-eclampsia?
It is high BP during a gestational (pregnancy) period.
What is the most severe form of hypertension?
Accelerated hypertension.
What are some examples of some conditions that hypertension is a major risk factor for?
- Stroke
- Myocardial infarction
- Heart failure
- Kidney disease
- Premature death
What is used to calculate a persons risk of developing a CV event within the next 10 years?
QRISK-3 calculator
What things should patients avoid while managing their hypertension?
- Alcohol
- Coffee/caffeine rich products
- Sodium intake
- Smoking
- Stress
What is the benefit of inhibiting the RAAS system?
It reduces peripheral vascular resistance & blood vol.
What do calcium channel blockers (CCB’s) do?
They inhibit Ca2+ influx into the myocytes, which is important in muscle contraction. This causes vasodilation & reduces heart rate.
What are some examples of CCBs?
Amlodipine, nifedipine
How do diuretics work?
They block Na+ reabsorption into the kidneys, so water follows & reduces blood vol.
How do b-blockers work?
They reduce the workload of the heart & vessels, resulting in a lower cardiac output and slower heart beats.
How do adrenergic inhibitors work?
They relax vascular smooth muscle which decreases peripheral resistance on the heart.
How do ACEi work?
ACEi: angiotensin-converting enzyme inhibitor
They block angiotensin II production, relaxing blood vessels & reducing BP.
They also decrease aldosterone secretion to decrease Na+/H2O retention.
How do angiotensin receptor blockers (ARBs) work?
They block aldosterone secretion and angiotensin II receptors.
This induces vasodilation which lowers BP & decreases Na+/H2O retention
What drug is never given with ARBs?
ACEi
What are some side effects associated with ACEi?
Headaches, dizziness, and a persistent dry cough.
What are some examples of ACEi?
Perindopril, ramipril (they all end in -PRIL)
What is the difference between non-dihydropyridines and dihydropyridines?
Dihydropyridines: they block Ca2+ channels in the blood vessels causing vasodilation
Non-dihydropyridines: they block Ca2+ channels in the heart causing a decreased heart rate
What is an example of a non-dihydropyridine?
Verapamil.
What are the 3 main types of diuretics?
- Loop diuretics
- K+ sparing
- Thiazides
Which type of beta receptor is found in the heart?
Beta-1 receptors.
What are some examples of b-blockers used?
Atenolol, bisoprolol, metoprolol (ending in -OLOL)
What system do alpha blockers work on, and what does this induce?
They work on the sympathetic nervous system, this induces vasodilation & a reduction in BP.
What is the ACD rule (used for <55years & non-black?)
A - ACEi or ARBs
C - CCBs
D - Diuretics
What are the steps of hypertensive treatment for >55yrs, or/& of black origin?
- CCB (1 drug)
- CCB + ARB or ACEi or thiazide (2 drugs)
- CCB + ACEi or ARB + thiazide (3 drugs)
What are some strategies which can improve drug adherence?
- Simplify drug regimen
- Start with small doses to lower risk of side effects
- Label prescriptions clearly
- Encourage calendars
