Hypertension Flashcards

1
Q

Primary/Essential Hypertension

A

A blood pressure which is associated with significant cardiovascular risk

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2
Q

Causes of Primary/Essential Hypertension

A

Not really known - multifactorial

Obesity? - Angiotensinogen produced by adipocytes

Insulin Resistance?
Excessive Alcohol Consumption
Genetics? - Activity of RAAS
Environment?
Foetal Programming? Low birth weight?
Salt sensitivity?
Age? - Stiffening of aorta
Ethnicity?
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3
Q

Causes of Secondary Hypertension

A
Renal Disease
Renovascular Disease
Conn's Syndrome - Increased aldosterone levels where patient retains Na+ and thus fluid
Cushing's Syndrome
Hyperthyroidism
Phaeochromocytoma
Pregnancy
Drugs (NSAIDs, Corticosteroids, Sympathomimetics)

***Don’t memorise these

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4
Q

NICE Hypertension Treatment Targets

A

SBP < 140mmHg (<140mmHg in diabetes/<130 with complications)

DBP < 90mmHg (<80mmHg in diabetes)

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5
Q

Goals of hypertension treatment

A
Reduction in cardiovascular damage
Preservation of renal function
Limitation or reversal of LV hypertrophy
Prevention of Ischaemic Heart Disease
Reduction in mortality due to stroke & MI
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6
Q

Formula for BP

A

Cardiac Output x Total Peripheral Resistance

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7
Q

Role of ACEIs in hypertension treatment

A

Renin is produced when kidneys detect low BP, Na+ or sympathetic stimulation

This makes Angiontensin I which is converted to AII via ACE. This then controls BP by:

  • Reducing arterial and venous vasoconstriction
  • Reduced salt & water retention
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8
Q

What does RAAS have a very significant effect on

A

Blood Pressure

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9
Q

Effect of Bilateral Renal Artery Stenosis on RAAS

A

Increases renin production significantly, increasing BP

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10
Q

AT1 Receptor Antagonists

A

Block action of Angiotensin II at AT 1 Receptor

Similar effect to ACEis without cough as a side effect

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11
Q

Vasodilators/Ca2+ channel inhibitors for Hypertension treatment

A

Inhibit voltage operated Ca2+ channels on vascular SM
- Leads to vasodilation and reduction in TPR thus BP

Dihydropyridines (e.g. amlodipine) best for hypertension as they don’t depress cardiac tissue

Rate-limiting (e.g. verapamil) has greater effects on cardiac tissue

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12
Q

Diurtetics for Hypertension Treatment

A

Thazide-like (e.g. Indapamide)
- Second line antihypertensives

Inhibit Na+/Cl- in distal convoluted tubule
Reduction in circulating volume

Important Side Effects

  • Hyperkalaemia
  • Postural Hypotension
  • Impaired glucose tension
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13
Q

Alpha blockers

A

Last-line antihypertensives
- Widespread side effect

Competitive receptor antagonists of a1-adrenoceptors

e.g. Doxazosin, prazosin

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14
Q

Beta-blockers for hypertension treatment

A

Reduction in sympathetic drive to heart, reducing cardiac output and cuase a reduction in sympathetically evoked renin release

Some Beta-blockers are B1 selective (Atenolol) while others are B non-selective (Propranolol)

Blocks renin from juxtaglomerular cells
May block bronchial B2 receptors - contraindicated in Asthma and caution in COPD

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15
Q

Adverse Effects of ACEIs

A

Cough
Severe first dose hypertension
Renal Damage

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16
Q

Adverse Effects of Calcium Channel Blockers

A
Peripheral Oedema (e.g. swollen ankles) as they cause vasodilation of small arterioles
Postural Hypotension
Some constipation
17
Q

Adverse Effects of Thiazides

A

Diabetogenic
Alter Lipid Profile
Hypokalaemia
Postural Hypotension

18
Q

Adverse Effects of Beta Blockers

A

Bronchospasm

19
Q

Adverse Effects of Alpha-blockers

A

Widespread
Postural hypotension

(affects sympathetic control of BP)

20
Q

Lifestyle changes to treat hypertension

A
Alcohol consumption should be reduced
Weight Reduction
Avoiding excess caffeine
Reducing fat and salt intake
Increasing fruit & oily fish in diet
Increasing exercise
21
Q

Importance of smoking cessation in hypertension treatment

A

Smoking does not increase BP, but it does increase risk of cardiovascular incidents

22
Q

Choice of antihypertensive in diabetics

A

ACE Inhibitors

23
Q

Choice of antihypertensive in ischaemic heart disease

A

Beta Blockers

24
Q

Choice of antihypertensive in patients with CHF

A

ACE Inhibitors

25
Q

Treatment of Hypertension with:
Type 2 Diabetics
<55 years & non-black

A

Step 1
ACEi/AT1 RA

Step 2
ACEi/AT1 RA + CCI or Diuretic

Step 3
ACEi/AT1 RA + CCI + Diuretic

Step 4
Referral, Add spironolactone, a-blocker or Beta blockers

**ACD Guidance

26
Q

Treatment of Hypertension for patients >55 years or black

A

Step 1
CCI

Step 2
CCI + ACEi/AT1 RA or Diuretic

Step 3
CCI + ACEi/AT1 RA + Diuretic

Step 4
Referral, Add spironolactone, a-blocker or Beta blockers

**ACD GUIDANCE

27
Q

Centrally Acting Antihypertensives

A

Act on brain to reduce BP

Types
Alpha-methyl dopa: False substrate result in an analogue of NA acting at central a2-adrenoceptors
- Used to treat hypertension in pregnancy as it is safe to use

Moxonidine: An imidazoline which activates central imidazoline receptors

Clonidine: a2-adrenoceptor agonist which acts centrally to decrease sympathetic output

***They’re really not that important don’t stress about them

28
Q

What anti-hypertensives are very contraindicated in pregnancy

A

ACE Inhibitors