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Year One - Cardiovascular System > Hypertension > Flashcards

Hypertension Flashcards

1
Q

What is hypertension?

A

It is a condition in which individuals have a chronically raised blood pressure

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2
Q

What is the normal blood pressure?

A

Systolic blood pressure = 90 – 140mmHg

Diastolic blood pressure = 60 – 90mmHg

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3
Q

What are the two main causes of hypertension?

A

Essential hypertension

Secondary hypertension

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4
Q

What cause of hypertension is more common?

A

Essential hypertension (95%)

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5
Q

What is another term for essential hypertension?

A

Primary hypertension

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6
Q

What is essential hypertension?

A

It means that the hypertension has developed on its own and does not have a secondary cause

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7
Q

What are the five risk factors of essential hypertension?

A

Family History

Increased Age

Black Ethnicity

Obesity

Alcoholism

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8
Q

What is secondary hypertension?

A

It means that the hypertension is due to secondary disease

It is important to note that the removal of the secondary cause doesn’t guarantee resolution of the hypertension, it will just improve blood pressure

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9
Q

What are the five secondary diseases that cause hypertension?

A

ROPED

Renal disease

Obesity

Pregnancy/Pre-eclampsia

Endocrine disease

Drugs

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10
Q

What four renal diseases are associated with secondary hypertension?

A

Glomerulonephritis

Chronic pyelonephritis

Adult polycystic kidney disease

Renal artery stenosis

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11
Q

What six endocrine diseases are associated with secondary hypertension?

A

Primary hyperaldosteronism

Phaeochromocytoma

Cushing’s syndrome

Liddle’s syndrome

Congenital adrenal hyperplasia (11-beta hydroxylase deficiency)

Acromegaly

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12
Q

What is the most common cause of secondary hypertension?

A

Primary hyperaldosternosim

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13
Q

What is the most common cause of primary hyperaldosteronism?

A

Bilateral adrenal hyperplasia

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14
Q

What is the first line investigation in suspected primary hyperaldosteronism?

A

Plasma aldosterone:renin ratio

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15
Q

What five drugs can cause secondary hypertension?

A

Steroids

Monoamine oxidase inhibitors

Combined oral contraceptive pill

NSAIDs

Leflunomide

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16
Q

In which patients should we consider secondary hypertension?

A

It should be considered in individuals who present with an acute onset of hypertension at a young age

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17
Q

How does hypertension typically present?

A

Asymptomatically

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18
Q

At what blood pressure reading can hypertension become symptomatic?

A

> 200/120 mmHg

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19
Q

What are the three clinical features of hypertension?

A

Seizures

Headaches

Visual disturbances

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20
Q

What three investigations are used to diagnose hypertension?

A

Clinic Blood Pressure Readings

24 Hour Ambulatory Blood Pressure

Home Blood Pressure Readings

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21
Q

What is a 24 hour ambulatory blood pressure?

A

It is 30 blood pressure measurements which are taken over 24 hours

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22
Q

What is the gold standard investigation used to diagnose hypertension?

A

Home blood pressure readings over a period of seven days, in which the patient records blood pressure readings morning and night

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23
Q

What clinical blood pressure result indicates prehypertension?

A

Systolic = 120-139mmHg

OR

Diastolic = 80-89mmHg

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24
Q

What clinical blood pressure result indicates stage one hypertension?

A

> 140/90mmHg

Systolic = 140 - 159mmHg

OR

Diastolic = 90 - 99mmHg

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25
Q

What ambulatory/home blood pressure result indicates stage one hypertension?

A

> 135/85mmHg

Systolic = 135 - 149mmHg

OR

Diastolic = 85 - 94mmHg

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26
Q

What clinical blood pressure result indicates stage two hypertension?

A

> 160/100mHg

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27
Q

What ambulatory/home blood pressure result indicates stage two hypertension?

A

> 150/95mmHg

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28
Q

What is white coat hypertension?

A

This is when patients have an elevated clinic blood pressure but normal ABPM/home blood pressure readings

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29
Q

How is white coat hypertension managed?

A

These patients don’t require treatment, however are more likely to develop hypertension in the future

30
Q

What is masked hypertension?

A

This is when patients have a normal clinic blood pressure but elevated ABPM

31
Q

What four investigations are conducted in hypertensive patients following a diagnosis? Why?

A

Bloods

ECG scan

Urinalysis

Fundoscopy

To assess for the development of complications - such as end-organ damage

32
Q

What three blood tests are conducted in hypertensive patients following a diagnosis?

A

U&Es

HbA1c

Lipids

33
Q

When is conservative management used to treat hypertension?

A

It is the first line management option in stage one hypertension

34
Q

In what five ways do we conservatively treat hypertension?

A

To Eat A Healthy Diet

To Reduce Salt Intake

To Exercise Regularly

To Reduce Alcohol Intake

To Stop Smoking

35
Q

When is pharmacological management used to treat hypertension?

A

It is the first line management option in stage two hypertension

It is also recommended when stage one hypertension patients develop target organ damage, established CDV, renal disease or diabetes

36
Q

What are the five pharmacological management options of hypertension?

A

ABCD

ACEIs/ARBs

Beta-blockers

Calcium channel blocker

thiazide Diuretics

37
Q

What is the mechanism of action of ACEIs?

A

They inhibit the conversion angiotensin I to angiotensin II

38
Q

What do all ACEIs end in?

A
  • ‘pril’
39
Q

What is the first line ACEI used to manage hypertension? What dose?

A

Ramipril

1.25mg up to 10mg once daily

40
Q

What are the three side effects of ACEIs?

A

Cough

Angioedema

Hyperkalaemia

41
Q

What is the most appropriate management step when ACEIs are not tolerated?

A

They should be stopped and switched for an ARB

42
Q

What investigation do we conduct in individuals on ACEIs? How often?

A

U&E blood tests

It should be conducted prior to administration

This should then be rechecked within 2 weeks of initiation or with any change of dose

Once the maintenance dose has been achieved, we conduct further U&E tests at 1, 3 and 6 months

43
Q

What U&E blood test result would indicate that ACEI patients need to consult a urologist?

A

Serum creatinine concentration increases by 30%

OR

eGFR decreases by 20%

44
Q

What is the mechanism of action of ARBs?

A

They block the effects of angiotensin II at the AT1 receptor

45
Q

What do all ARBs end in?

A

‘sartan’

46
Q

What is the first line ARBs used to manage hypertension? What dose?

A

Candesartan

8mg up to 32mg once daily

47
Q

What is the side effect of ARBs?

A

Hyperkalaemia

48
Q

What is the mechanism of action of betablockers?

A

They bind to beta-adrenoreceptors and thereby block the binding of noradrenaline

49
Q

What is the first line beta-blocker used to manage hypertension? What dose?

A

Bisoprolol

5mg up to 20mg once daily

50
Q

What are five side effect of beta-blockers?

A

Cold peripheries

Erectile dysfunction

Reduced hypoglycaemic awareness

Insomnia

Plaque psoriasis

51
Q

What is the mechanism of action of CBBs?

A

They block voltage-gated calcium channels relaxing vascular smooth muscle and force of myocardial contraction

52
Q

What is the first line CCB used to manage hypertension? What dose?

A

Amlodipine

5mg up to 10mg once daily

53
Q

What are the three side effects of dihydropyridine CCBs (amlodipine, nifedipine, felodipine)?

A

Flushing

Headache

Ankle swelling

54
Q

What are the four side effects of diltiazem?

A

Hypotension

Bradycardia

Heart failure

Ankle swelling

55
Q

What are the five side effects of verapamil?

A

Heart failure

Constipation

Hypotension

Bradycardia

Flushing

56
Q

What is the mechanism of action of thiazide diuretics?

A

They inhibit sodium absorption at the beginning of the distal convoluted tubule

57
Q

What is the first line thiazide diuretic used to manage hypertension? What dose?

A

Indapamide

2.5mg once daily

58
Q

What are the six side effects of thiazide diuretics?

A

Hyponatraemia

Hypokalaemia

Hypercalcaemia

Hypocalciuria

Dehydration

Digoxin toxicity

59
Q

What is step one for hypertension management?

A

In individuals less than 55 years old and non-black, we prescribe an ACEI

In individuals over 55 years old or black, we prescribe a CCB

60
Q

What is step two of hypertension management?

A

In individuals who are < 55 years old and non-black, we add a CCB to ACEI

In individuals who are > 55 years old and black, we add an ARB

61
Q

What is step three of hypertension management?

A

We administer ACEI, CCB and thiazide diuretics

62
Q

What is step four of hypertension treatment - in individuals who have a serum potassium > 4.5mmol/l?

A

We add an alpha or beta blocker

63
Q

What is a side effect of thiazide diuretics?

A

Hypokalaemia

64
Q

What is step four of hypertension treatment - in individuals who have a serum potassium < 4.5mmol/l?

A

We add a potassium sparing diuretic - spironolactone

65
Q

What is the mechanism of action of spironolactone?

A

It works by blocking the action of aldosterone in the kidneys resulting in sodium excretion and potassium reabsorption

66
Q

What does spironolactone administration increase the risk of?

A

Hyperkalaemia

67
Q

What other hypertensive drug increases the risk of hyperkalaemia?

A

ACEI

68
Q

What is the first line management option of hypertension in diabetics - regardless of age?

A

ACE Inhibitors

OR

ARBs

69
Q

What blood pressure reading do we aim for in hypertensive patients < 80?

A

< 140/90

70
Q

What blood pressure reading do we aim for in hypertensive patients < 80 - who also suffer from CKD or diabetes?

A

<130/80

71
Q

What blood pressure reading do we aim for in hypertensive patients > 80?

A

< 150/90

72
Q

What are the five complications of hypertension?

A

Ischaemic heart disease

Cerebrovascular disease

Hypertensive retinopathy

Hypertensive nephropathy

Heart failure

Year One - Cardiovascular System (20 decks)

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