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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
What ambulatory/home blood pressure result indicates stage one hypertension?
>135/85mmHg Systolic = 135 - 149mmHg OR Diastolic = 85 - 94mmHg
26
What clinical blood pressure result indicates stage two hypertension?
> 160/100mHg
27
What ambulatory/home blood pressure result indicates stage two hypertension?
> 150/95mmHg
28
What is white coat hypertension?
This is when patients have an elevated clinic blood pressure but normal ABPM/home blood pressure readings
29
How is white coat hypertension managed?
These patients don't require treatment, however are more likely to develop hypertension in the future
30
What is masked hypertension?
This is when patients have a normal clinic blood pressure but elevated ABPM
31
What four investigations are conducted in hypertensive patients following a diagnosis? Why?
Bloods ECG scan Urinalysis Fundoscopy To assess for the development of complications - such as end-organ damage
32
What three blood tests are conducted in hypertensive patients following a diagnosis?
U&Es HbA1c Lipids
33
When is conservative management used to treat hypertension?
It is the first line management option in stage one hypertension
34
In what five ways do we conservatively treat hypertension?
To Eat A Healthy Diet To Reduce Salt Intake To Exercise Regularly To Reduce Alcohol Intake To Stop Smoking
35
When is pharmacological management used to treat hypertension?
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
What are the five pharmacological management options of hypertension?
ABCD ACEIs/ARBs Beta-blockers Calcium channel blocker thiazide Diuretics
37
What is the mechanism of action of ACEIs?
They inhibit the conversion angiotensin I to angiotensin II
38
What do all ACEIs end in?
- 'pril'
39
What is the first line ACEI used to manage hypertension? What dose?
Ramipril 1.25mg up to 10mg once daily
40
What are the three side effects of ACEIs?
Cough Angioedema Hyperkalaemia
41
What is the most appropriate management step when ACEIs are not tolerated?
They should be stopped and switched for an ARB
42
What investigation do we conduct in individuals on ACEIs? How often?
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
What U&E blood test result would indicate that ACEI patients need to consult a urologist?
Serum creatinine concentration increases by 30% OR eGFR decreases by 20%
44
What is the mechanism of action of ARBs?
They block the effects of angiotensin II at the AT1 receptor
45
What do all ARBs end in?
'sartan'
46
What is the first line ARBs used to manage hypertension? What dose?
Candesartan 8mg up to 32mg once daily
47
What is the side effect of ARBs?
Hyperkalaemia
48
What is the mechanism of action of betablockers?
They bind to beta-adrenoreceptors and thereby block the binding of noradrenaline
49
What is the first line beta-blocker used to manage hypertension? What dose?
Bisoprolol 5mg up to 20mg once daily
50
What are five side effect of beta-blockers?
Cold peripheries Erectile dysfunction Reduced hypoglycaemic awareness Insomnia Plaque psoriasis
51
What is the mechanism of action of CBBs?
They block voltage-gated calcium channels relaxing vascular smooth muscle and force of myocardial contraction
52
What is the first line CCB used to manage hypertension? What dose?
Amlodipine 5mg up to 10mg once daily
53
What are the three side effects of dihydropyridine CCBs (amlodipine, nifedipine, felodipine)?
Flushing Headache Ankle swelling
54
What are the four side effects of diltiazem?
Hypotension Bradycardia Heart failure Ankle swelling
55
What are the five side effects of verapamil?
Heart failure Constipation Hypotension Bradycardia Flushing
56
What is the mechanism of action of thiazide diuretics?
They inhibit sodium absorption at the beginning of the distal convoluted tubule
57
What is the first line thiazide diuretic used to manage hypertension? What dose?
Indapamide 2.5mg once daily
58
What are the six side effects of thiazide diuretics?
Hyponatraemia Hypokalaemia Hypercalcaemia Hypocalciuria Dehydration Digoxin toxicity
59
What is step one for hypertension management?
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
What is step two of hypertension management?
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
What is step three of hypertension management?
We administer ACEI, CCB and thiazide diuretics
62
What is step four of hypertension treatment - in individuals who have a serum potassium > 4.5mmol/l?
We add an alpha or beta blocker
63
What is a side effect of thiazide diuretics?
Hypokalaemia
64
What is step four of hypertension treatment - in individuals who have a serum potassium < 4.5mmol/l?
We add a potassium sparing diuretic - spironolactone
65
What is the mechanism of action of spironolactone?
It works by blocking the action of aldosterone in the kidneys resulting in sodium excretion and potassium reabsorption
66
What does spironolactone administration increase the risk of?
Hyperkalaemia
67
What other hypertensive drug increases the risk of hyperkalaemia?
ACEI
68
What is the first line management option of hypertension in diabetics - regardless of age?
ACE Inhibitors OR ARBs
69
What blood pressure reading do we aim for in hypertensive patients < 80?
< 140/90
70
What blood pressure reading do we aim for in hypertensive patients < 80 - who also suffer from CKD or diabetes?
<130/80
71
What blood pressure reading do we aim for in hypertensive patients > 80?
< 150/90
72
What are the five complications of hypertension?
Ischaemic heart disease Cerebrovascular disease Hypertensive retinopathy Hypertensive nephropathy Heart failure

Year One - Cardiovascular System (20 decks)

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