HYPERTENSION Flashcards
what is considered normal bp>
between 90/60 and 120/80
what is considered stage 1 hypertension?
140/90 or higher
what is considered stage 2 hypertension?
160/100mmHg or higher
what is considered severe hypertension?
systolic >180mmHg or diastolic >1120mmHg
what are the 2 types of hypertension and which is most common?
primary (90%) and secondary (10%)
outline the difference between early and chronic hypertension?
in early hypertension we see increased blood volume and CO due to Na+ retention
in chronic hypertension the blood volume and CO are normal due to increased systemic vascular resistance caused by thickening of vessel walls and reduced lumen diameters
what is secondary hypertension?
raised bp with an identifiable undelrying cause
what are potential causes of secondary hypertension?
renal artery stenosis chronic renal disease primary hyperaldosteronism pheochromocytoma coarctation of the aorta pregnancy cushings disease thyroud disease alcohol
outline how renal artery stenosis can lead to secondary hypertension?
decreased pressure in afferent arteriole to the kidney so the kidney assumes bp is low and this causes release of renin. renin increases bp through angiotensin 2 and aldosterone increases.
what are exaples of 2 conditions that can damage the kidney?
diabetic nephropathy and glomerulonephritis
how does chronic renal disease cause secondary hypertension?
damage to the kidney decreases excretion of Na+ so we great retention leading to increased blood volume and CO
we also get renin release in an attempt to increase kidney perfusion and restore GFR
what is Conn’s syndrome?
primary hyperaldosteronism
how does Conn’s syndrome lead to secondary hypertension?
aldosterone acts in the DCT at the Na+/K+ exchanger so we get retaining Na+ and H2O and therefore an incrwase in bp
what is pheochromocytoma?
a rare adrenal medullary tumour that secretes catecholamines
how does pheochromocytoma cause secondary hypertension?
it secretes catecholamines which raise bp and cause tachycardia
what is coarctation of the aorta?
a narrowing of the aorta just after the subclavian artery
whats a diagnostic sign of coarctation of the aorta?
hypertension above the coaraction and normotension below it (feel femoral and radial pulse at the same time and there should be a radio-femoral delay)
whats the effect of hypertension on the heart?
concentric left ventricular hypertrophy
whats the effect of hypertension on the aorta?
risk of atheroma, aneurysm and aortic dissection
whats the effect of hypertension on the brain?
strokes
vascular demtnia risk
whats the efefct of hypertension on the kidneys?
glomerular damage
gradual parenchymal loss accelerate the kidneys decline in function
whats the effect of hypertension on the eyes?
hypertensive retinopathy - you may see papilloedema (swelling of optic nerve)
what is accelerate hypertension?
a recent significant elevation over the baseline blood pressure that is associated with target organ damage (>180 systolic and >120 diastolic)
usually seen as neurological, cardiovascular or renal damage
how may a hypertensive emergency present?
headaches fits nausea and vomiting visual disturbance chest pain neurological deficits microangiopathic haemolytic anaemia
whos most at risk for accelerate hypertension?
men
smokers
patients with secondary hypertension
whats the treatment for hypertension
ACEi
Ca2+ channel blockers
beta blockers
Diurretics
occasionally use alpha blockers
lifestyle changes
what are examples of ACEi?
captopril
enalapril
which calcium channel blockers are used for hypertension
amlodipine
nifedipine
felodipine
what are examples of beta blockers?
Propranolol and atenolol
what are examples of diuretics given to treat hypertension?
hydrochlorothiazide
chlorthalidone
indapamide
(thiazide)
