Hypertension Flashcards
What is hypertension?
Elevated Blood Pressure
List two criteria for the diagnosis of hypertension
2 high blood pressure readings in the outpatient setting OR
1 BP reading of >180/110mmHg
When is the diagnosis of hypertension made?
When the systolic and iastolic pressures have risen above the threshold that corresponds to the level of BP at which Cardiovascular complications and treatment benefits outweigh the treatment costs and potential side effects of therapy (if not treated)
List 7 pertinent diseases to r/o when elliciting the past medical history from a hypertensive patient
Stroke Myocardial Infacrtion PAD Hyperlipidemia Diabetes Kidey Failure Thyroid Disease
In the examination of the hypertensive patient, where should you listen for bruits?
Renal Arteries
3cm superior and lateral to umbilicus bilaterally
What is the difference between hypertensive emergency and urgency
Hypertensive emergency is characterized by the presence of acute end organ damage
How is Hypertensive Urgency treated
Treated as an outpatient, gradually reducing the blood pressure with oral antihypertensives
What value is considered elevated BP
120-129/80
What value is considered Stage 1 hypertension
130-139/80-89
What value is considered Stage 2 hypertension
> 140/90
What value is considered Hypertensive Crisis
> =180/110
What is the term used to describe the occurence when you have normal blood pressures at home but elevated blood pressures at the office or hospital
White Coat Hypertension
What is the GOLD STANDARD management for White Coat Hypertension Syndrome
Ambulatory BP test
WHat is Ambulatory BP test
Gold Standard for White Coat Hypertension Syndrome
Avg BP at night is taken, Avg BP at day is taken, AVG overall BP is taken and determined whether normal, elevated or hypertensive.
There is Primary and Secondary Hypertension, What percentage of hypertensive patient have primary ?
And Secondary?
Primary: 90-95%
Secondary: 5-10%
How do you determine that hypertension is secodary and not primary
- New onset <30yrs
- Sudden onset on controlled elderly pt >70yrs
- Symptoms of diseases that can cause hypertension
List 7 secondary causes of hypertension
Obstructive Sleep Apnea Cushing's Disease Hyper/Hypothyroidism Renal Disease Cushing's Disease Cushing's Syndrome Pheochromocytoma Drugs Pregnancy
3 signs of Obstructive Sleep Apnea
Daytime Somnolence
Snoring
Morning Headaches
Which organs may be damaged in hypertension?
Kidney
Eyes
Brain
Peripheral Vessels
List the four signs of Hypertensive Retinopathy
- Silver Wiring : arteriolar thickening
- Arteriovenous Nipping: Constriction of the veins where the artery crosses it
- Cotton Wool Spots/Exudate + Flame Haemorrhage: Retinal ischaemia
- Papilloedema: blurring of optic disc
List 5 groups of medication used to treat hypertension
ACEi (angiotensin converting enzyme 1) ARB (Angiotensin receptor blocker) CCB (Calcium channel blocker) Thazide like diuretic Vasodilators B-Blocker
List 2 beta and A1 blockers that are useful in hypertension
Labetalol
Carvedilol
List a vasodilator that is useful in treating hypertension, and one complication.
Hydralazine
SE: Lupus like reaction
List two diuretics that are used to treat hypertension and a side effect
Spirinolactone: gynacomastia
Eplerenone
What advantage does Eplerenone have over Spirinolactone when treating hypertensive males?
Eplerenone does not cause gynaecomastia unlike Spirinolactone
List 2 Angiotensin Recepton Blockers (ARB) that are useful in the hypertensive patient
Lasartan
Valsartan
List 1 Ca2+ Channel Blocker (CCA) that is useful in treating hypertension
Amlodipine
What is step 1 in “NICE GUIDELINES for treating hypertension”?
ACEi + ARB
OR
CCB
What is step 2 in “NICE GUIDELINES for treating hypertension”?
If the patient is on ARB + ACEi give them CCB additionally.
If the patient is on CCB add ARB+ACEi
What is step 3 in “NICE GUIDELINES for treating hypertension”?
Add a thiazide-like diuretic (Indapimide, metozalone)
What is step 4 in “NICE GUIDELINES for treating hypertension”?
1) Change diuretic to Aldactone (spirinolactone/Eplerenone)
2) Add Alpha Blocker
3) Add Vasodilator (Minoxidil)
This should be considered Resistant Hypertension
R/O Secondary Hypertension
List 5 lifestyle changes to be incorperated in the hypertensive patient
Potassium (K+)
rich fruit and vegetable intake
150 hrs /week exercise or 30 mins per day
5hrs restful sleep
List 4 signs of Cushing’s Syndrome
Moon Face
Buffalo Hump
Striae
Thinning fragile skin that bruises easily
What is Cushing’s Syndrome
1) Excess glucocorticoid secretion
2) Loss of feedback mechanism from hypothalo-pituitary-adrenal axis
3) Circadian Cortisol rhythym imbalace
What is Cushing’s Disease?
Benign adrenal hyperplasia from an ACTH (adrenocorticotrophic hormone) secreting pituitary adenoma
What is pheochromocytoma?
Catecholamine producing tumours in the adrenal gland
List the Pheochromocytoma Triad
Episodic Headache
Sweating
Tachycardia
List 4 drug groups that can cause hypertension
Acetaminophens
Decongestants
Antidepressants
NSAIDs
