Hypertension Flashcards

1
Q

What is hypertension?

A

Elevated Blood Pressure

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2
Q

List two criteria for the diagnosis of hypertension

A

2 high blood pressure readings in the outpatient setting OR

1 BP reading of >180/110mmHg

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3
Q

When is the diagnosis of hypertension made?

A

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)

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4
Q

List 7 pertinent diseases to r/o when elliciting the past medical history from a hypertensive patient

A
Stroke
Myocardial Infacrtion
PAD
Hyperlipidemia
Diabetes
Kidey Failure
Thyroid Disease
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5
Q

In the examination of the hypertensive patient, where should you listen for bruits?

A

Renal Arteries

3cm superior and lateral to umbilicus bilaterally

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6
Q

What is the difference between hypertensive emergency and urgency

A

Hypertensive emergency is characterized by the presence of acute end organ damage

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7
Q

How is Hypertensive Urgency treated

A

Treated as an outpatient, gradually reducing the blood pressure with oral antihypertensives

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8
Q

What value is considered elevated BP

A

120-129/80

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9
Q

What value is considered Stage 1 hypertension

A

130-139/80-89

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10
Q

What value is considered Stage 2 hypertension

A

> 140/90

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11
Q

What value is considered Hypertensive Crisis

A

> =180/110

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12
Q

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

A

White Coat Hypertension

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13
Q

What is the GOLD STANDARD management for White Coat Hypertension Syndrome

A

Ambulatory BP test

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14
Q

WHat is Ambulatory BP test

A

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.

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15
Q

There is Primary and Secondary Hypertension, What percentage of hypertensive patient have primary ?
And Secondary?

A

Primary: 90-95%
Secondary: 5-10%

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16
Q

How do you determine that hypertension is secodary and not primary

A
  • New onset <30yrs
  • Sudden onset on controlled elderly pt >70yrs
  • Symptoms of diseases that can cause hypertension
17
Q

List 7 secondary causes of hypertension

A
Obstructive Sleep Apnea
Cushing's Disease
Hyper/Hypothyroidism
Renal Disease
Cushing's Disease
Cushing's Syndrome
Pheochromocytoma
Drugs
Pregnancy
18
Q

3 signs of Obstructive Sleep Apnea

A

Daytime Somnolence
Snoring
Morning Headaches

19
Q

Which organs may be damaged in hypertension?

A

Kidney
Eyes
Brain
Peripheral Vessels

20
Q

List the four signs of Hypertensive Retinopathy

A
  1. Silver Wiring : arteriolar thickening
  2. Arteriovenous Nipping: Constriction of the veins where the artery crosses it
  3. Cotton Wool Spots/Exudate + Flame Haemorrhage: Retinal ischaemia
  4. Papilloedema: blurring of optic disc
21
Q

List 5 groups of medication used to treat hypertension

A
ACEi (angiotensin converting enzyme 1)
ARB (Angiotensin receptor blocker)
CCB (Calcium channel blocker)
Thazide like diuretic 
Vasodilators
B-Blocker
22
Q

List 2 beta and A1 blockers that are useful in hypertension

A

Labetalol

Carvedilol

23
Q

List a vasodilator that is useful in treating hypertension, and one complication.

A

Hydralazine

SE: Lupus like reaction

24
Q

List two diuretics that are used to treat hypertension and a side effect

A

Spirinolactone: gynacomastia

Eplerenone

25
Q

What advantage does Eplerenone have over Spirinolactone when treating hypertensive males?

A

Eplerenone does not cause gynaecomastia unlike Spirinolactone

26
Q

List 2 Angiotensin Recepton Blockers (ARB) that are useful in the hypertensive patient

A

Lasartan

Valsartan

27
Q

List 1 Ca2+ Channel Blocker (CCA) that is useful in treating hypertension

A

Amlodipine

28
Q

What is step 1 in “NICE GUIDELINES for treating hypertension”?

A

ACEi + ARB
OR
CCB

29
Q

What is step 2 in “NICE GUIDELINES for treating hypertension”?

A

If the patient is on ARB + ACEi give them CCB additionally.

If the patient is on CCB add ARB+ACEi

30
Q

What is step 3 in “NICE GUIDELINES for treating hypertension”?

A

Add a thiazide-like diuretic (Indapimide, metozalone)

31
Q

What is step 4 in “NICE GUIDELINES for treating hypertension”?

A

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

32
Q

List 5 lifestyle changes to be incorperated in the hypertensive patient

A

Potassium (K+)
rich fruit and vegetable intake
150 hrs /week exercise or 30 mins per day
5hrs restful sleep

33
Q

List 4 signs of Cushing’s Syndrome

A

Moon Face
Buffalo Hump
Striae
Thinning fragile skin that bruises easily

34
Q

What is Cushing’s Syndrome

A

1) Excess glucocorticoid secretion
2) Loss of feedback mechanism from hypothalo-pituitary-adrenal axis
3) Circadian Cortisol rhythym imbalace

35
Q

What is Cushing’s Disease?

A

Benign adrenal hyperplasia from an ACTH (adrenocorticotrophic hormone) secreting pituitary adenoma

36
Q

What is pheochromocytoma?

A

Catecholamine producing tumours in the adrenal gland

37
Q

List the Pheochromocytoma Triad

A

Episodic Headache
Sweating
Tachycardia

38
Q

List 4 drug groups that can cause hypertension

A

Acetaminophens
Decongestants
Antidepressants
NSAIDs