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HDT 2.2 COPY > Hypertension > Flashcards

Hypertension Flashcards

1
Q

What is hypertension?

A

high blood pressure

140/90 is upper limit of normal

ABPM daytime average or home BP monitoring of 135/85 or higher

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2
Q

What does hypertension increase the risk of?

A
  • heart failure
  • coronary heart disease
  • stroke

largest single known risk factor for CV disease

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3
Q

What are the different stages of hypertension?

A
  • stage 1: BP in surgery higher than 140/90, ABPM or HBPM 135/85 - 149/94
  • stage 2: BP in surgery higher than 160/100, ABPM or HBPM higher than 150/95
  • stage 3: BP in surgery higher than 180/120
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4
Q

What are causes of secondary hypertension?

A
  • renal diseases
  • endocrine diseases
  • vascular causes
  • drugs (NSAID, oestrogens)
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5
Q

How to take a BP measurement?

A
  • use correct machine - manual or automatic
  • seated BP taken unless elderly
  • support arm with hand relaxed and cuff at heart level
  • measure BP in both arms, if persistent difference of >15mmHg then take the rest in the arm with higher BP
  • if pule irregular, use manual method
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6
Q

What to do with BP results?

A
  • if BP >140/90mmHg offer ABPM or b. HBPM
  • ABPM: take 2 or more readings every waking hour, and average minimum 14 measurements
  • HBPM: take two consecutive measurements while seated. Do this twice daily (morning and evening) over 4 or more days. disregard first, average rest
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7
Q

What are non-pharmacological responses to hypertension?

A
  • weight reduction if obese
  • diet - five portions of fruit and veg, brown rice, low fat foods, cut alcohol intake
  • smoking cessation
  • encouarge exercise
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8
Q

What do you investigate with hypertension?

A
  • check target organ damage
  • hypertensive retinopathy
  • perform blood tests - serum electrolytes, creatinine, eGFR
  • urinalysis
  • determine CV risk
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9
Q

How can you calculate the risk of CVD?

A

QRISK3

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10
Q

Whats the formula for blood pressure?

A

BP = CO x TPR

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11
Q

What diuretics can be used for hypertension?

A

thiazide like diuretics: chlortalidone, indapamide

loop diuretics: only if renal function significantly impaired

aldosterone antagonist: spironolactone - if resistant

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12
Q

What antagonists can be used for hypertension?

A
  • ACEi angiotensin converting enzyme inhibitor - ramipril, lisinopril
  • ARBS angiotensin II receptor blocker - losartan, candestartan
  • renin antagonist - aliskiren (add on therapy)
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13
Q

Whats the mechanism of an ACEi?

A

blocks conversion of Ang I to Ang II - vasodilation, potassium retention and inhibition of salt and water retention

block breakdown of bradykinin, a vasodilator (reason for dry cough)

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14
Q

What are common problems with ACEi and ARBs?

What monitoring is required?

A
  • cough, rash, renal failure, angiodema, hyperkalemia
  • first dose hypotension
  • postural hypotension
  • monitor renal function, potassium and BP before starting and during
  • monitor creatinine
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15
Q

What are beta blockers and examples?

A

block the action of adrenaline at beta receptors - decreased contraction and HR

eg bisoprolol, atenolol

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16
Q

What are the two types of beta adrenoreceptors and where are they found?

A

beta 1 - heart and kidney

beta 2 - lung, peripheral blood vessels and skeletal muscle

17
Q

What receptors are on kidney and what does blockage cause?

A

beta 1 - inhibit release of renin - decreased BP

18
Q

What receptors are on the heart and what does blockage cause?

A

beta 1 adrenoreceptors in the SAN - reduces HR

beta 1 adrenoreceptors in myocardium - decreases cardiac contractility

19
Q

What do beta blockers do to the nervous system?

A

inhibits release of neurotransmitters and decreases sympathetic activity

20
Q

What are common problems with beta blockers?

A
  • bronchospasm
  • bradycardia
  • Raynauds phenomenon
  • CNS effects
  • tiredness and fatigue
  • masking of hypoglycaemia in insulin dependent diabetes
  • hyperglycaemia
21
Q

Describe the use of alpha blockers in hypertension.

Mechanism, examples, effects

A

add on drugs

eg doxazosin

blocks peripheral alpha 1 receptors = vasodilation

first dose postural hypotension

22
Q

How do calcium channel blockers work?

Examples? with adverse effects?

A

block calcium channels, reducing influx into vascular smooth muscles = vasodilation and reduced BP

eg verapamil (SE constipation), diltiazem

HDT 2.2 COPY (18 decks)

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