Hypertension Flashcards
What is high blood pressure classed as? [1]
What calculation do you use to calculate BP? [1]
What is high blood pressure classed as? [1]
140/90 mm Hg
What calculation do you use to calculate BP? [1]
BP = Cardiac output (itself influenced by HR, diastolic filling & heart contractility) X systemic vascular resistance (arterial BV diameter)
Which organ is most directly effected by high BP?
Lungs
Heart
Kidneys
Eyes
Brain
Which organ is most directly effected by high BP?
Lungs
Heart
Kidneys
Eyes
Brain
Name 5 consequences of hypertension [5]
Hypertension:
Left ventricular hypertrophy
Myocardial infarction
Dilated cardiomyopathy
Stroke (haemorrhagic & ischaemic)
Hypertensive kidney disease
How does hypertension damage the heart?
- what changes to SVR occurs as a result of HTN? [1]
- What cardiac remodelling initially occurs because of result of HTN? [1]
- What subsequent cardiac remodelling occurs of prolonged HTN? [1]
HTN leads to increased systemic vascular resistance compared to normal in HTN.
Initially leads to:
- left ventricular hypertrophy (which is initially protective, but long term is damaging) to produce higher end systolic pressure to overcome increased afterload:
Longterm leads to:
- diastolic and (eventually) systolic dysfunction (as there is less space to in ventricle to pump blood out) leading to dilated cardiomyopathy/congestive heart failure
Long term HTN can lead to which pathologies? [3]
- If increased cardiac muscle is not well perfused myocardial ischaemia and myocardial infarction can follow.
- Conducting system also impacted –increasing risk arrythmias
what can left ventricular hypertrophy lead to? [3]
- dilated cardiomyopathy/congestive heart failure.
- If increased cardiac muscle is not well perfused myocardial ischaemia and myocardial infarction can follow.
- Conducting system also impacted: increasing risk arrythmias
Why does HTN cause viscious cycle with kidney disease? [1]
What is the mechanism for HTN & kidney disease? [1]
Why does HTN cause viscious cycle with kidney disease? [1]
Vicious cycle: – once kidneys damaged as they play role in BP regulation: Kidney disease increases blood pressure!
What is the mechanism for HTN & kidney disease? [1]
High BP damages glomeruli: sends more blood to remaining glomeruli (via vasodilation). But increased filtration causes more damage (Causes glomerular hypertension, glomerular hyperfiltration, and progressive glomerular sclerosis). Cycle repeats
HTN increases risk CVA in which three ways? [3]
Large and medium vessel atherosclerosis: stress on arteries causes endothelial damage and atherosclerosis
Lipohyalinosis: accumulation of lipids and decreased luminal diameter – increased risk rupturing and bleeding. Causes lacunar infarcts –> damage to middle cerebral arteries
Cardio-embolic stroke: Increases risk for atrial fibrillation (which increases clots) by causing increased afterload and atrial dilatation.
Hypertensive damage to the retinal blood vessels include? [2]
Arteriolar narrowing: Manifestations of these changes include ‘Silver or Copper wire’ arterioles where the centre of the (swollen) arteriole shines due to reflected light.
Haemorrhages from retinal capillaries. These show up in ophthalmoscope as blot & flame haemorrhages, ’cotton wool spots’
How do you measure hypertension? [2]
What are stage 1, 2 and 3 hypertension measurements? [3]
How do you measure hypertension? [2]
- Clinic & Ambulatory BP (daytime average) or Home BP
What are stage 1, 2 and 3 hypertension measurements?
Stage 1: Clinic: 140-159 / 90- 99 mmHg. Ambulatory: 135-149 / 85-94 mmHg
Stage 2: Clinic: 160-179 / 100-119 mmHg. Ambulatory: >150 / > 95 mmHg
Stage 3: Clinic: >180 / > 120 mmHg
Don’t need both systolic or diastolic measurements to be hypertensive for diagnosis, just one. xx
What are the BP ranges for isolated diastolic BP? [1]
Abstract. In various guidelines, isolated diastolic hypertension is defined as diastolic blood pressure >80 or >90mmHg in individuals with normal systolic blood pressure.
What is the difference between primary and secondary hypertension? [1]
Name 4 causes of 2ry HTN [4]
Primary HTN: no obvious direct underlying pathological cause; Strong polygenic familial trend. 90-95%
- *Secondary HTN:** clear underlying causes:
- Renal or renovascular disease
- Endocrine disease
- Coarctation of the aorta
- Iatrogenic (induced inadvertently by medical treatment or diagnostic procedures). eg. NSAIDs / hormones
Which major systems controls blood pressure and circulatory blood volume? [2]
RAAS system [1]
ANP (atrial natriuretic peptide) & BNP‘brain’ natriuretic peptide systems [1]
Sympathetic nervous system: baroreceptors in carotid sinus detect lower BP; stress –> causes release of nor
REVIEW YEAR 1 notes
Which factors, controlled by genes, influences increased BP? [4]
Which non-modfiable factors influences BP? [4]
Which modifiable factors influence BP? [6]
- *Gene controlled:**
- sodium channels
- Angiotensinogen
- Aldosterone
- ANP & BNP
- *Non modiafiable:**
- Age
- Sex (male)
- Black ancestry
- FHx
- *Modiafiable**:
- Weight
- Activity
- Salt
- Stress
- Alchohol
- Smoking
Why does obesity increase BP? [3]
- increased oxidative stress damages endothelium of BV: stiffer
- increased RAAS system
- increases sympathetic system
which all influence CVD and CKD, which themselves contribute to BP
Decision of how to treat HTN is guided by which factors? [3]
At which stage would you suggest immediate referall to specialist / admission to hospital for treatment with BP? [1]
Decision of how to treat HTN is guided by which factors? [3]
Degree of HTN
Co-morbidities: CVD, CKD, DM
End organ damage
At which stage would you suggest immediate referall to specialist / admission to hospital for treatment with BP? [1]
If BP >180/120 AND evidence of end organ damage
When do you start pharmalogical treatment for stage 1 hypertension? [6]
When do you start pharmalogical treatment for stage 2/3 hypertension? [1]
When do you start pharmalogical treatment for stage 1 hypertension?
1 or more of following:
- Target organ damage
- Established cardiovascular disease
- Renal disease
- Diabetes
- Estimated 10‑year risk of cardiovascular disease of 10% or more.
- Use clinical judgement for people with frailty or multimorbidity
When do you start pharmalogical treatment for stage 2/3 hypertension? [1]
- Straight away
What are the main classes of antihypertensives? [5]
ACE inhibitors:
Example: enalapril
Angiotensin-II receptor antagonists:
Example: losartan
Calcium-channel blockers:
Example: amlodipine
Diuretics:
Example: (thiazide-like diuretic) indapamide
Beta-blockers:
Example: metoprolol
Which antihypertensives should not be used for pregnant / breastfeeding women? [2]
ACE inhibitors
AT II receptor antagonists
What is Step One Treatment for HTN?
Offer ACE inhibitor or Angiotensin receptor blockers (ARBs) if have:
- type 2 diabetes
- under 55 but not black African / African-Caribbean
OR
Offer calcium-channel blocker (CCB) who:
- aged 55 or over AND no type 2 diabetes
- black African / African-Caribbean
What is Step Two Treatment for HTN?
- If already on ACE inhibitor? [2]
- If already on CCB? [3]
If on ACE inhibitor:
- Add CCB or thiazide-like diuretic [2]
If on CCB:
- Add ACE inhibitor or ARB or thiazide-like diuretic
What is Step Three Treatment for HTN? [3]
ACE inhibitor or ARB
&
CCB
&
Thiazide-like diuretic
What is step 4 treatment?
If hypertension is not controlled in adults taking optimal tolerated doses of an ACE inhibitor or an ARB plus a CCB and a thiazide-like diuretic, regard them as having resistant hypertension.
Before considering further treatment for a person with resistant hypertension:
Confirm elevated clinic blood pressure measurements using ambulatory or home blood pressure recordings.
For people with confirmed resistant hypertension, consider adding a fourth antihypertensive drug as step 4 treatment or seeking specialist advice.
What specifically about obesity causes increase in HTN? [1]
High leptin levels increase activity of RAAS and sympathetic NS
How do you treat hypertensive emergencies (180/120 or greater & organ damage)? [1]
What would you do if there was no target organ damage occuring despite the high BP of 180/120? [1]
How do you treat hypertensive emergencies (180/120 or greater & organ damage)? [1]
Immediate referral to specialist / A&E
What would you do if there was no target organ damage occuring despite the high BP of 180/120? [1]
Repeat clinic BP measuremtn within a week & if still elevated begin treatment
