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CR2 > Hypertension > Flashcards

Hypertension Flashcards

1
Q

Blood pressure

A

Force per unit area exerted by blood on arterial walls

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2
Q

When does blood pressure peak

A

Mid systole - systolic bp

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3
Q

When is blood pressure lowest

A

End of diastole - diastolic bp

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4
Q

What blood pressure value shows hypertension

A

140/90

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5
Q

What physiological determinants effect blood pressure

A

Cardiac output
Systemic vascular resistance

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6
Q

What impacts cardiac output

A

Heart rate
Diastolic blood volume
Heart contractility

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7
Q

What impacts systemic vascular resistance

A

Arterial blood vessel diameter
Function of vessel smooth muscle tone
Endothelial wall stiffness

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8
Q

What conditions can hypertension lead too

A

Hypertensive heart disease
Left ventricular hypertrophy
Dilated cardiomyopathy
Myocardial infarction
Hypertensive kidney disease
Hypertensive retinopathy
Haemorrhagic stroke
Ischaemic stroke

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9
Q

How does hypertension affect afterload

A

increases - HTN increases systemic vascular resistance

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10
Q

How is the heart remodelled to overcome increased afterload in hypertension

A

Left ventricular hypertrophy to produce higher end systolic pressure

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11
Q

What is left ventricular hypertrophy

A

Left ventricular wall thickens

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12
Q

What can left ventricular hypertrophy lead to

A

Diastolic myocardial dysfunction
Systolic myocardial dysfunction
Dilated cardiomyopathy
Congestive heart failure

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13
Q

What can occur is heart muscle is not well perfused

A

Myocardial ischaemia
Myocardial infarction
Arrhythmia

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14
Q

How are blood pressure and kidney damage linked

A

Kidneys have role in bp regulation

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15
Q

Which pre-existing conditions enhance susceptibility to accelerated renal damage from hypertension

A

Renal disease
Diabetes mellitus

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16
Q

What part of the kidney is damaged by hypertension

A

Nephron glomeruli

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17
Q

How do nephrons compensate for glomurular damage from hypertension

A

Vasodilation of afferent arterioles to incr renal blood flow and glomerular filtration

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18
Q

What does vasodilation of afferent arterioles lead to

A

Incr glomerular bloodflow and and filtration
Glomerular hypertension
Glomerular hyperfiltration
Progressive glomerular sclerosis

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19
Q

How does hypertension increase CVA risk

A

Large and medium vessel Atherosclerosis
Small vessel lipohyalinosis
Cardio-emboli stroke

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20
Q

How does hypertension cause atherosclerosis

A

Stress on arteries causes vessel damage where fats can build up

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21
Q

How does hypertension cause small vessel lipohyalinosis

A

Vessel walls damaged by lipid accumulation and decreased luminal diameter, increasing risk of rupture and bleeding

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22
Q

How does hypertension cause cardioembolic stroke

A

Increased afterload and atrial dilation lead to atrial fibrillation

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23
Q

What damage can hypertension cause in retinal blood vessels

A

Arteriolar narrowing and abnormalities where arterioles and venues cross
Haemorrhages from retinal capillaries

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24
Q

What are silver/copper wire arterioles in the eyes

A

Arterioles swell due to arteriolar narrowing and the centre shines due to reflected light

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25
Q

What are cotton wool spots in eyes

A

Haemorrhages from retinal capillaries

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26
Q

How many stages of hypertension are there

A

3

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27
Q

What bp values are stage 1 hypertension

A

Clinic - Systolic 140-159 and/or Diastolic 90-99
Ambulatory - systolic 135-149 and/or diastolic 85-94

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28
Q

What bp values are stage 2 hypertension

A

Clinic - systolic 161-180 and/or diastolic 100-119
Ambulatory - systolic 150 and/or diastolic 95

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29
Q

What bp values are stage 3 hypertension

A

Clinic systolic 180 and/or diastolic 120

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30
Q

What bp values show prehypertension

A

Systolic 120-139
Diastolic 85-89

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31
Q

What is isolated systolic hypertension

A

High systolic pressure, normal diastolic pressure

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32
Q

What is the most common form of hypertension in people over 65

A

Isolated systolic hypertension

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33
Q

What underlying conditions can cause isolated systolic hypertension

A

Artery stiffness
Hyperthyroidism
Diabetes
Heart valve problems
Obesity

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34
Q

Which arm should blood pressure be measured in

A

Both

35
Q

When may an automated bp device not get an accurate measurement

A

Pulse irregularity

36
Q

Measures to get an accurate bp reading

A

Patient seated for 5+ mins
Correct cuff size
Check pulse is regular
Check more than once
Check outside clinic

37
Q

Manual bp measuring method

A

Inflate 20-30mmHg above loss of radial pulse
Deflate 2mmHg per sec
1st sound = systolic bp
2nd sound = diastolic bp

38
Q

Primary hypertension

A

No obvious direct underlying pathological cause

39
Q

Secondary hypertension

A

Clear underlying cause

40
Q

Secondary hypertension causes

A

Renal disease
Renovascular disease
Endocrine disease
Coarctation of the aorta
Latrogenic

41
Q

Which enzymes are involved in the RAAS system

A

Renin
Angiotensin converting enzyme

42
Q

What physiological effect activates the RAAS

A

Decreased renal perfusion pressure

43
Q

What are the effects of the RAAS system

A

System pic vasoconstriction
Increased renal sodium reabsorption

44
Q

Natriuretic peptides

A

Peptide hormones synthesised by the heart

45
Q

Where is ANP synthesised

A

Atria

46
Q

Where is BNP synthesised

A

Cardiac ventricles

47
Q

What is released in response to atrial and ventricular dilation

A

Natriuretic peptides

48
Q

What do ANP and BNP cause

A

Vasodilation
Decreased renin
Increased glomerular filtration rate

49
Q

What hormones are released when bp increases

A

ANP
BNP

50
Q

What hormones are released in response to decreased BP

A

Local + systemic noradrenaline
Systemic adrenaline

51
Q

How do local noradrenaline, systemic noradrenaline, and systemic adrenaline increase bp

A

Incr heart rate
Incr myocardial contractility
Systemic vasoconstriction

52
Q

What are genetic impacts on hypertension risk

A

Sodium channels
Angiotensinogen
Aldosterone
ANP + BNP

53
Q

Non modifiable risks for hypertension

A

Age
Sex
Family history
Black ancestry

54
Q

Modifiable risks for hypertension

A

Weight
Activity
Salt
Stress
Alcohol
Smoking

55
Q

What is the DASH diet

A

Low fat, low meat, 8-10 fruit/veg, whole grains, low sodium

56
Q

What are the 3 parts of metabolic syndrome

A

Central obesity
Hypertension
Insulin resistance

57
Q

How does diabetes contribute to hypertension

A

Sclerosis
Increases SVR via -
atheroma formation
Hyperglycaemia
Disordered lipid profile
Vascular endothelium damage
Decr NO production

58
Q

Lifestyle modifications for hypertension patients

A

Potassium rich diet
DASH diet
Weight maintenance/loss
Exercise
Limit alcohol
Smoking cessation

59
Q

When should a hypertensive patient not have a potassium rich diet

A

Chronic kidney disease
On medication that reduces potassium excretion

60
Q

When should stage 1 hypertension be treated with drugs in under 80s

A

If patient has 1 or more of -
Target organ damage
Established CV disease
Renal disease
Diabetes
Estimated 10 yr risk of CV disease over 10%
Clinical judgement - frailty or multimorbidity

61
Q

What additional measures should be used for patients under 40 with hypertension

A

Specialist evaluation of secondary causes
Detailed assessment of long term treatment benefits and risks

62
Q

What are the main classes of hypertensive drugs

A

ACE inhibitors
Angiotensin II receptor antagonists
Calcium channel blockers
Diuretics
Beta blockers

63
Q

What drug class in enalapril

A

ACE inhibitor

64
Q

What drug class in losartan

A

Angiotensin II receptor antagonist

65
Q

What drug class is amlodipine

A

Calcium channel blocker

66
Q

What drug class is indapamide

A

Thiazide like diuretic

67
Q

What drug class is metoprolol

A

Beta blocker

68
Q

Why should ACE inhibitors and angiotensin II receptor antagonists not be used in pregnant or breastfeeding women

A

Teratogenic

69
Q

How many steps to hypertension treatment

A

4

70
Q

At what stage should hypertensive drug treatment be used

A

Stage 2
Stage 1 w comorbidities

71
Q

When should an ACE inhibitor or ARB be used in step 1 of HTN treatment

A

Type II diabetes
Aged under 55 and not black African/ Afro Caribbean origin

72
Q

When should a calcium channel blocker be used to treat stage 1 hypertension

A

Over 55 and no type 2 diabetes
Black African/ Afro Caribbean origin and no type 2 diabetes

73
Q

Can an ace inhibitor and ARB be combined for hypertension treatment

A

No

74
Q

What is given in step 2 treatment of a hypertension patient on an ACE inhibitor or ARB

A

CCB or thiazide like diuretic

75
Q

What is given in step 2 treatment of a hypertension patient on a CCB

A

ACE inhibitor or ARB or thiazide like diuretic

76
Q

What is given in step 3 hypertensive treatment

A

ACE inhibitor or ARB
CCB
Thiazide like diuretic

77
Q

What is hypertension regarded as if not controlled by step 3 treatment

A

Resistant hypertension

78
Q

How is resistant hypertension treated (step 4 treatment)

A

Fourth hypertensive drug or specialist advice

79
Q

How should resistant hypertension be confirmed before starting step 4 treatment

A

Confirm bp with ambulatory or home measurements

80
Q

What should be done if bp is not decreasing with treatment

A

Discuss medication adherence w patient
Discuss how meds are being taken w patient
Consider secondary causes

81
Q

What is evidence of end organ damage

A

Papilloedema
Retinal haemorrhage
Mental status changes
Chest pain
Dyspnoea
Acute heart failure
Acute kidney injury

82
Q

What is a hypertensive emergency

A

BP 180/120 +
Evidence of end organ damage

83
Q

How are hypertensive emergencies treated

A

Immediate specialist referral and/or hospital admission

84
Q

Why should BP 180-120+ with no evidence of end organ damage not be treated until repeat measurement taken

A

No evidence for benefit in rapid reduction
Aggressive therapy may cause cardiac, renal, or cerebral hypoperfusion

CR2 (33 decks)

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