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Cardiology > Hypertension > Flashcards

Hypertension Flashcards

1
Q

What is normal BP

A

Systolic <120mmHg
Diastolic <80 mmHg

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2
Q

What is the BP is severe hypertension

A

Clinic:
Systolic 180 mmHg or higher
Or
Diastolic 110 mmHg or higher

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3
Q

What BP is stage 1 hypertension

A

Clinic:
Systolic 140 mmHg or higher
Diastolic 90 mmHg or higher

ABPM or HBPM daytime average: 135/85 mmHg or higher

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4
Q

What is stage 2 hypertension

A

Clinic:
Systolic 160 mmHg or higher
Diastolic 100 mmHg or higher

ABPM or HBPM daytime average: 150/95 mmHg or higher

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5
Q

What does high blood pressure do to the blood vessel walls?

A

Causes wear and tear to the endothelial wall, can develop tears (damage) -> MI, aneurysm, stroke

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6
Q

What is primary hypertension

A

Hypertension with no clear cause, pressure in arteries slowly increase

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7
Q

Risk factors for hypertension

A
  • Old age (>65)
  • Obesity
  • Salt-heavy diets
  • Inactive lifestyles
  • Smoking
  • Lots of alcohol and caffeine consumption

can be improved with lifestyle changes

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8
Q

What is secondary hypertension

A

Caused by an underlying issue e.g anything lowering renal blood flow (blood flow to kidneys)
Examples of what can limit blood flow to kidneys:
->atherosclerosis, vasculitis, aortic dissection
->fibromuscular dysplasia (thickening of arteries, mostly occurs in young women)

Also be caused by a tumour which produces excess aldosterone which also causes water retention (like renin)

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9
Q

How does low renal blood flow cause hypertension

A

Kidney secretes hormones REnin when there is not enough blood flow to it -> helps the kidneys REtain more water
That water contributes to more blood in arteries making them more full = higher pressure (hypertension)

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10
Q

What is a hypertensive crisis

A

Systolic pressure > 180mmHg
And/or
Diastolic pressure > 120mmHg

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11
Q

What are the two types of hypertensive crisis

A
  • Urgency:
    No damage to end organs e.g. the brain, kidneys, heat, lungs
    Emergency:
  • Damage to end organs
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12
Q

What are the symptoms of primary hypertension

A

Usually none (silent killer)

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13
Q

What are the symptoms of secondary hypertension

A

Variety of symptoms associated with underlying cause

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14
Q

What are the symptoms of emergency hypertension

A

Confusion
Drowsiness
Chest pain
Breathlessness

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15
Q

What are the first line treatment of hypertension

A

Lifestyle changes:
- diet
- exercise
- stress reduction

Antihypertensive medication

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16
Q

What is hypertension a big risk factor for?

A

Heart disease and stroke

17
Q

Home blood pressure monitoring (HBPM)

A
  • 2 consecutive seated measurements, 1 min apart
  • BP recorded twice a day for at least 4 days, preferably 7
  • measurements on 1st day discarded, average value for all remaining is used
18
Q

Ambulatory Blood Pressure Monitoring (ABPM)

A

At least 2 measurements per hour during the persons usual waking hours (usually 14 times per day)

19
Q

What is the white coat effect?

A
  • Patients exhibit hypertension only during a clinical visit
  • a discrepancy of more than 20/10mmHg between clinic and average ABMP or average HBPM
20
Q

How to asses cardiovascular risk and target organ damage e.g tests

A
  • Test urine for presence of protein
  • Take blood to measure: glucose, e;e truly tes, creatina, estimated glomerular filtration rate and cholesterol
  • Examine fundi for hypertensive retinopathy, Funduscopic examination
  • Arrange a 12-lead ECG
21
Q

Examples of established vascular disease which gives a >20% CV risk over ten years

A

Ischaemic heart disease
Verbo-vascular disease
Peripheral vascular disease
Diabetes

22
Q

What to do/ask on assessment

A
  • Medical history
  • Familial hypercholesterolemia (FH) - genetic disorder causing premature coronary vascular disease
  • Smoking
  • CV examination (pulses, bruits - ‘thrill’ or palpable vibratory sensation over vessel - turbulence)
  • Repeated BPs
    -or ABPM or home monitoring
  • Examine fundi? Carry out a funduscopy, usefulness is questioned
23
Q

What are the classifications of hypertensive retinopathy

A

Grade I - slight/modest narrowing of retinal arterioles
Grade II - modest-severe narrowing of retinal arterioles
Grade II - bilateral soft exudates (fluid that leaks out of blood vessels into nearby tissues) or flame shaped haemorrhages
Grade IV - bilateral optic nerve oedema

24
Q

After drug treatment, what is the target blood pressure in people aged under 80 in the clinic?

A

140/90 mmHg

25
Q

After drug treatment, what is the target blood pressure in people aged 80 and over in the clinic?

A

150/90 mmHg

26
Q

After drug treatment, what is the target blood pressure in people aged 80 and over when doing ABMP/HBPM?

A

Below 145/85 mmHg

27
Q

After drug treatment, what is the target blood pressure in people aged under 80 when doing ABMP/HBPM?

A

Below 135/85 mmHg

28
Q

What is polygenic scores (PRSs)

A

The sum of the risk conferred by multiple disease-associated single nucleotide variants across the genome

29
Q

What are examples of causes of secondary hypertension

A

Common:

  • Renal disease
  • Obstructive sleep apnoea
  • Aldosteronism
  • Reno-vascular disease

Uncommon:

  • Cushings
  • Phenochromocytoma
  • Hyperparathyroidism
  • Aortic coarctation
  • Intracranial tumor
30
Q

What is hypertensive retinopathy?

A

retinal vascular damage caused by hypertension

31
Q

What can hypertension be a risk factor for/what can it cause?

A
  • Retinopathy - complication of diabetes, damaging the back of the eye
  • heart disease
    - Left ventricular hypertrophy
  • heart attacks
  • strokes
  • heart failure
  • peripheral arterial disease
  • aortic aneurysms
  • kidney disease
    - Albuminuria/microalbuminuria - high level of albumin, sign of kidney disease
    - High creatinine levels
  • vascular dementia

Cardiology (20 decks)

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