hypertension Flashcards
what is a generalised and useful hypertension definition?
‘HT is that blood pressure at which the benefits of treatment with antihypersensitive drug reducing CV, cerebrovascular and peripheral vascular risk outweighs the risk of treatment
what is the NICE BP requirement for hypertension?
140/90
what are some of the morbidities associated with hypertension?
ischaemic heart disease and stroke (raised to 7% and 10% by just even increase by 2mmHg in BP) and 20mmHg doubles risk of CVD mortality
name some risk factors in hypertension
myocardial infarction, heart failure, stroke, CVD (accounting for 41% of ALL CVD deaths)
what is the requirement for stage 1 hypertension?
Clinic BP 140/90 or higher
ABPM daytime average 135/85 mmHg or higher
what is the requirement for stage 1 hypertension?
Clinic BP 140/90 or higher
ABPM daytime average 135/85 mmHg or higher (do ABPM monitoring which is continuous over the day for more reliability)
what is the requirement for stage 2 hypertension?
Clinic BP 160/100 or higher
ABPM daytime average 150/95 mmHg or higher
stage 3 hypertension?
Clinic systolic BP 180/120mmHg or higher
what are some of the most common secondary causes of secondary hypertension:
Chronic renal disease
Renal artery stenosis
Endocrine disease – Cushing’s, Conn’s syndrome ( Primary hyperaldosternism), Phaeochromocyoma
what is the risk factor with the highest mortality?
inactivity
what are the primary contributors to BP physiology?
CO = stroke vol. x heart rate, peripheral vascular resistance
what does the SNS do to peripheral vascular resistance and CO?
vasoconstriction - increased PVR
reflex tachycardia and increased SV (increased CO)
what does the the SNS stimulate the release of and what 2 things does this produce and their effect?
renin
it produces angiotensin 2 (a vasoconstrictor), think TENSE
aldosterone (causes salt and water retention which increases circulating blood volume)
what is the renin angiotensin-aldosterone system (RAAS) responsible for?
Maintenance of sodium balance
Control of blood volume
Control of Blood pressure
what stimulates the RAAS and where is renin released from in response to these?
fall in BP, circulating volume and sodium depletion
renin is released from the kidneys
write down the steps of RAAS in response to stimulation
Renin converts angiotensinogen to angiotensin I
Angiotensin I is converted to angiotensin II by Angiotensin converting enzyme (ACE)
Angiotensin II is a potent vasoconstrictor and stimulates the release of aldosterone from the adrenal glands.
the sodium homeostatic effect is one of the likely causes of hypertension, explain what is meany by this
kidneys are unable to secrete sodium and as a result it is retained and BP increases
what are the steps of diagnosing and then dealing with hypertension in a patient?
confirm diagnosis - assess risk factors - assess end organ damage
when should treatment for stage 1 hypertension be offered?
people younger than 80 with one or more of the risk factors and BP of 135/85
if younger than 40, assess for end organ damage
for elderly (55-80), target blood pressure is 145/85
when should stage 2 hypertension be treated?
if over 150/95
what treatment should patients over 55 or from African descent be treated with?
calcium channel blocker or thiazide
what should patients under 55 be treated with?
ACE inhibitor or ARB
note: do not give to pregnant or African people
How do Angiotensin Converting Enzyme Inhibitors (ACEI) work and give two examples?
they completely inhibit ACE which is helpful as this enzyme converts angiotensin 1 to active angiotensin which is a potent vasoconstrictor
ramipril and perindopril (any ending in -il)
when should ACEI not be used?
renal artery stenosis, impaired renal functioning, hyperkalaemia, and fertile women
