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Cardiovascular > Hypertension > Flashcards

Hypertension Flashcards

1
Q

What is hypertension?

A

Is that blood pressure at which benefits of treatments with antihypertensive agents in reducing cardiovascular, cerebrovascular and peripheral vascular risk outweighs the risk of treatment

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2
Q

When does a person have hypertension?

A

140/90

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3
Q

What happens when there is a 2 mmHg rise in BP?

A

7% increase risk of mortality in IHD
10% increase mortality from stroke

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4
Q

What does an increase in BP of 20mmHg systolic and 10mmHg diastolic?

A

Doubles risk of CVD death regardless of age

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5
Q

What is hypertension a risk factor for?

A

MI, Heart failure, stroke, cardiovascular disease

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6
Q

What organ does hypertension affect?

A

Damages every organ
End-organ damage

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7
Q

What can make BP fluctuate during the day?

A

Physical and mental stress

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8
Q

What is stage 1 hypertension?

A

140/90 mmHg
ABPM daytime average of 135/85 mmHg or more

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9
Q

What is stage 2 hypertension?

A

160/100 mmHg
ABPM daytime average of 150/120 mmHg or higher

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10
Q

What is stage 3 or severe hypertension?

A

180/120 mmHg or higher

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11
Q

What is ABPM measurements?

A

30 measurements over the day or so
More accurate reflection of BP

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12
Q

What is primary hypertension?

A

No cause is identified - 80-90% of cases

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13
Q

What is secondary hypertension?

A

Can have chronic renal disease, renal artery stenosis or endocrine disease
More common in younger patients

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14
Q

What is the risk factors for hypertension?

A

Cigarette smoking, Diabetes, Renal disease, Male (2x), hyperlipidaemia, previous stroke and LV hypertrophy (2x)
Low fitness is main factor

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15
Q

What are the primary contributors to BP?

A

Cardiac output - CO=SV x HR
Peripheral vascular resistance

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16
Q

What does sympathetic system activation produce?

A

Vasoconstriction
Reflex tachycardia
Increased stroke volume

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17
Q

What does renin stimulation produce?

A

Produces angiotensin II and aldosterone
Angiotensin II - vasoconstrictor
Aldosterone - salt and water retention which increases the circulating blood volume

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18
Q

What is the RAAS responsible for?

A

Maintenance of sodium balance
Control of blood volume
Control of blood pressure

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19
Q

What is RAAS stimulated by?

A

Fall in BP
Fall in circulating volume
Sodium depletion
These stimulate release of renin from the juxtaglomerular apparatus

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20
Q

Explain the aetiology of hypertension?

A

Polygenic - major genes and poly genes
Polyfactorial - environment, individual and shared

21
Q

What is the likely causes of hypertension?

A

Increased reactivity of resistance vessels and resultant increase in peripheral resistance
Sodium homeostatic effect - kidneys unable to secrete appropriate amounts of Na for any given BP. Fluid is then retained so BP increases

22
Q

What are other factors that can cause hypertension?

A

Age, genetics and FH, environment, weight, alcohol intake and race

23
Q

Explain hypertension and age

A

BP tends to rise with age due to decreased arterial compliance
Treatment will reduce stroke and MI risk
Pragmatic approach as elderly more susceptible to adverse effects

24
Q

Explain hypertension and genetics

A

Hypertension can run in families
Closest correlation is between siblings
Environmental factors have a role in the development

25
Q

Explain environment and hypertension

A

Mental and physical stress increase BP
True stress - tend to be highly resistant to treatment
White coat hypertensives are at risk of CVD

26
Q

Explain alcohol and hypertension

A

Common causes in young men
Large amounts of alcohol increase BP
If reduce alcohol intake then BP will fall

27
Q

Explain weight and hypertension?

A

Obese patients have increased BP
Weight loss can produce a fall in BP
Most important non- pharmacological measure

28
Q

Explain birth weight and hypertension

A

Low birth weight is associated with higher likelihood of developing hypertension and heart disease in adulthood
Each Kg lost, 1-2mmHg higher

29
Q

Explain race and hypertension?

A

Caucasians have lower BP then African populations in same environment
Reasons are unclear
African populations seen as salt retainers so more sensitive

30
Q

What are the steps in treatment for hypertension?

A

Confirm diagnosis
Assess risk factors - calculator/ Q risk
Assess end organ damage

31
Q

How do you assess end organ damage?

A

ECG, Echocardiogram, proteinuria, renal ultrasound, renal function

32
Q

What are some treatable causes for hypertension?

A

Obesity, renal artery stenosis, endocrine causes, coarctation of aorta, drug induced and sleep apnoea

33
Q

Explain treatment for stage 1 hypertension?

A

Antihypertensive - if under 80 with one of: target end organ damage, renal disease, CVD, Diabetes
Under 40s - look for causes
Elderly - offer antihypertensive taking into account of co-morbidities

34
Q

What is the treatment for stage 2 hypertension?

A

Antihypertensive to people of any age

35
Q

What is step 1 of choosing antihypertensive?

A

Aged over 55 or black people f African/Caribbean descent - calcium channels blocker or thiazide like diuretic
Under 55 - ACE inhibitor or ARB. Careful with women of child bearing age

36
Q

What is step 2 and 3 of choosing antihypertensive drug treatment?

A

2 - add thiazide type diuretic to step 1 (Indapamide)
3 - Add CCB, ACEi and diuretic together

37
Q

What is step 4 for choosing an antihypertensive drug treatment?

A

Resistant hypertension
Unable to achieve target BP despite 3 or more agents
Consider compliance issues, high dose thiazide, or further diuretic therapy (spironolactone)

38
Q

What are some antihypertensive drugs?

A

Angiotensin converting enzyme inhibitors
Competitively inhibit the action of ACE - ACE converts angiotensin I to II which is a vasoconstrictor

39
Q

What are some contradictions to ACEi?

A

Renal artery stenosis
Impaired renal function
Hyperkalaemia
Fertile female

40
Q

What are some drug-drug interactions that can occur?

A

NSAIDs - precipitate acute renal failure
Potassium supplements/ potassium sparing diuretics - hyperkalaemia

41
Q

Explain angiotensin II receptor blockers

A

ARB ex. losartan, valsartan, candesartan
Inhibit action of angiotensin II at AT1 receptor
Advantage of ACEi - fewer side effects

42
Q

Describe some calcium channels blockers

A

Vasodilators - reduce peripheral vascular resistance. >55 and women of child bearing age
Rate limiting Ca2+ blockers - reduce HR and produce some vasodilation
Both block the L type Ca2+ channels in myocytes

43
Q

What are some adverse drug reactions to calcium channel blockers?

A

Flushing, headaches, ankle oedema, indigestion
Can be rate limiting as can also cause bradycardia and constipation

44
Q

What are some contraindications for CCB?

A

Acute MI
Heart failure
Bradycardia

45
Q

Describe thiazide type diuretics

A

Ex. Indapamide
First line therapy usually in people of African/ Caribbean origin
Can be used in combination with antihypertensive
Benefit in reducing risk of stroke and MI
Low doses so don’t cause significant diuresis

46
Q

What is thiazide type diuretics mechanism of action?

A

Enhances urinary excretion of sodium
Resistance vessel dilation - reduced resistance
Effect may take weeks
Side effects include gout and ED

47
Q

What are some less commonly used agents?

A

Alpha adrenoreceptor antagonist - Doxazosin which opposes smooth muscle contraction
Centrally acting agents - methylopa and moxonidine which can be used in pregnancy
Vasodilators - hydralazine and minoxidil

48
Q

Explain common treatment regime for age >55 or African/ Caribbean origin

A

Start CCB
Add thiazide diuretic
Add ACEi or ACE
Add beta blocker or alpha blocker
Add less commonly used agent

49
Q

Explain a common treatment regime for an under 55?

A

Start ACEi
Add thiazide diuretic
Add CCB
Add beta blocker
Add less commonly used agent

Cardiovascular (33 decks)

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