Hypertension Flashcards
Define hypertension
Blood pressure at which the benefits of treatment with antihypertensive agents in reducing cardiovascular, cerebrovascular and peripheral vascular risk outweighs the risk of treatment.
wordy but just read it
What BP indicates a person has hypertension?
140/90
What increase in BP doubles a persons risk of CVD death, regardless of age?
An increase in BP of 20mmHg systolic and 10 mmHg diastolic above ideal
Does BP stay fairly steady throughout the day?
No, it fluctuates
What can contribute to hypertension?
Physical stress
Mental stress
When is BP classified as stage 1 hypertension?
Clinic BP 140/90 or higher
ABPM daytime average 135/85 mmHg or higher
When is BP classified as being stage 2 hypertension?
Clinic BP 160/100 or higher
ABPM daytime average 150/95 mmHg or higher
When is BP classified as being stage 3 hypertension?
Clinic systolic BP 180/120mmHg or higher
What is the most reliable measurement of BP?
ABPM as gets 30 readings a day
What % of cases are primary hypertension with no cause?
80-90%
What are some of the causes of secondary hypertension?
Chronic renal disease
Renal artery stenosis
Endocrine disease
Is secondary hypertension more common in older or younger patients?
Younger
If a patient <40 has hypertension, what should be done?
They should be referred to a specialist
What are some of the risk factors for hypertension?
Smoking
Diabetes
Renal disease
Male
Hyperlipidaemia
Previous storke/MI
LV hyperterphophy
Those with diabetes are how much more at risk?
5-30 x more risk
Males are how many times more at risk?
2x
If an individual have LV hypertrophy, how much greater is their risk?
2x
What are the primary contributors to BP?
Cardiac output (SV x HR)
Peripheral vascular resistance
What are the three things the sympathetic NS can cause to happen?
- Vasocontraction
- Reflex tachycardia
- Increased SV
What does the SNS cause to release?
Renin
What does the release of renin in turn release?
Angiotensin 1 and 2
What is the role of angiotensin 2?
Is a vasoconstrictor
What does aldosterone do?
Causes salt and water retention which increases the circulating blood volume
What is RAAS essential for?
-renin angiotensin-aldosterone system
Maintenance of sodium balance
Control of blood volume
Control of Blood pressure
What is the RAAS stimulated by?
Depletion of sodium
Fall in BP
Fall in circulating volume
Where is renin released from?
Juxtaglomerular apparatus
What does renin do?
Converts angiotensinogen to angiotensin 1
What converts angiotensin 1 to angiotensin 2?
Angiotensin converting enzyme (ACE)
What does angiotensin 2 stimulate the release of?
Aldosterone from the adrenal glands
What are the two subdivisions of causes of hypertension?
Polygenic
Polyfactorial
What are some of the factors which can contribute to hypertension?
Age
Genetics and family history
Environment
Weight
Alcohol Intake
Race
Describe how age can affect BP
BP increases w age
Describe how genetics and family history affect BP?
Hypertension tends to run in families.
->more in siblings than parents!
How does the environment affect BP?
Physical and mental stress
Does removing stress lower BP?
Not necessarily
What is one of the most common causes of hypertension in young men?
Alcohol
What do small amounts of alcohol do to BP?
Reduces it
What do large amounts of alcohol do to BP?
Increase it
Describe which weight changes can positively affect BP.
Weight loss of 9kg has been reported to produce a fall in BP of 19/18mmHg
Describe how a long birth weight can increase BP.
For each kg underweight, systolic BP is 1-2mmHg lower
Which race tend to have higher BP’s?
African
How can you assess end organ damage?
ECG
Echocardiogram
Proteinuria
Renal ultrasound
Renal function
What are some of the treatable causes of hypertension?
Obesity
Renal artery stenosis/ fibromuscular dysplasia
Endocrine causes
Coarctation of aorta
Drug induced
Sleep apnoea
How do you quantify a patient’s risk of CVD?
Assign risk calculator/Q risk
What is the starting goal of treatment?
Reduce risks by 10% over 10 years
For those with stage 1 hypertension what is the treatment if the patient-
Is <80 and has at least one of the following-
Target end organ damage
Established cardiovascular disease
Renal disease
Diabetes
10 year CV risk 10% or greater
Antihypertensive drugs
What do you offer elderly patients with stage 1 hypertension?
Offer the same antihypertensive drug treatment but BP target of 145/85
What is the treatment for anyone with stage 2 hypertension?
Antihypertensive drugs
Which treatment would you consider giving a patient who is over 55 or Black people of African/Caribbean descent?
Start a calcium channel blocker or a thiazide like diuretic
Which treatment would you offer someone <55?
Offer ACE inhibitor or ARB
Who <55 would you not offer ACE or ARB and why?
African or Caribbean – less effective and higher risk of angioedema
Women of child bearing age – teratogenic in early stages and fetal toxic in later stages
What is step 2 in hypertension treatment after initial treatment?
Add Thiazide type diuretic to step 1
What is step 3 in hypertension treatment?
Add CCB, ACEi and diuretic together
When does a patient have resistant hypertension?
When they start stage 4 of treatment
Give some examples of ACE inhibitors.
Ramipril, perindropril
all end in pril
When would you not give someone ACE?
Renal artery stenosis
Impaired renal function
Hyperkalaemia
Fertile Female
What do ARBS do?
Competitively inhibit the action of angiotensin II at the angiotensin AT1 receptor
Which has fewer side effects- ACEi or ARBS?
ACEi
Give examples of calcium channel blockers.
Amlodipine, felodipine
end in dipine
If someone has an adverse drug reaction to calcium channel blockers, what can happen?
Flushing
Headache
Ankle oedema
Indigestion/reflux
Who would not be given calcium channel blockers?
If someone had had any of the following-
Acute MI
Heart failure
Bradycardia (rate limiting CCBs)
What is usually the first line therapy in mild-mod hypertension in people of African/Caribbean origin?
Thiazide Type Diuretics
What are the mechanisms of action for thiazide type diuretics?
Enhance Urinary excretion of sodium
Resistance vessel dilation – reduce peripheral vascular resistance
Full antihypertensive effect may take weeks
Adverse drug reactions are not common but include gout and ED
What is white coat hypertension?
BP only raised when taken by a doctor or a nurse
