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4th year passmedicine by topic > Hypertension > Flashcards

Hypertension Flashcards

1
Q

What is a ‘normal’ blood pressure?

A

Most healthy people have a blood pressure between 90/60 mmHg and 140/90 mmHg.

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2
Q

NICE define hypertension as follows:

A

a clinic reading persistently above >= 140/90 mmHg, or:

a 24 hour blood pressure average reading >= 135/85 mmHg

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3
Q

Patients with hypertension may be divided into two categories, these are?

A

(around 90-95%) have primary, or essential, hypertension

Secondary hypertension may be caused by a wide variety of endocrine, renal and other causes

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4
Q

Renal causes of hypertension?

A

Glomerulonephritis
Chronic pyelonephritis
Adult polycystic kidney disease
Renal artery stenosis

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5
Q

Endocrine causes of hypertension?

A
  • Primary hyperaldosteronism
  • Phaeochromocytoma
  • Cushing’s syndrome
  • Liddle’s syndrome
  • Congenital adrenal hyperplasia (11-beta hydroxylase deficiency)
  • Acromegaly
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6
Q

Drugs that cause hypertension?

A

• Glucocorticoids
• NSAIDs
• Combined oral contraceptive pill
monoamine oxidase inhibitors

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7
Q

hypertension does not typically cause symptoms unless it is very high

A

true

> 200/120 mmHg

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8
Q

NICE recommend measuring blood pressure in both arms when considering a diagnosis of hypertension

A

True
If the difference in readings between arms is more than 20 mmHg then the measurements should be repeated.
If the difference remains > 20 mmHg then subsequent blood pressures should be recorded from the arm with the higher reading.

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9
Q

pathological causes of unequal blood pressure readings from the arms?

A

supravalvular aortic stenosis

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10
Q

NICE also recommend taking a second reading during the consultation, if the first reading is > 140/90 mmHg. Which reading should determine further management?

A

The lower reading of the two should determine further management.

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11
Q

How do you confirm the diagnosis of hypertension?

A

Ambulatory blood pressure monitoring (ABPM)
at least 2 measurements per hour during the person’s usual waking hours (for example, between 08:00 and 22:00)
use the average value of at least 14 measurements

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12
Q

If ABPM is not tolerated then offer?

A

Home blood pressure monitoring (HBPM)
for each BP recording, two consecutive measurements need to be taken, at least 1 minute apart and with the person seated
BP should be recorded twice daily, ideally in the morning and evening
BP should be recorded for at least 4 days, ideally for 7 days
discard the measurements taken on the first day and use the average value of all the remaining measurements

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13
Q

How many stages of hypertension are there?

A

3

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14
Q

What is Stage 1 hypertension?

A

Clinic BP >= 140/90 mmHg and subsequent ABPM daytime average or HBPM average BP >= 135/85 mmHg

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15
Q

What is Stage 2 hypertension?

A

Clinic BP >= 160/100 mmHg and subsequent ABPM daytime average or HBPM average BP >= 150/95 mmHg

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16
Q

What is Stage 3 hypertension?

A

Clinic systolic BP >= 180 mmHg, or clinic diastolic BP >= 120 mmHg

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17
Q

What lifestyle adivice is offered for hypertension?

A

a low salt diet is recommended
caffeine intake should be reduced
the other general bits of advice remain: stop smoking, drink less alcohol, eat a balanced diet rich in fruit and vegetables, exercise more, lose weight

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18
Q

What salt intake should people aim for?

A

less than 6g/day, ideally 3g/day

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19
Q

The average adult in the UK consumes around 8-12g/day of salt.

A

true

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20
Q

reducing salt intake by 6g/day can lower systolic blood pressure by 10mmHg

A

true

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21
Q

When should you treat Stage 1 Hypertension?

A

treat if < 80 years of age AND any of the following apply;
target organ damage, cardiovascular disease, renal disease, diabetes or a 10-year cardiovascular risk equivalent to 10% or greater

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22
Q

in stage 2 hypertension

offer drug treatment regardless of age

A

true

For patients < 40 years consider specialist referral to exclude secondary causes.

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23
Q

What is Step 1 of Hypertension Treatment?

A

patients < 55-years-old or a background of type 2 diabetes mellitus: ACE inhibitor or a Angiotensin receptor blocker (ACE-i or ARB)

patients >= 55-years-old or of black African or African–Caribbean origin: Calcium channel blocker (C)

24
Q

Why would ARBs be used instead of ACE?

A

cough

25
Q

ACE inhibitors have reduced efficacy in patients of black African or African–Caribbean origin are therefore not used first-line

A

true

26
Q

What is Step 2 of Hypertension Treatment?

A

if already taking an ACE-i or ARB add a Calcium channel blocker or a thiazide-like Diuretic

if already taking a Calcium channel blocker add an ACE-i or ARB or a thiazide-like Diuretic

27
Q

for patients of black African or African–Caribbean origin taking a calcium channel blocker for hypertension, if they require a second agent which drug is preferable?

A

angiotensin receptor blocker in preference to an ACE inhibitor

28
Q

What is Step 3 of Hypertension Treatment?

A

add a third drug to make, i.e.:
if already taking an (A + C) then add a D
if already (A + D) then add a C
(A + C + D)

29
Q

Step 4 treatment of hypertension is classified as resistant hypertension

A

true

30
Q

What should you check for first resistant hypertension?

A

first, check for:
confirm elevated clinic BP with ABPM or HBPM
assess for postural hypotension.
discuss adherence

31
Q

What should you add in terms of a 4th drug in terms of resistant hypertension?

A

if potassium < 4.5 mmol/l add low-dose spironolactone

if potassium > 4.5 mmol/l add an alpha- or beta-blocker

32
Q

Patients who fail to respond to step 4 measures should be referred to a specialist.

A

true

33
Q

Blood pressure targets Age < 80 years

A

Clinic 140/90 mmHg

ABPM/HBPM 135/85 mmHg

34
Q

Blood pressure targets Age > 80 years

A

Clinic 150/90 mmHg

ABPM/HBPM 145/85 mmHg

35
Q

5-10% of patients diagnosed with hypertension have what?

A

primary hyperaldosteronism, including Conn’s syndrome

most common cause of secondary hypertension.

36
Q

What is the blood pressure target for type 2 diabetics is the same as other patients

A

true
Intervention levels for recommending blood pressure management should be 135/85 mmHg unless the adult with type 1 diabetes has albuminuria or 2 or more features of metabolic syndrome, in which case it should be 130/80 mmHg

37
Q

Which antihypertensive drugs have a renoprotective effect?

A

ACE-inhibitors

38
Q

Which antihypertensive drug is first line in diabetics?

A

ACE-inhibitors

39
Q

What should diabetics of afro-caribbean descent be offered first line for hypertension?

A

ACE-inhibitor plus either a thiazide diuretic or calcium channel blocker

40
Q

Which medications should be avoided in diabetics re hypertension?

A

beta-blockers in uncomplicated hypertension should be avoided, particularly when given in combination with thiazides
may cause insulin resistance, impair insulin secretion and alter the autonomic response to hypoglycaemia

41
Q

Diabetics & hypertension: autonomic neuropathy may result in more postural symptoms in patients taking antihypertensive therapy.

A

true

42
Q

The majority of patients with chronic kidney disease (CKD) will require more than two drugs to treat hypertension

A

true

43
Q

Which hypertensive drug is used in patients with chronic kidney disease (CKD)?

A

ACE inhibitors are first line

44
Q

ACE inhibitors are first line and are particularly helpful in which renal disease?

A

proteinuric renal disease (e.g. diabetic nephropathy

45
Q

Why can we expect a decrease of eGFR in patients on ACE inhibitors?

A

As these drugs tend to reduce filtration pressure a small fall in glomerular filtration pressure (GFR) and rise in creatinine can be expected.

46
Q

What renal changes are acceptable in patients on ACE-inhibitors?

A

decrease in eGFR of up to 25% or a rise in creatinine of up to 30% is acceptable
any rise should prompt careful monitoring and exclusion of other causes (e.g. NSAIDs). A rise greater than this may indicate underlying renovascular disease.

47
Q

Which drug is useful as a anti-hypertensive in patients with CKD, particularly when the GFR falls to below 45 ml/min?

A

Furosemide
It has the added benefit of lowering serum potassium
If the patient becomes at risk of dehydration (e.g. Gastroenteritis) then consideration should be given to temporarily stopping the drug

48
Q

In younger children secondary hypertension is the most common cause, what is most common condition?

A

renal parenchymal disease accounting for up to 80%

49
Q

Most common causes of secondary hypertension In younger children?

A 
renal parenchymal disease
renal vascular disease
coarctation of the aorta
phaeochromocytoma
congenital adrenal hyperplasia
essential or primary hypertension (becomes more common as children become older)
50
Q

How do you measure BP in children?

A

correct cuff size is approximately 2/3 the length of the upper arm
the 4th Korotkoff sound is used to measure the diastolic blood pressure until adolescence, when the 5th Korotkoff sound can be used
results should be compared with a graph of normal values for age

51
Q

Hypokalaemia with hypertension is seen in which conditions?

A

Cushing’s syndrome
Conn’s syndrome (primary hyperaldosteronism)
Liddle’s syndrome
11-beta hydroxylase deficiency

52
Q

Carbenoxolone, an anti-ulcer drug, and liquorice excess can potentially cause hypokalaemia associated with hypertension

A

true

53
Q

Isolated systolic hypertension (ISH) is common in which group?

A

elderly, affecting around 50% of people older than 70 years old.

54
Q

What is first line for Isolated systolic hypertension (ISH)?

A

thiazides

55
Q

In patients with a new blood pressure (BP) >= 180/120 mmHg, given there are no worrying signs, then the first step is?

A

urgent investigations for end-organ damage.

urgent ECG, urine dipstick and blood tests

4th year passmedicine by topic (96 decks)

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