Hypertension Flashcards
what is hypertension
blood pressure that is too high
what does blood pressure include
systolic and diastolic pressures
what is BP measured in
mmHg
BP measurement
clinic/surgery
24hr ambulatory
home/self
all - relax for 5mins - at least 3 readings - first assessment both arms
at least 3 readings over several weeks - should be away from clinical setting
CVD and risk factors - mainly refers to diseases affecting:
coronary heart disease
cerebrovascular diseases
other arterial diseases
coronary heart disease - risks for what diseases
MI
angina
sudden cardiac death
heart failure
cerebrovascular diseases - risks for what diseases
cerebrovascular attack - cva, stroke
transient ischaemic attack (TIA)
multi-infarct dementia
other arterial diseases - risks for what diseases
peripheral vascular disease
renal impairment, renal artery stenosis
abdominal aortic aneurysm (AAA)
retinopathy, papilledema
risk factors for atherosclerosis and CVD
hypertension
hyperglycaemia
kidney disease
dyslipidaemia
insulin resistance
obesity
poor fitness
family history of CVD
lifestyle risk factors - smoking, poor diet, poor sleep
CVD risk factors
age
elevated BP
elevated cholesterol
increased BMI
impaired glucose tolerance
decreased renal function
what does diagnosis of hypertension require
both conventional BP > 140/90
and ABPM/home BP >135/85
signs of hypertensive tissue damage
kidneys - urinalysis for proteinuria
heart - ecg, left ventricular hypertrophy
retina - fundoscopy, hypertensive retinopathy
treating hypertension
target people with highest sustained BP - grade 2 HT and/or TOD
and highest absolute risk - best to prioritise treatment in high risk groups
includes those with existing CVD, diabetes, chronic kidney disease, 10yr CVD risk
ACE inhibitors
inhibit angiotensin converting enzyme, block RAAS, increase bradykinin (vasodilator), dilate arteries and veins
ACE inhibitor side effects
cough, rise in or high K+, renal dysfunction
examples of ACE inhibitors
enalapril
lisinopril
ramipril
angiotensin 2 receptor blockers
similar to ACE inhibitors, no BK effect
angiotensin 2 receptor blocker side effects
few
rise in/high K+, renal dysfunction
angiotensin 2 receptor blocker examples
losartan
candesartan
calcium channel blockers
block voltage gated calcium channels, dilate arteries, sometimes heart rate reduction
calcium channel blocker side effects
headaches, flushing, ankle swelling, tachycardia
side effects of rate limiting calcium channel blockers
bradycardia, constipation, other GI symptoms
examples of calcium channel blockers
nifedipine
amlodipine
rate limiting - verapamil, diltiazem
diuretics
inhibit Na Cl symport, distal tubular natriuresis, dilate arteries and veins
side effects of diuretics
impotence, rashes, biochemical - low Na+, low K+
raised glucose (risk of diabetes), high urate (risk of gout)
examples of diuretics
bendroflumethiazide
chlortalidone
indapamide
beta blockers
block β-adrenoceptors, reduce cardiac rate and output, block RAAS, initially vasoconstrict, ultimately vasodilate
side effects of beta blockers
wheeze (caution with asthma/copd), cold peripheries, lassitude, exercise intolerance, impotence, bradycardia, heart block, raised glucose
examples of beta blockers
atenolol
metoprolol
bisoprolol
mineral corticoid blockers
block mineral corticoid receptors, distal nephron natriuresis/limit potassium loss
potassium sparing diuretics
side effects of MC blockers
rise in/high K+, gynaecomastia (with spironolactone)
examples of MC blockers
spironolactone
eplerenone
alpha blockers
block ⍺1-adrenoceptors, dilate arteries and veins
side effects of alpha blockers
dizziness, especially on standing
urinary symptoms
tachycardia
oedema
examples of alpha blockers
doxazosin
reasons for treatment failure
poor adherence
ineffective combinations
other drugs e.g. NSAIDs
inappropriately low doses
secondary causes
primary and secondary cause percentage
~95% primary
~5% secondary
environmental causes of hypertension
body weight - obesity
physical inactivity
excess calorie intake
salt - high sodium, low potassium, low magnesium
excess alcohol
stress
diet rich in grains, veg, low saturated fat
genetic causes of hypertension
30-50% genetic heritability
twins
association
genome wide linkage
genome wide association studies not finding genes of major effect
