Hypertension Flashcards
what are the two types of hypertension
essential/primary
secondary
describe the cause of primary HP
there is no identifiable cause, it develops over time
Describes secondary hyptensions cause
caused by underlying conditions
what is secondary hypertension linked to
Obstructive sleep apnoea, Kidney
problems, Adrenal gland tumours, Thyroid problems, Certain defects you’re born with
(congenital) in blood vessels, medications such as birth control pills/ cold remedy/
decongestants/ over-the-counter pain relievers / some prescription drugs / Illegal
drugs such as cocaine and amphetamine
what is elevated blood pressure
Systolic = 120-129
Diastolic = <80
what is high blood pressure
Systolic = 130-139
Diastolic = 80-89
what is hypertension’s blood pressure
Systolic = 140<
Diastolic =90<
what type of hypertension is most likely to arise in young adults
Essential/primary
what is used to measure the risk of hypertension, and what score is needed for intervention
QRISK3, 10%+ score is needed
hypertension can cause other conditions in the body (7)
Heart failure, Myocardial ischaemia/infarction, stroke, aneurysm, Nephrosclerosis (renal failure), Retinopathy, Atherosclerosis (thrombus)
what non-pharmaceutical treatments can be used to treat hypertension
lifestyle changes
healthy eating, decrease salt, increase exercise, limiting alcohol, Non-smoking, reducing stroke/controlling BP, relaxation practise/slow breathing exercise.
pharmaceutical treatment for hypertension
Ca2+ channel blockers, ACE inhibitors, ARBs, Thiazide-like Diuretics, Beta blockers
what aspect of the RAAS system causes hypertension
Angiotensin II
what enzyme converts angiotensin to angiotensin I
Renin
Angiotensin I is inactive, true or false
true
what enzymes causes Angiotensin I to Angiotensin II
ACE - Angiotensin converting enzymes
what are the 5 effects of Angiotensin II that causes hypertension
1) stimulates adrenal cortex to relase aldosterone (promotes Na + water retension)
2) release of ADH from pituitary (water reabsorption)
3) stimulates thirst
4) causes vasoconstriction
5) Cardiac + vascular hypertrophy (more muscle mass which increases cardiac output)
Give an example of a Ca2+ channel blocker which treats hypertension
Amlodipine
What is the mechanism of action for Ca2+ channel blockers
inhibits influx of Ca2+
- on myocardial muscle, inhibits contractibility
- in the myocardial conducting system which inhibits formation +propagation of depolarisation
-on the vascular smooth muscle = vasodilation
what are the adverse effects of amlodipine
oedema, headaches/dizzy, flushing, pounding heartbeat, swollen ankles
when is amlodipine prescribed
- used in older patients as they have constrictive arteries (55<)
- people without type 2 diabetes
-African/Afro-caribean
What is Iosartan
angiotensin receptor blockers
how do ARBs work
selective compettive blockers of angiotensin II at the AT1 receptor, similar effects to ACE inhibitors
ARBs are used to treat hypertension if they are -
-if they also have type 2 diabetes
- younger than 55
- not african/ afrocarribean
adverse effects of ARBs
dizziness, headaches, nausea, vomiting, diarrhoea, pain in joints
If a patients is - then they cannot be prescribed ARBs
pregnant
or have hyperkalemia
what type of diuretics is used for hypertension, and name an example of these
Thiazide-like
Indapamide
what is the mechanism of indapamide
- inhibits Na+ and Cl- reabsorption from the distal convoluted tubules by blocking the Na+/Cl- symporters
- at lower doses vasodilation is more prominent than diuresis
when are thiazide-like diuretics prescribed
2nd/3rd step for treatment
what are Indapamide’s adverse effects
severe fluid and electrolyte imbalance
-hyponatremia (decrease Na+)
-hypokalaemia (decrease K+)
-hypocholeremic alkalosis
when are thiazide-like diuretics not appropriate
- patients that suffers from kidney problems
- elderly with a risk of falling
what type of drugs is used to treat hypertension in patients with resistant hypertension
K+ sparing diruetics (weak) - Spironolactone
what is spironolactone’s mechanism of action
- its a steroid pro-drug, blocks aldosterone which induced production of soldium transport protien in the DCT which causes Na+ and H20 loss
- K+ retention
what are spironolactone adverse effects
hyperkalaemia, GI disturbance, Oestrogenic side effects, gynecomastia, menstrual disturbance, reduced libido, testicular atrophy
what are Spironolactone contraindications
Addisons, anuria, hyperkalaemia, caution for elderly
what is an example of an ACE inhibitor
lisinopril
how does lisinopril work
inhibits the angiotensin converting enzyme in the RAAS system
- reduce thirst, stops ADH and inhibits vasoconstriction
-stops release aldosterone and stops hypertrophy
- boost brandykinin levels = vasodilation by different mechanims
- inhibits kininase II
adverse effects of lisinopril,
low BP
dizziness /headache
dry cough
when is lisinopril prescribed
- patients with type 2 diabetes
- <55
-not african/afrocarribean
when is lisinopril not prescribed
- patients with hyperkalaemia
- have a history of angioedema
- allergic to ACE inhibitors
- recently took heart medication
what is the last resort to treat hypertension and give an example
beta-blocker
bisoprolol
what is the mechanism of beta blockers
noradrenaline in cardiac tissue is decreased
- decreases cardiac output (negative inotrope effect) = decrease BP
- swich off one of the mechanism of the RAAS pathway
- inhibits adrenergic B1 receptors
- inhibits release of renin
- slows firing of SAN/AVnode which decrease HR
beta blocker’s adverse effects
cold fingers/toes (peripheries), erectile dysfunction, tired, dizzy, lightheadedness, sleeping problems
indications for beta blockers
- may be considered for young people
- intolerence/contraindication to ACEi or ARBs
- women of child bearing potential
- evidence of increase sympathetic drive
describe atherosclerosis
development of of fatty acid and cholesterol in the wall of the arteries as part of the inflammatory response
-arteries are narrowed due to plaque build up
- high BP can damage artery’s wall
