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cardiovascular > hypertension > Flashcards

hypertension Flashcards

1
Q

what is essential hypertension?

A

HTN with known cause

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2
Q

what are the diagnostic levels for the different stages of hypertension?

A

stage 1: clinic ≥140/90 or ABPM ≥135/85
stage 2: clinic ≥160/100 or ABPM ≥150/95
stage 3: clinic ≥180/120

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3
Q

what is malignant hypertension and what do you do if you see it?

A

≥180/120 with signs of end stage organ damage
nice guidance =send them straightt o hospital

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4
Q

what are the risk factors for hypertension?

A

increasing age
ethnicity
FH
high salt, sat fat, and trans fat intake
overweight/obese
alcohol misuse
smoking
amphetamines/cocaine
sedentary

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5
Q

what are the 2 type of secondary hypertension?

A

renal
endocrine

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6
Q

what are the 2 types of renal causes of hypertension?

A

primary renal disease
renovascular disease

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7
Q

what are the causes of renovascular disease in which groups?

A

fibromuscular dysplasia -if younger usually
atherosclerosis -if older usually

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8
Q

what is fibromuscular dysplasia (FMD) ?

A

disease of blood vessels that causes abnormal growth within the wall of the artery -medium sized arteries narrow and can get longer

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9
Q

what are the most common sites of fibromuscular dysplasia?

A

renal and carotid arteries

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10
Q

what are the symptoms of FMD in the renal arteries?

A

reduced renal function
high BP

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11
Q

what are the symptoms of FMD in the brain?

A

headaches
tinnitus
dizziness

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12
Q

what are the RFs for FMD?

A

female, in 50s, smokers

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13
Q

what are the endocrine causes of hypertension?

A

conn’s syndrome (excess aldosterone)
cushing’s syndrome (excess cortisol)
phaechromocytoma (excess catecholamines)

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14
Q

what do you do if in clinic someone’s BP is between 140/90 and 180/120?

A

give them ABPM of HBPM if they can’t do ABPM to confirm diagnosis
check for end organ damage

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15
Q

what do you do if in clinic someone’s BP is over 180/120?

A

investigate for end organ damage
if none -repeat BP measurement in 7 days
if yes -send to hospital

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16
Q

how do you test for end stage organ damage?

A

kidneys: urine dip -check for haematuria, urine ACR, plasma U+E
eyes -fundoscopy
heart -ECG
diabetes -hba1c

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17
Q

what ECG changes could you see in someone with severe hypertension?

A

LVH

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18
Q

what are you looking for in fundoscopy of someone with severe hyptertension?

A

hypertensive retinopathy -retinal haemorrhage, papilloedema

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19
Q

what are the criteria to refer someone with hypertension for same day specialist assessment?

A

> 180/120 and: signs of retinal haemorrhage, papilloedema, new onset confusion, chest pain, signs of HF, AKI
suspected phaeochromocytoma

20
Q

what are some signs of suspected phaeochromocytoma?

A

labile BP or postural hypotension, headaches, palpitations, pallor, abdo pain, diaphoresis

21
Q

what is diaphoresis?

A

excess sweating

22
Q

what does labile mean?

A

easily changed

23
Q

how do you investigate for suspected renal hypertension?

A

renal USS +doppler

24
Q

in which situations would you investigate for ?renal hypertension?

A

resistant HTN
isolated htn in young woman
reduced egfr
proteinuria/haematuria
acute pulmonary oedema
patient has atherosclerosis
renal artery bruits

25
Q

how do you investigate for ?aldosterone excess?

A

plasma aldosterone: renin ratio

26
Q

in which situations would you investigate for ?aldosterone excess?

A

resistant HTN
hypokalaemia

27
Q

which blood results suggest aldosterone excess?

A

low k+
normal na+
high bicarb

28
Q

what do you do if there’s ?aldosterone excess based on clinic picture and bloods?

A

CT with/without selective venous sampling

29
Q

what is the non pharmacological management for hypertension?

A

diet modification
weight loss
discourage excessive caffeine consumption
smoking cessation
reduced alcohol
calculate QRISK3 and act accordingly

30
Q

what is the drug treatment pathway for chronic hypertension?

A

https://www.notion.so/hypertension-d9a07e5cf2884ac3a08350e65c7a036b?pvs=4#5ce2ca444bfe4945bba9b812f49b5a5e

31
Q

what’s an important monitoring point about ACEis?

A

after initiation and every dose change you have to check kidney function in the next 2 weeks.

32
Q

what are 2 examples if ACEis?

A

ramipril, lisinopril

33
Q

what are 2 examples of ARBs?

A

losartan, candesartan

34
Q

what is an example of a CCB?

A

amlodipine

35
Q

what is the most common complaint for CCBs and a solution to this?

A

swollen ankles
can try licandopine which doesn’t tend to do it as much

36
Q

what is an example of a thiazide like diuretic?

A

indapamide

37
Q

how do thiazide like diuretics work?

A

inhibit na/cl pump in distal nephron -pee out more sodium -pee out more water -less circulating blood volume

38
Q

what drug should you give for hypertension in people with evidence of heart failure?

A

thiazide like diuretic

39
Q

what is an example of a potassium sparing diuretic?

A

spironolactone

40
Q

how does spironolactone work?

A

aldosterone receptor antagonist -competitively inhibits aldosterone via its receptors in the DCT

41
Q

what is the most common contraindication of beta blockers?

A

any history of obstructive airway disease or bronchospasm, eg asthma, COPD

42
Q

what are the recommended alpha blockers to use in hypertension?

A

doxazosin and terazosin

43
Q

what is the most common contraindication of alpha blockers?

A

postural hypotension

44
Q

what are some examples of SGLT2 inhibitors?

A

empagliflozin, canagliflozin

45
Q

what are the BP targets for blood pressure on medications?

A

adults <80: <140/90
adults 80+: <150/90

46
Q

what is the management of renal hypertension?

A
  • primary renal disease: treat underlying cause, manage as any other htn
  • renovascular disease: stenting of renal artery stenosis if possible, avoid RAAS blocking agents
47
Q

what is the management of mineralocorticoid excess?

A
  • surgery if caused by single adenoma to remove it
  • aldosterone receptor blockers

cardiovascular (9 decks)

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