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Small Animal Medicine > Hypertension > Flashcards

Hypertension Flashcards

1
Q

What 2 things affect systemic BP?

A
  1. cardiac output - HR (SNS, cardiac function), stroke volume (blood volume, RAAS)
  2. systemic vascular resistance - vascular tone (SNS, RAAS)
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2
Q

What is systemic hypertension? What are the 2 types?

A

persistent elevation in systemic BP with systolic > 160 mmHg

  1. primary/essential = idiopathic
  2. secondary = most common in dogs and cats
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3
Q

What are the 4 most common causes of hypertension in dogs?

A
  1. acute/chronic kidney disease
  2. hyperadrenocorticism
  3. diabetes mellitus - more modest increase
  4. pheochromocytoma - increased catecholamine release from adrenal medulla (severe)
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4
Q

What are the 4 most common causes of hypertension in cats?

A
  1. CKD**
  2. hyperthyroidism*
  3. primary hyperaldosteronism (no response to potassium or anti-hypertensives)
  4. hyperadrenocorticism
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5
Q

What are 5 other factors that affect BP?

A
  1. age
  2. breed - Sighthounds
  3. obesity - < 5 mmHg in dogs
  4. anxiety/stress*
  5. pharmacologic agents - alpha-agonists = vasoconstriction
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6
Q

What are the 4 target organs affected by hypertension?

A
  1. eye
  2. brain
  3. kidney
  4. heart

eye, brain, and kidney have vascular autoregulation to offset changes in BP

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7
Q

What are some ocular signs of systemic hypertension?

A
  • hemorrhage of the retina, vitreous, or anterior chamber
  • retinal vessel tortuosity
  • retinal edema and detachment (bullous, generalized)
  • optic nerve edema and atrophy
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8
Q

What are some neurologic signs of systemic hypertension?

A
  • vestibular signs —> head tilt, nystagmus
  • focal neurological deficits
  • behavior abnormalities
  • seizures
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9
Q

What are some renal signs of systemic hypertension?

A
  • decreased renal function
  • proteinuria
  • glomerular and tubulointerstitial changes
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10
Q

What are some cardiac signs of systemic hypertension?

A
  • left ventricular hypertrophy
  • gallop rhythm
  • heart mumur
  • epistaxis (changes in vessels)
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11
Q

Why is it important to measure BP?

A

evidence of target organ damage

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12
Q

In what 5 situations should BP be measured in cats?

A
  1. kidney disease, proteinuria
  2. endocrinopathies (hyperthyroidism, euthyroidism)
  3. auscultable cardiac abnormalities
  4. cardiomegaly, cardiac wall hypertrophy
  5. older age
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13
Q

In what 3 situations should BP be measured in dogs?

A
  1. kidney disease, proteinuria
  2. endocrinopathies - HAC, DM
  3. cardiac hypertrophy
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14
Q

What is the gold standard for measuring BP?

A

direct —> anesthetized patient with arterial catheters

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15
Q

What are the 2 most common indirect ways to measure BP?

A
  1. Doppler
  2. oscillometric

(+ photoplethysmography, auscultatory)

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16
Q

What does oscillometric BP measure? What 3 arteries are used?

A

systolic, diastolic, mean*, pulse rate

  1. cranial tibial
  2. coccygeal
  3. median (large breed dogs)
17
Q

What does Doppler BP measure? What artery is used?

A

systolic

median in small dogs and cats

18
Q

What should the cuff size of BP measurements be? What general aspects are important for proper BP measurements?

A

30-40% limb circumference

  • keep cuff level to the base of the heart
  • multiple readings (accurate = close to one another)
  • quiet environment and calm patient
  • same site, cuff, and position (note in records!)
19
Q

How can the white coat affect be avoided to improve accuracy of BP measurement in clinics?

A
  • let the patient acclimate to the environment for about 10 mins
  • measure BP before examination
  • let owner be present
20
Q

In what 3 instances is antihypertensive therapy considered?

A
  1. severe hypertension (systolic > 200 mmHg or diastolic > 120 mmHg)
  2. evidence of TOD with moderate to severe hypertension
  3. persistent elevated BP > 160 mmHg with evidence of clinical disease known to be caused or lead to hypertension
21
Q

What is the “gray zone?”

A

moderately elevated systolic BP 160-180 mmHg without evidence of clinical disease or signs

22
Q

When is hypertensive therapy not recommended?

A

mildly elevated BP 120-160 mmHg without clinical signs

23
Q

What are the 2 aims to systemic hypertension treatment? What is the goal?

A
  1. control underlying diseases, like CKD, hyperthyroidism, HAC
  2. antihypertensive therapy - decreases CO, TPR
  • avoidance of TOD
  • close to 150 mmHg systolic
24
Q

What is the first-line therapy of hypertensives for cats with increased BP?

A

calcium channel blockers —> Amlodipine

25
Q

What is the first-line therapy of hypertensives for dogs with increased BP? What is another option?

A

RAAS inhibitors —> ACE inhibitors, Benazepril (less kidney excretion) and Enalapril = moderate decrease, Amlodopine can help too!

angiotensin receptor blocker —> Telmisartan

26
Q

When are aldosterone antagonists recommended in patients with systemic hypertension? What is one example?

A

hyperaldosteronism, where increased aldosterone causes water and sodium retention which increases BP

Spironolactone

27
Q

When are alpha antagonists recommended in patients with systemic hypertension? What are 2 examples?

A

pheochromocytomas that secrete catecholamines

  1. Phenoxybenzamine
  2. Prazosin
28
Q

What 2 groups of drugs affect the cardiovascular system in patients with systemic hypertension?

A
  1. beta blockers - Atenolol
  2. direct vasodilators - Hydralazine (decreases BP acutely, used for emergencies)
29
Q

What 2 alterations to diets help in patients with systemic hypertension?

A
  1. decreased caloric intake to induce weight loss in obese patients
  2. decreased sodium chloride
30
Q

What 6 things should be monitored in patients with systemic hypertension?

A
  1. BP
  2. serum creatinine
  3. UA and UPC
  4. fundic exams
  5. tests for secondary disease management (aldosterone, T4, glucose)
  6. electrolytes
31
Q

How often should patients be monitored for systemic hypertension?

A
  • TOD present = 1-3 days
  • TOD not present = 7-10 days
  • stable = every 3 months

Small Animal Medicine (52 decks)

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