Hypertension Flashcards

1
Q

What is hypertension

A

condition where bp is elevated to an extent where clinical benefit is obtained by lowering it

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2
Q

Textbook bp

A

120/80

Top is systolic and bottom is diastolic

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3
Q

Consequences of hypertension

A

• Myocardial infarction (MI)
• Cerebral vascular accident (CVA)
(2 biggest)
• Heart failure
• Renal (kidney) disease
• Peripheral vascular disease
• Vascular dementia

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4
Q

Mercury increases

A

For every 5 mm increase of mercury in diastolic it increases risk of stroke by 35-40%

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5
Q

High risk patients for complications

A

• Evidence of cardiovascular disease
• Elderly
• Diabetes
• Renal failure
• Lifestyle factors (smoke, diet, stress etc)

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6
Q

How common is hypertension

A

• UK adult population: 31% men +
26% women
• 65% 65-74yrs
• Ethnicity: Black African + Black
Caribbeans higher incidence
• Still underdiagnosed and
undertreated
• Government target

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7
Q

2 types of hypertension

A

• 90-95% Primary/Essential
- cause unknown

• 5-10% Secondary
- underlying cause renal (80%) and endocrine disease, pregnancy and drugs

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8
Q

Risk factors of primary

A

– age
– Gender
– Socio-economic status
– Obesity
– Excess alcohol
– Salt intake
– Ethnicity
– Family history
– Lack of exercise
– Diet (fats)
– Stress
– Smoking
– Other diseases eg DM, renal failure

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9
Q

Drug causes of 2ndary

A

Rugs that increase BP

• Combined Oral Contraceptives
• NSAIDs e.g. ibuprofen
• Steroids e.g. prednisolone
• Sympathomimetic amines
e.g.pseudoephedrine (cold remedies)

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10
Q

Hypertension clinical presentation

A

• Asymptomatic
• Headache - unclear if cause or incidental
• Detected at population screening or
presentation of patient with
complication eg. Myocardial infarction,
renal failure etc

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11
Q

Malignant hypertension

A

• Uncommon
• increase bp (>180/120)
• Confusion, headache, visual loss, coma
• Evidence of small vessel damage:
– Eyes
– Kidneys
– Brain
• Medical emergency
• Rapid control of bp over 12-24 hrs
• Often fatal
• 1 year survival <20%
• Long-term morbidity
• Careful follow-up

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12
Q

Arteries in manual bp measurements

A

Palpitation of radial artery

Auscultation of brachial artery

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13
Q

Bp can be affected by:

A

– Fear & anxiety ( including ”white-coat” HT)
– Physical activity
– Caffeine
– Alcohol
– Tobacco
– Temperature
– Full bladder
– Obesity (correct cuff size)

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14
Q

Drug groups to treat hypertension

A

• Diuretics
• Angiotensin converting enzyme inhibitors
(ACEI’s)
• Angiotensin-II receptor antagonists
(ARBs)
• Calcium channel blockers (CCB)
• Betablockers
• Alpha- blockers
• Centrally acting agents
• Renin inhibitors

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15
Q

Factors which affect which drug to use fast

A

• (Ability to reduce bp)
• Ability to reduce complications
• Patient characteristics
• Other conditions
• Side-effects
• Adherence
• Cost

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16
Q

What is the 1st factor

A

Reduce complications

17
Q

What is the 2nd factor

A

Patient characteristics

Age - renin drops
ethnicity - people of colour produce less renin
pregnancy - only a few drugs are safe
allergies

18
Q

When to combine drugs

A

When target BP isnt reached with monotherapy

75% of people with HT cannot be controlled on one drug alone

19
Q

How to combine drugs

A

Combine drugs with different pharmacology/mechanisms of actions or act on different pathways

Avoid combining drugs with same side effects

20
Q

1st line drugs and their groups

A

CCB

ACEIs

Diuretics

Aldosterone antagonists

Angiotensin II receptor blockers - ARBs

Beta-blockers

Alpha blockers

Renin inhibitors

Centrally acting agents

21
Q

CCB

A

(amodipine, diltiazem) - 1st line for >55years and or black African Caribbean for any age

22
Q

ACEIs

A

ACEIs (ramipril, lisinopril) - 1st line for >55yeras and all diabetics

23
Q

Diuretics

A

indapamide

Used in combination with other antihypertensives

Can cause low K levels

Not for patients in renal failure

24
Q

Aldosterone antagonists

A

Spironolactone

Can cause high K levels

Used for heart failure

25
Q

Angiotensin II receptor blockers
(ARBs)

A

Losartan and candesartan

Alternative to ACEIs

26
Q

Beta blockers

A

Atenolol and bisoprolol

Used for heart failure
Caution in athsma

27
Q

Alpha blockers

A

Doxazosin

Used in renal impairment

28
Q

Renin inhibitors

A

Aliskirin

29
Q

Centrally acting agents

A

Conidine