Hypertension Flashcards
what is the definition of hypertension ?
Systolic bp above 140
diastolic bp above 90
what are the types of hypertension?
primary hypertension
2ndary hypertension
what is primary hypertension ?
unknown cause but mostly GENETICS
environmental factors affecting CV and renal structure function
associated with certain risk factors
Rarely in young
TREATED BY TREATING HTP ITSELF AND ITS FACTORS
what is secondary hypertension 5-10%
Has a cause —>DRUG, DISEASE ( adrenal tumor, excessive corticosteroid ) , PREGNANCY
occurs in all ages including YOUNG
Treat the cause causing HTN
what are the risk factors for primary hypertension?
Smoking
unhealthy diet
excess salt and water retention
stress
physical inactivity
obesity
males
alcohol
black
aged
genetics
these are js risk factors not causes
what are IMPORTANT CAUSES of secondary hypertension ?
Conns Syndrome —> Excessive aldosterone due to adenoma
Cushing syndrome —> excessive cortisol
Pheochromocytoma —> rare tumor causes excessive release of catecholamines
Renal disease —> renovascular disease , renoparenchymal disease
Obstructive sleep apnea
Hyper parathyroidism —> high calcium –> HTN
Hypothyroidism and hyperthyroidism
Oral contraceptive pills —> Steroids –> salt and water retention
Chronic use of NSAIDS –> salt + water retention
Antipsychotic/ anti depressants drugs —> increase BP
Erythropoietin —> increased RBCS and viscosity –> more force –> HTN
Cytoxic drugs —> endothelial damage
Cocaine —> episodic HTN
vasoconstrictor drugs
sodium containing antacids
Liquorice —> Increase aldosterone release
what is the organ responsible for managing BP?
kidneys
what are the 3 major causes of 2dry hypertension ?
Primary aldosteronosim ( PA )
Renal disease
Obstructive sleep apnea
describe primary aldosteronism ?
high BP , High PH , low K
hypokalemia , metabolic alkalosis due to high PH greater than 7.45
Elevated aldosterone / renin ration —> this means aldosterone is secreted without stimulus from renin
what are the renal disease ?
renovascular hypertension
reno parenchymal hypertension
what are the causes of renovascular hypertension?
fibromuscular dysplasia –> young patients –> ABNORMAL GROWTH OF WALL CELLS LEADING TO NARROWING OF THE VESSEL OR BULGING –> stenosis
atherosclerosis —> older patients
what is reno parenchymal hypertension?
hypertension due to primary kidney disease —> ACUTE OR CHRONIC
how does OSA cause hypertension?
Typically seen in OBESE PATIENTS
Obesity is a risk factor for HYPERTENSION
50% of ppl with OSA have hypertension
what are the complications of hypertension?
cerebrovascular disease —> Stroke due to hemorrhage or ischemia/ TIA , encephalopathy
RETINOPATHY
aneurysm
Atrial fibrillation
coronary artery disease
Left ventricle hypertrophy and heart failure
Chronic kidney disease and nephropathy –> CDK can lead to hypertension and vice versa
peripheral artery disease
what are the grades of hypertension?
normal BP —-> 120-130 Systole , 80-84 diastole
High than normal —-> 130-139 systole , 85-89 diastole
Stage 1 hypertension —> 140-159 systole and 90-99 diastole
stage 2 hypertension —> 160-179 systole and 100-109 diastole
stage 3 hypertension —–> 180 + systole and 110 + diastole
add 20 systole and 10 diastole from stage 1
from normal to stage 1 js add 10 so 120 then 130 is higher than normal and 140 is stage 1
what do you have to note for diabetes mellitus and coronary artery disease patients?
BP has to be below 130 / 80 otherwise it is stage 1
what is fundoscopy and when is it required?
examination that uses magnifying lens and light to check the fundus of the eye ( retina and optic nerve )
stage1 –> 140-159/ 90-99 fundoscopy is not needed
stage 2 —-> 160-179/100-109 -FUNDSCOPY IS REQUIRED
stage 3 —> 180 + / 110+ FUNDSCOPY IS REQURIED
so fundoscopy is required for stage 2 and 3
what is hypertensive urgency?
patient with SEVERE hypertension and symptoms BUT NO END ORGAN DAMAGE
oral medications are enough and outpatient treatment
considered hypertensive crisis
what is hypertensive EMERGENCY?
patient with severe hypertension and SYMPTOMS but WITH ORGAN DAMAGE like acute renal failure , pulmonary edema, heart failure
I.v drugs + hospital admission IN PATIENT TREATMENT
considered hypertensive crisis
what do you when you have different systole and diastole grading?
pick the highest one
Example patient with 150/105 bp
150 is grade 1 systole
105 is grade 2 diastole
So hes grade 2
what is malignant hypertension and accelerated hypertension ?
old terms and now replaced with urgency and emergency
what are the symptoms of hypertension ?
often asymptomatic for many years –> called silent killer
Screening for hypertension in the general population is recommended cuz no symptoms
sometimes is associated with :
headaches
fatigue
dizziness
tinnitus —> tinnitus medical condition for hearing noises in your ears
visual blurring
chest discomfort
Shortness of breath
Epistaxis —–> bleeding in the nose
what is the proper way of measuring BP?
back supported
proper cuff placement and size
cuff should not be placed over clothing
patient arm should be supported
measure from both sides but right arm is the best
Avoid caffeine, exercise , nicotine 30 minutes before measurement
both feet on the floor –> no leg crossing
normal breathing no deep breathing
when is hypertension diagnosed ?
when measured in office and it is 140> SYSTOLE or 90+ diastole —> measure 2 times , should be at least 1 week apart and to confirm OUT OF OFFICE MEASUREMENT using Ambulatory BP monitoring or home BP measurement
Systole above 180 or diastole above 110 this is hypertension confirmed
what is ambulatory blood pressure monitoring ?
BP measuring method where a device is given to the patient and it measures the BP every 30 minutes automatically —> 36 times a day and then gets an average
if the BP is high during sleep as well then hypertension is diagnosed
what is white coat hypertension?
BP high in the clinic but normal in home or when ambulatory method
in this case we either go for ABPM for 24 hours
or HBPM –> patient measure two times at home one in morning and one in the evening for 7 days and we will take average
what is masked hypertension ?
Opposite to white coat
high outside the office
but NORMAL in the office
what is isolated systolic hypertension?
systolic is high above 140
diastole is normal below 90
common in elderly due to decreased arterial elasticity and increased stiffness
what is isolated diastolic hypertension ?
only diastolic is high but systolic is normal
smokers, obese , alcoholics
what is resistant hypertension ?
uncontrolled hypertension ——> High BP despite compliance to right doses of 3 ANTI HYPERTENSION DRUGS of different classes INCLUDING diuretic ( after excluding white coat effect )
Controlled hypertension —-> BP requires 4 MEDICATIONS to achieve control
what are the hypertensive crisis?
hypertensive urgency –> stage 3 hypertension ( 180+, 110+ ) but no target organ damage
Hypertensive emergency –> stage 3 hypertension WITH TARGET ORGAN DAMAGE
what are the examples of damage seen in hypertensive emergency ?
Retinopathy —> Grade 3 or grade 4
dissecting aortic aneurysm
acute LV failure with pulmonary edema
Acute MI
Acute renal failure
eclampsia —> seizures or coma in pregnant woman with preeclampsia —> pregnancy with high blood pressure
what is grade 3 retinopathy?
hemorrhage and exudate
visible signs of damage like bleeding and retinal hemorrhage and white patches on retina
what is grade 4 retinopathy ?
papilledema
disease entity that refers to the swelling of optic disc due to elevated intracranial pressure ( ICP )
what are the types of hypertension in pregnancy?
Chronic hypertension
gestational hypertension
pre- eclampsia
Eclampsia
describe chronic hypertension in pregnancy? ?
High Bp before pregnancy
High BP in pregnancy BEFORE W20
continue for at least 12 weeks POST PARTUM
describe gestational hypertension in pregnancy?
High BP in 2nd half of pregnancy AFTER W20
NO PROTEINURIA
continues up to 6 WEEKS postpartum
describe pre ecampsia in pregnancy?
Hypertension + PROTEINURIA
edema AFTER w20 of pregnancy
what is eclampsia in pregnancy?
same as pre eclampsia BUT
With seizures and coma
what are the non pharmacological treatment of hypertension ?
Weight lose ( 1kg loss = 1 mmhg systole reduced ) —> reduce calorie intake and exercise
Diet recommendation : reduce systole by 10 mmhg
Low sodium intake
High potassium and protein intake
LOW fat and sugar
Smoking cessation
limit consumption of alcohol
Limit caffeine intake
regular physical activity –> reduce 5 mmhg
meditation / relaxation practice
what are the characteristics of hypertension drug ?
Once daily for 24 hours BP control –> mono or combination therapy
least possible adverse effects profile
evidence based prognostic benefits
affordable cost
when do we start hypertension medications ?
Stage 2 hypertension
stage 1 hypertension with DM or CVD
10% > risk of developing CVD in 10 years
what are the goals of hypertension medications ?
reduce BP to below 140/90
reduce it to 130 /80 in DM or CVD or 10% risk patients
results should appear within 3 months
what are the first line medications for hypertension ?
ACE inhibitors / ARBs
Thiazide diuretics
CCB
what are the second line drugs ?
Loop diuretics –> frusemide and K+ SPARING DIURETICS
BB , Alpha blockers
central alpha 2 agonist
direct vasodilator
direct renin inhibitors
what are k+ sparing diuretics ?
eplerenone
Spironolactone
what are the drugs used in step 1 to step 3 in management of hypertension?
1st line drugs –> ACE, CCB , Diuretics
step 1 —> use 1 from them
step 2—> use any 2 of them
step 3 —-> combine all 3
step 4 you use 2nd line medications
when are ACEIs and ARBS used as 1st line treatment?
diabetes
Ischemic heart disease
chronic kidney disease
systolic HF
when are beta blockers used ?
Systolic HF
improve survival
when are mineralocorticoid receptor antagonist used ?
systolic HF
with normal renal function
when are diuretics used?
Volume overload control in HF or CKD
what drugs are used in african american / african descent patients ?
CCB –> even if diabetic
thiazides diuretics
hydralazine ( Vasodilator )
what drugs are used in pregnant women?
methyldopa
labetalol
nifedipine —> NICARDEPINE —> NO REFLEX TACHYCARDIA
what is the treatment for hypertension emergency?
ICU admission
I.V anti hypertensive medications
what is the target of therapy in hypertensive emergency ?
reduction of systolic BP by 25% within 1 hour
reduction of systolic BP by 5-10% within the next 23 hours
followed by oral drugs and titrate dose while wearing off i.v medications
<140/90 within 48 hours with oral medications
whats the target in MI, ECLMAPSIA ?
Reduce Systolic BP to below 140 within 1 hour
what is the target in aortic dissection ?
reduce systolic BP to below 120 in ONE HOUR
