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hospital > Hypertension > Flashcards

Hypertension Flashcards

1
Q

what is the definition of hypertension ?

A

Systolic bp above 140

diastolic bp above 90

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2
Q

what are the types of hypertension?

A

primary hypertension

2ndary hypertension

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3
Q

what is primary hypertension ?

A

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

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4
Q

what is secondary hypertension 5-10%

A

Has a cause —>DRUG, DISEASE ( adrenal tumor, excessive corticosteroid ) , PREGNANCY

occurs in all ages including YOUNG

Treat the cause causing HTN

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5
Q

what are the risk factors for primary hypertension?

A

Smoking
unhealthy diet
excess salt and water retention
stress
physical inactivity
obesity
males
alcohol
black
aged
genetics

these are js risk factors not causes

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6
Q

what are IMPORTANT CAUSES of secondary hypertension ?

A

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

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7
Q

what is the organ responsible for managing BP?

A

kidneys

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8
Q

what are the 3 major causes of 2dry hypertension ?

A

Primary aldosteronosim ( PA )

Renal disease

Obstructive sleep apnea

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9
Q

describe primary aldosteronism ?

A

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

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10
Q

what are the renal disease ?

A

renovascular hypertension

reno parenchymal hypertension

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11
Q

what are the causes of renovascular hypertension?

A

fibromuscular dysplasia –> young patients –> ABNORMAL GROWTH OF WALL CELLS LEADING TO NARROWING OF THE VESSEL OR BULGING –> stenosis

atherosclerosis —> older patients

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12
Q

what is reno parenchymal hypertension?

A

hypertension due to primary kidney disease —> ACUTE OR CHRONIC

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13
Q

how does OSA cause hypertension?

A

Typically seen in OBESE PATIENTS

Obesity is a risk factor for HYPERTENSION

50% of ppl with OSA have hypertension

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14
Q

what are the complications of hypertension?

A

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

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15
Q

what are the grades of hypertension?

A

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

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16
Q

what do you have to note for diabetes mellitus and coronary artery disease patients?

A

BP has to be below 130 / 80 otherwise it is stage 1

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17
Q

what is fundoscopy and when is it required?

A

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

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18
Q

what is hypertensive urgency?

A

patient with SEVERE hypertension and symptoms BUT NO END ORGAN DAMAGE

oral medications are enough and outpatient treatment

considered hypertensive crisis

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19
Q

what is hypertensive EMERGENCY?

A

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

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20
Q

what do you when you have different systole and diastole grading?

A

pick the highest one

Example patient with 150/105 bp

150 is grade 1 systole

105 is grade 2 diastole

So hes grade 2

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21
Q

what is malignant hypertension and accelerated hypertension ?

A

old terms and now replaced with urgency and emergency

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22
Q

what are the symptoms of hypertension ?

A

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

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23
Q

what is the proper way of measuring BP?

A

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

24
Q

when is hypertension diagnosed ?

A

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

25
Q

what is ambulatory blood pressure monitoring ?

A

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

26
Q

what is white coat hypertension?

A

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

27
Q

what is masked hypertension ?

A

Opposite to white coat

high outside the office

but NORMAL in the office

28
Q

what is isolated systolic hypertension?

A

systolic is high above 140

diastole is normal below 90

common in elderly due to decreased arterial elasticity and increased stiffness

29
Q

what is isolated diastolic hypertension ?

A

only diastolic is high but systolic is normal

smokers, obese , alcoholics

30
Q

what is resistant hypertension ?

A

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

31
Q

what are the hypertensive crisis?

A

hypertensive urgency –> stage 3 hypertension ( 180+, 110+ ) but no target organ damage

Hypertensive emergency –> stage 3 hypertension WITH TARGET ORGAN DAMAGE

32
Q

what are the examples of damage seen in hypertensive emergency ?

A

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

33
Q

what is grade 3 retinopathy?

A

hemorrhage and exudate

visible signs of damage like bleeding and retinal hemorrhage and white patches on retina

34
Q

what is grade 4 retinopathy ?

A

papilledema

disease entity that refers to the swelling of optic disc due to elevated intracranial pressure ( ICP )

35
Q

what are the types of hypertension in pregnancy?

A

Chronic hypertension

gestational hypertension

pre- eclampsia

Eclampsia

36
Q

describe chronic hypertension in pregnancy? ?

A

High Bp before pregnancy

High BP in pregnancy BEFORE W20

continue for at least 12 weeks POST PARTUM

37
Q

describe gestational hypertension in pregnancy?

A

High BP in 2nd half of pregnancy AFTER W20

NO PROTEINURIA

continues up to 6 WEEKS postpartum

38
Q

describe pre ecampsia in pregnancy?

A

Hypertension + PROTEINURIA

edema AFTER w20 of pregnancy

39
Q

what is eclampsia in pregnancy?

A

same as pre eclampsia BUT

With seizures and coma

40
Q

what are the non pharmacological treatment of hypertension ?

A

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

41
Q

what are the characteristics of hypertension drug ?

A

Once daily for 24 hours BP control –> mono or combination therapy

least possible adverse effects profile

evidence based prognostic benefits

affordable cost

42
Q

when do we start hypertension medications ?

A

Stage 2 hypertension

stage 1 hypertension with DM or CVD

10% > risk of developing CVD in 10 years

43
Q

what are the goals of hypertension medications ?

A

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

44
Q

what are the first line medications for hypertension ?

A

ACE inhibitors / ARBs

Thiazide diuretics

CCB

45
Q

what are the second line drugs ?

A

Loop diuretics –> frusemide and K+ SPARING DIURETICS

BB , Alpha blockers

central alpha 2 agonist

direct vasodilator

direct renin inhibitors

46
Q

what are k+ sparing diuretics ?

A

eplerenone

Spironolactone

47
Q

what are the drugs used in step 1 to step 3 in management of hypertension?

A

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

48
Q

when are ACEIs and ARBS used as 1st line treatment?

A

diabetes

Ischemic heart disease

chronic kidney disease

systolic HF

49
Q

when are beta blockers used ?

A

Systolic HF

improve survival

50
Q

when are mineralocorticoid receptor antagonist used ?

A

systolic HF

with normal renal function

51
Q

when are diuretics used?

A

Volume overload control in HF or CKD

52
Q

what drugs are used in african american / african descent patients ?

A

CCB –> even if diabetic

thiazides diuretics

hydralazine ( Vasodilator )

53
Q

what drugs are used in pregnant women?

A

methyldopa

labetalol

nifedipine —> NICARDEPINE —> NO REFLEX TACHYCARDIA

54
Q

what is the treatment for hypertension emergency?

A

ICU admission

I.V anti hypertensive medications

55
Q

what is the target of therapy in hypertensive emergency ?

A

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

56
Q

whats the target in MI, ECLMAPSIA ?

A

Reduce Systolic BP to below 140 within 1 hour

57
Q

what is the target in aortic dissection ?

A

reduce systolic BP to below 120 in ONE HOUR

hospital (2 decks)

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