Hypertension Flashcards

1
Q

What is hypertension?

A

Hypertension is persistently elevated blood pressure, defined as systolic BP ≥ 140 mmHg and/or diastolic BP ≥ 90 mmHg in clinic measurements.

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2
Q

What are the classifications of hypertension?

A

It is classified as primary (essential) or secondary, with primary hypertension being more common.

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3
Q

What is the difference between primary and secondary hypertension?

A

Primary hypertension has no identifiable cause, while secondary hypertension is due to an underlying condition, such as renal disease or endocrine disorders.

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4
Q

What are the common symptoms of hypertension?

A

Hypertension is often asymptomatic but can cause headaches, dizziness, visual disturbances, or symptoms related to complications.

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5
Q

What is the aetiology of primary hypertension?

A

It is multifactorial, involving genetic predisposition, lifestyle factors, and environmental influences.

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6
Q

What are the common causes of secondary hypertension?

A

Causes include renal artery stenosis, chronic kidney disease, endocrine disorders (e.g., Cushing’s syndrome, hyperaldosteronism), and medications like NSAIDs.

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7
Q

What is the pathophysiology of hypertension?

A

It involves increased systemic vascular resistance and/or cardiac output, often due to factors like endothelial dysfunction, overactivation of the RAAS, or sympathetic nervous system hyperactivity.

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8
Q

What are the risk factors for hypertension?

A

Age, obesity, high salt intake, sedentary lifestyle, excessive alcohol consumption, smoking, and a family history of hypertension.

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9
Q

What is the prevalence of hypertension in the UK?

A

It affects around one-third of adults in the UK, with prevalence increasing with age.

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10
Q

How is blood pressure measured in diagnosing hypertension?

A

Blood pressure is measured in both arms, and ambulatory or home BP monitoring is recommended to confirm the diagnosis.

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11
Q

What is the role of ambulatory blood pressure monitoring (ABPM) in hypertension?

A

ABPM provides multiple BP readings over 24 hours, helping to confirm hypertension and detect white coat or masked hypertension.

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12
Q

What investigations are performed in a patient with newly diagnosed hypertension?

A

Blood tests (e.g., U&Es, lipid profile, glucose), urinalysis, ECG, and fundoscopic examination to assess for target organ damage.

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13
Q

What are the clinical signs of target organ damage in hypertension?

A

Signs include left ventricular hypertrophy (ECG), retinopathy (fundoscopy), proteinuria (urinalysis), and chronic kidney disease.

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14
Q

What are the differential diagnoses for hypertension?

A

White coat hypertension, masked hypertension, and secondary causes like pheochromocytoma or renal artery stenosis.

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15
Q

What are the complications of untreated hypertension?

A

Complications include stroke, myocardial infarction, heart failure, chronic kidney disease, and hypertensive retinopathy.

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16
Q

What is the first-line treatment for hypertension in patients under 55 years of age?

A

An ACE inhibitor (e.g., ramipril) or an angiotensin receptor blocker (ARB) if ACE inhibitors are not tolerated.

17
Q

What is the first-line treatment for hypertension in patients aged over 55 or of African/Caribbean descent?

A

A calcium channel blocker (e.g., amlodipine) is preferred.

18
Q

What lifestyle modifications are recommended for managing hypertension?

A

Reducing salt intake, maintaining a healthy weight, increasing physical activity, moderating alcohol consumption, and following a DASH diet.

19
Q

What is resistant hypertension, and how is it managed?

A

Resistant hypertension is BP that remains uncontrolled despite three antihypertensive agents. It is managed by optimising therapy and investigating secondary causes.

20
Q

How is hypertensive urgency different from hypertensive emergency?

A

Hypertensive urgency involves severely elevated BP without target organ damage, while hypertensive emergency involves target organ damage (e.g., encephalopathy, acute renal failure).

21
Q

How is hypertensive emergency managed?

A

It is managed with intravenous antihypertensive medications (e.g., labetalol, nitroprusside) and careful BP monitoring to avoid rapid drops.

22
Q

What is the target blood pressure for patients with hypertension?

A

< 140/90 mmHg in clinic settings or < 135/85 mmHg with home or ambulatory monitoring. Lower targets may be recommended for high-risk patients.

23
Q

What is white coat hypertension?

A

It refers to elevated blood pressure readings in a clinical setting but normal readings outside of it, often due to anxiety.

24
Q

Why is patient education important in managing hypertension?

A

Educating patients improves adherence to lifestyle changes and medication, reducing the risk of complications.

25
Q

How can hypertension be prevented?

A

Prevention strategies include regular exercise, healthy eating, maintaining a healthy weight, limiting alcohol intake, and avoiding smoking.