Hypertension Flashcards by Pallavi Kumar

What is hypertension?

high blood pressure
above 120/80 (hard to define due to population skew)

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Can you rely on a single reading for hypertension?

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What does hypertension do to the risk of developing other conditions?

increases it

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What is stage 1 hypertension?

clinic >140/90 + ambulatory (regularly measured over 24hr period) BP average >135/85

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What is stage 2 HTN?

clinic >160/100 + ambulatory BP average >150/95

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What is severe HTN?

> 180/110

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What is white coat hypertension?

incr. in BP when at doctors

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How is HTN diagnosed?

measure BP in both arms
if raised, confirm with ABPM at home
once diagnosis confirmed, patient should be investigated for target organ damage

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What are the 2 types of HTN?

primary (essential): no known cause, multifactorial, 85-95% of adult cases
secondary: caused by identifiable underlying condition, 5-15%

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What are the modifiable risk factors for primary HTN?

obesity
? excess salt
lack of exercise
excessive alcohol
stress
smoking
diabetes

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What are the non-modifiable risk factors for primary HTN (5) ?

older age
family history
ethnicity
male (if <65)
female (if >65)

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What are 5 main causes of secondary hypertension?

pregnancy
renal disease
pharmacology
endocrine
other

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How can pregnancy lead to secondary HTN?

pre-eclampsia (normally settles after pregnancy)

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How can renal disease lead to secondary HTN?

intrinsic
renovascular (systemic which develops secondary to compromised blood supply to the kidneys due to a lesion blocking the main artery)

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How can other things lead to secondary HTN?

coarctation of aorta
obstructive sleep apnoea

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What pharmacologically leads to secondary HTN (5)?

alcohol
cocaine
COCP
Anti-depressant
Herbal remedies

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What endocrine causes lead to secondary HTN?

Cushing’s
Conn’s
Thyroid dysfunction
Acromegaly
Phaeochromocytoma
Hyperparathyroidism

What other conditions is HPN a risk factor for?

stroke
ischaemic heart disease
AAA
peripheral arterial disease
heart failure
vascular dementia
chronic kidney disease

What are the clinical features of primary HTN?

usually asymptomatic
maybe headaches

What are the clinical features of secondary HTN?

usually asymptomatic
look for signs of end-organ damage

What is malignant hypertension?

accelerated HTN
severe HTN (>180/120) which develops over a short period of time + signs of end organ damage (eg. cerebral haemorrhage, acute renal failure, aortic dissection or HF)

What must a patient have signs of to make a diagnosis of malignant hypertension?

papilloedema

what may patients with malignant HTN present with?

headache and confusion
due to hypertensive encephalopathy

How is malignant HTN treated?

urgent
must reduce BP slowly to prevent strokes

What are end organ damage consequences can occur due to constant HTN?

- CV events: L ventricular hypertrophy -> diastolic dysfunction -> congestive HF - Renal events: renal failure and other renal problems (kidneys become smaller) - Retinal events: hypertensive retinopathy (4 grades)

How does HTN lead to left ventricular hypertrophy?

- due to adaptive changes to constant HTN - L ventricular wall hypertrophies (to incr. the cardiac output in the face of incr. peripheral resistance) - over long term, myocytes in heart atrophy, ventricle dilates, reduction in muscle volume, eventually leads to L ventricular dilation and then congestive cardiac failure

How can renal events happen?

glomerular ischemic changes -> glomerular hyperperfusion injury -> glomerulosclerosis + necrosis

What are the 4 grades of hypertensive retinopathy?

I: tortuous arteries with shiny walls (copper/silver wiring) II: A-V nipping - narrowing as arterioles cross veins III: Flame haemorrhages and cotton wool spots IV: Papilloedema

hypertension leads to a higher risk of infarction and haemorrhage which leads to?

- vascular dementia - stroke - encephalopathy

What is the 3 step investigation when confirming HTN?

1. confirm HTN 2. assess for secondary cause 3. assess end organ damage

How do you assess for secondary causes?

- 24hr urinary metanephrines - cortisol - renin-aldosterone ratio - calcium -imaging of renal arteries

How do you assess for end-organ damage?

- urine dipstick (protein and blood) - renal function - renal ultrasound - 12 lead ECG (LVH) - echo - fundoscopy

What are the 2 main ways to treat hypertension?

non-pharmacological -lifestyle modification (eg. weightloss, lower salt intake, lower alcohol intake, regular exercise) pharmacological - if BP too high in several recordings

What is the treatment of HTN

image

What are some examples and SEs of ACEis?

eg. ramapril, enalapril - dry cough - angioedema - renal failure

What are some examples and SEs of ATRAs?

eg. condesartan, losartan vertigo, pruritus

What are some examples and SEs of calcium-channel blockers?

eg. amlodipine, verepamil, diltiazem flushes, ankle oedema, fatigue

What are some examples and SEs of diuretics?

eg. bendroflumethiazide, indapamide hypokalaemia, hyponatraemia

What are some examples and SEs of b-blockers?

eg. atenolo, bisoprolol bronchospams, lethargy, HF