Hypertension Flashcards
What is primary prevention?
Preventing the disease from occuring.
What is secondary prevention?
Preventing the disease from progressing/recurring
What is tertiary prevention?
Reduce complications of established disease
What is the blood pressure of a hypertensive patient?
A patient is hypertensive if they have a blood pressure of over 140/90.
What can hypertension increase the risk of?
- Heart Failure
- Stroke
- Chronic artery disease
- Chronic Kidney disease
- Peripheral arterie disease
- Vascular dementia
- Visual Impairment
What is the cause of primary hypertension?
No single gene cause identified - Link between genetics and environment
What is the cause of secondary hypertension?
- Renal disease
- Endocrine disease
- More common in young patients
- If it is in individuals under 40, report to specialist
What are the risk factors of hypertension?
- Birth weight
- Age
- Deprivated areas
- Genetics
- Lifestyle - Smoking, obesity, alcohol, stimulants, lack of exercise
What is sympathetic activation?
Flight or fight. It manages rapid BP changes.
What does sympathetic activation do?
It will vasoconstrict first of all. The pump delivering the fluid will increase the stroke volume and heart rate and more fluid will be in there, therefore, the pressure will be even higher. It also stimulates renin release
What is the renin-angiotensin-aldosterone system stimulated by?
- Fall in blood pressure
- Fall in circulating volume
- Sodium Depletion
Any of these are able to stimulate the release if renin from the juxtaglomerular apparatus.
How is high blood pressure treated?
- Confirm Diagnosis
- Manage Risk Factors e.g. reduce alcohol intake
- Asses end organ damage - This can be asses via blood tests, ECHO, ECG
- Assess Risk
What are the advantages of angiotensin converting enzyme inhibitor?
- Improves mortality, heart pump function
- It is an inhibitor of Angiotensin converting enzyme (ACE). It inhibits the conversion of angiotensin I to angiotensin II
- It is good for a secondary preventative treatment for heart attacks, stroke etc.
- It is also good for blood pressure and remodelling the heart.
What is the side effects of ACE inhibitors?
- Dry Cough
- Angiodema
Do not give this to pregnant women! ACE inhibitors are bad for kidneys
How do calcium channel blockers work?
Some act peripherally and some act centrally
What are side affects of calcium channel blockers ?
- Swelling in the legs
- Dry mouth
- Bradycardia (non-dihydropyridine)
Thiazide like diuretics
e.g indapamide
- Low doses mainly vasodilates
- Higher doses = diuretic effect
- Profound diuretic effect if combined with loop diuretic
What is the main side effect of thiazide-like diuretics?
Hypokalaemia
Mineralcorticoid receptor agonist
e.g. spironolactone, eplerenone
- Inhibits the action of aldosterone at the DCT/CD
- Potassium Sparing
What is the main side effect of a mineralcorticoid receptor agonist?
Hyperkalaemia, gynaecomastia
