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Cardiology > Hypertension > Flashcards

Hypertension Flashcards

What are the Framingham Criteria

1
Q

What are the main causes of death in hypertensive patients

A

Stroke 45%
Heart Failure 35%
Kidney Failure 3%
others 17%

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2
Q

What factors increase the risk of dying in hypertensive patients

A

male
young
family hx
increasing diastolic pressure

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3
Q

What is malignant hypertension

A

Diastolic >120mmHg and exudative vasculopathy retinal and kidney circulations.

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4
Q

What is refractory Hypertension

A

BP >140/90mmHg despite max dosage of two drugs for >3-4months

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5
Q

What is Essential Hypertension

A

presence of sustained hypertension in the absence of underlying, potentially correctable kidney, adrenal or other factors.

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6
Q

What is grade 1 hypertension (mild)

A

140-159/90-99

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7
Q

What is Grade 2 Hypertension (moderate)

A

160-179/100-109

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8
Q

What is grade 3 hypertension (severe)

A

> 180/>110

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9
Q

How do you stratify CV risk

A

based on BP level, absolute CV risk factors, assoc clinical conditions, target organ damage

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10
Q

How common is Essential HTN verse Secondary HTN

A

Essential HTN is the cause in 90-95% of all HTN patients

Secondary HTN is implicated in 5-10% of cases.

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11
Q

What are the causes of secondary Hypertension

A 
Kidney, 
ENdocrine,
 misc (Coarctation of the aorta, Immune disorder (e.g. polyarteritis nodosa),
 Drugs (NSAIDs, corticosteroids)
Pregnancy
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12
Q

What Endocrine causes of HTN are there

A 
Primary Aldosternoism (conn Sydx
Cushing Syndrome
Phaeochromocytoma
oral contraceptives
other endocrine factors
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13
Q

what kidney causes of HTN are there

A 
glomerulnephritis
reflux nephropathy
kidney artery stenosis
diabetes
other renovascular dx
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14
Q

What clinical features would you look for as a cause of secondary hHTN

A
  • abdominal systolic bruits (Kidney artery stenosis)
  • proteinuria, haematuria, casts (glomerulonephritis)
  • Bilateral kidney massess +/- Haematuria (polycystic dx)
  • Hx of claudication and delayed femoral pulse (coarctation of aorta)
  • progressive nocturia, weakness (Primary aldosteronism)
  • paroxysmal hypertension with headache, pallor, sweating, palpitations (phaeochromocytoma)
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15
Q

How would you investigate for renal artery stenosis?

A

Arterial artery Doppler USS

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16
Q

What symptoms would indicate possible end organ damage from HTN

A 
headache
dyspnoea
cehst pain
claudication
ankle oedema
haematuria
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17
Q

What pro-hypertensive medications are there?

A 
Oral & depot contraceptives
HRT
steroids
NSAIDs/COX 2 inhibitors
nasal decongestants and other cold remedies
appetite suppressants 
amphetamines
MAOI
ergotamine (migraine Rx)
cyclosporin (immune supressor - organ transplant)
tacrolimus (immunosupressant)
carbenoxolone & liqourice
buproprion (anti smoking pill)
sibutramine (diet pill - no longer available)
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18
Q

What routine tests would you perform in a pt with elevated BP

A 
BSL
Lipid studies (complete)
Serum creatinine/eGFR
serum uric acid
serum potassium and sodium
Hb and Haematocrit
U/A (& urinary sediment)
ECG
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19
Q

What tests would be recommended in HTN

A 
Echo
Carotid/femoral US
postprandial BSL
CRP
Microalbuminuria
Quantatative Proteinuira (if U.A Positive)
Fundoscopy
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20
Q

what are the benefits of BP control

A

reduces CV and total mortality
reduces stroke
reduces coronary events
this is true of all types of BP

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21
Q

what are some non-pharmacological life-style mx options

A
  • weight loss
  • Alcohol - reduction of excessive alcohol intake - increases the BP and makes Rx harder - can reduce BP by 5-10mmHg
  • Reduce Na intake - (<100mmol/day)
  • increased exercise - walking ok, avoid weights and other forms of isomeric exercises as they incr BP
  • stress reduction - either avoid or reduce with meditation/relacxtion
  • diet - avoid liquorice, lacto-vegan diet or high calcium, low fat, low caffeine may be beneficial
  • smoking - may negate any Rx benefits
  • Mx sleep apnoea
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22
Q

What would you start a new HTN pt on?

A

ACEI or ARB
or Ca Chanel blocker (CCB)
or low dose thiazide diuretic (if >65yrs)

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23
Q

If pt fails initial drug what second line agent would you use

A

ACEI or ARB + CCB
or
ACEI or ARB + thiazide

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24
Q

If target not reached with 2 drugs what would you then give

A

ACEI/ARB & CCB & Thiazide

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25
Q

What combinations of antihypertensives should you not use.

A

ACEI/ARB & K+ sparing diuretic - causes hyperkaleamia
or
More than one drug from same family - eg. B-Blockers and Verapamil - causes heart block/failure

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26
Q

What combination of antihypertensives are not very effective

A

diuretic and CCB

B-Blockers and ACEI

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27
Q

What diuretics are a good first line choice

A

Thiazides

28
Q

when would you not use a thiazide and why?

A

In pt with kidney impairment - less effective
T2DM
Hyperuricameia

29
Q

what diuretic would you use in a patient with cardiac or kidney failure

A

loop diuretic

30
Q

what Thiazde diuretics are there?

A

Indapamide
hydrochlorothiazide
chlorathalidone

31
Q

What B-Blockers are there

A

Atenolol
Metoprolol
pindolol
propranolol

32
Q

what Calcium chanel blockers are there

A 
amlodipine
diltiazem
felodipine
lercandipine
nifedipine
Verapamil
33
Q

What ACE inhibitors are there

A

ramipril
captopril
enalapril
lisinopril

34
Q

What ARBs are there?

A

irbesartan

losartan

35
Q

when would you use a central acting agent and what options are there?

A

Pergnancy and asthma,
Methyldopa
Clonidine

36
Q

What alpha-blockers are there

A

Prazosin
Terasozin
Labetalol (alpha and beta blocer)

37
Q

what hypertensive agent my precipitate gout

A

thiazide diuretic

38
Q

why should you not have NSAIDs if Hypertensie

A

NSAIDS reduces the effects of diuretics

39
Q

why would you choose indapamide over the other thiazides

A

Less effect on serum lipids

40
Q

what could taking Verapamil and B-Blocker result in

A

Heart block by uncovering a conduction abnormality

41
Q

what effect does stopping a B-blocker in someone with likely IHD do

A

can cause Angina at rest

42
Q

How do Calcium Chanel blockers work?

A

vadodilation

43
Q

Can CCb be used with a B-Blocker?

A

Only some - Verapamil and diltiazem slow the heart so should not be used with B-Blockers

44
Q

When is it not safe to use verapmil

A

in 2nd and 3rd heart block

45
Q

what effect does NSAID have on B-Blockers?

A

reduces its hypotensive effect

46
Q

If one b-blocker has failed to reduce HTN sufficiently would changing to another be useful?

A

No. If one has failed, another is unlikely to have a different effect.

47
Q

what are the downsides to using the calcium channel blockers - nifedipine and felodipine?

A

They have more vasodilation than other druge therefore more side effects

48
Q

are calcium channel blockers of the dihydropiridine compounds (nifedipine and felodipine) safe to use with B-blockers?

A

Yes

49
Q

How does ACE-I work?

A

ACE converts Angiotensin I into Angiotensin II (which acts a vasoconstrictor and stimulates aldosterone secretion), and breaks down Bradykinin (a vasodilator)

50
Q

how common is the ACE-I induced cough?

A

15% of patients

51
Q

does the ACE-I cough decrease with time or dose

A

Sometimes

52
Q

When else would you consider using an ACE-I outside of HTN?

A

In diabetics with microalbuminuria, Even if normotensive.

53
Q

Can you use ARBS with Thiazide diuretics?

A

Yes

54
Q

why would you choose an ARB over an ACE-I

A

Generally ACE-I are better but if pt has discontinued due to cough then ARB is a good alternative as they have similar kidney protecting profiles

55
Q

What do you need to warn pts about, when starting Prazosin?

A

That for their first dose they may have an acute syncopal episode after 90 minutes. Therefore should take it at night before bed

56
Q

in which patients would you consider Prazosin as a first line Rx?

A

in those patients unsuitable for diuretics or B-Blocker therapy
eg. diabetics, asthma or hyperlipidaemia

57
Q

Can you use Prazosin with B-Blockers?

A

Yes - they actually increase the effect of B-Blockers and if possible should be used together.

58
Q

what vascular smooth muscle relaxants are there?

A

Calcium channel blockers
hydralazine
minoxidil
diazoxide

59
Q

When would you use vascular smooth m.m relaxants?

A

In refractory HTN or HTN emergencies.

60
Q

What affect does aldosterone have on the body?

A

vasoconstirction an dvascular remodellin

61
Q

How would you treat a pt with mild HTN

A

avoid medication as much as possible due to likely risks outweighing benefits
non-pharmacological Rx
If not successful in 6 months then Rx with medication

62
Q

What drugs are preferred in management of isolated systolic HTN

A

ACE-I, Ca - channel blocker, and/or diuretics

63
Q

when treating hypertension in the elderly what is the first line treatment option

A

indapamide or low dose thiazide diuretic review in 2-4 weeks and if hypokaleamia develops add a K-sparing diuretic feather than K supplements

64
Q

what type of drug is frusemide

A

a loop diuretic

65
Q

what antihypertensive agents are assoc with erectile dysfunction

A

B-Blocker, thiazide diuretics, methyldopa, resrpine,

66
Q

what antihypertensive agents would you use in a pt with Erectile dysfunction

A

ACE-I, and calcium channel blockers

Cardiology (10 decks)

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