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Cardio: T15 Dyslipidaemia And Hypertension > Hypertension > Flashcards

Hypertension Flashcards

1
Q

When hypertension decreases renin secretion causes?

A

Natriuresis

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2
Q

Phenotypes associated with

salt-sensitive hypertension

A 
Low renin Hpt (Primary)
Black ethnicity
Older age
Obesity
Metabolic syndrome
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3
Q

What can cause a natriuretic handicap?

A

Sodium Channelopathies
Genetics (APOL1 gene variants)
Renal injury
Low nephron mass

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4
Q

What can cause renal injury?

A

Sympathetic system
Uric acid
High salt diet

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5
Q

When is ambulatory BP monitoring indicated?

A

For the evaluation of “white coat” HTN (in absence of target organ injury)

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6
Q

If there is an absence of a BP drop while sleeping, it could indicate?

A

Increased CVD risk

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7
Q

Circumstances needed for office BP measurement

A 
No coffee 30min before
Pt seated quietly 5min
Arm supported at heart level
Appropriate sized cuff
At least 2 measurements
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8
Q

Uses for self-measurment of BP

A

Check response to antihypertensive Rx
Improve adherence with Rx
Evaluate ‘white coat’ HTN

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9
Q

3 objectives when evaluating a pt. with HTN

A

Identify other CV risk factors or concomitant disorders that affects prognosis and guides treatment
Reveal identifiable causes of high BP
Assess the presence or absence of target organ damage and CVD

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10
Q

Name some CVD risk factors

A 
Metabolic syndrome components
Smoking
Inactivity
Microalbuminuria/GFR<60
Age
Family history of premature CVD
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11
Q

Name some identifiable causes of HTN

A 
Sleep apnea
Drug-induced
Chronic kidney disease
Chronc steriod Rx (Cushing's)
Pheochromocytoma
Coarctation of the aorta
Thyroid/parathyroid disease
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12
Q

Name some possible effects of target organs damage

A 
LVH, Angina, prior MI, HF, Prior coronary revascularization
Stroke, transient ischaemic attack
Chronic kidney disease
Peripheral artery disease
Retinopathy
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13
Q

Important aspects on clinical exam

A

Fat distribution and muscle strength
Peripheral pulses
Wheezes and crackles
Renal masses and bruits

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14
Q

Lab tests for HTN

A 
ECG (LVH)
Urinalysis (albumin:creatinine)
Glucose, hematocrit
Creatinine, GFR
Lipid profile
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15
Q

How does the sympathic nervous system respond to a decrease in BP?

A

It stimulates the activation of both the B1 adrenoceptors of the heart and the A1 adrenoceptors on smooth muscle

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16
Q

How does the renin-angiotensin-aldosterone system respond to a decrease in BP?

A

The decrease in renal blood flow causes:

  1. An increase in renin and therefore angiotensin secretion which increases aldosterone secretion
  2. decrease in GFR causing increase in retention of sodium and water
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17
Q

5 classes of anti-hypertensive drugs

A 
Diuretics
ACE-I
ARB
Sympatholytics
Calcium channel blockers
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18
Q

What is Furosemide’s MOA?

A

Inhibits Na-K-Cl co-transporter

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19
Q

How do thiazide diuretics decrease BP?

A

They decrease peripheral resistance and sodium retention

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20
Q

What are the AE of hydrochlorothiazide?

A

Decrease K and Na
Hyperuricaemia and gout
High doeses - glucose intolerance and adverse lipid profile

21
Q

Classes of ACE-I

A
  1. Captopril
  2. Prodrugs: enalapril
  3. Water-soluble: lisinopril
22
Q

ACE-I can cause coughing as they prevent the metabolism of?

A

Bradykinin

23
Q

AE of ACE-I

A

Coughing
Othostatic HTN
Hyperkalaemia
Angioedema

24
Q

C/I of ACE-I

A

Pregnancy

Renal artery stenosis

25
Q

What important AEs of ACE-I is not found when using ARBs?

A

Coughing

Angioedema

26
Q

2 e.g. of ARBs

A

Losartan

Volsartan

27
Q

Egs of sympatholytics

A

B1 and B2: propranolo, nadolol

B1: atenolo, bisoprolol, metoprolol

28
Q

How do sympatholytics decrease BP?

A

They decrease renin secretion and activity of B1 on the heart

29
Q

When are B-blockers used?

A

Not recommended unless compelling indication

30
Q

AE and C/I of B-blockers

A 
Asthmatics
IDDM
Heart block
Verapamil
Symptomatic CCF
31
Q

Eg of calcium channel blocker

A

Nifedipine

Verapamil

32
Q

CCB C/I

A

Tachycardia
Hypotension
Unstable angina/acute MI
B-blockers

33
Q

Stepwise approach to HTN Rx

A

Lifestyle modification
Low dose HCTZ
ACE-I/ARB
Long acting CCB

34
Q

When can combination Rx be considered from the start?

A

If BP>20/10 above goal

35
Q

Compelling indications for diuretics

A

HF
Elderly
Isolated systolic HTN
Africans respond well

36
Q

Compelling indications for ACE-i & ARB

A

HF
Post MI
Non-diabetic & diabetic nephropathy
Proteinuria

37
Q

Compelling indications for B-blockers

A

Angina pectoris
Post MI
HF (unless bradycardia or poorly controlled) - carvedilol, metoprolol & bisoprolol
Tachyarrythmias

38
Q

Compelling indications for CCB

A

Isolated systolic hypertension
Peripheral vascular disease
Stable angina
Pregnancy (nifedipine)

39
Q

Drugs that cause HTN

A 
NSAIDs
Sympathomimetics: Nasal decongestants & appetite suppressants
Cocaine, amphetamines, caffeine
Liquorice
Cyclosporine, tacrolimus, EPO
•MAO-I, TCA
40
Q

Who to treat with anti-hypertensive drugs?

A

If repeated BP >140/90

If DM/chr renal failure BP >130/80

41
Q

What is usually measured during follow-ups for HTN?

A

Serum potassium and creatinine

42
Q

Special situations for HTN Rx

A 
Women, elderly, children and adolescents
Black pts
Metabolic syndrome
LVH
PVD
Postural hypotension
43
Q

BP management with LVH

A

Weight loss
Sodium restriction
All drug classes (not hydralazine, minoxidil)

44
Q

Aspirin should be used with HTN in the case of?

A

PVD

45
Q

Postural hypotension is more frequently seen in older pts wiith?

A

DM
Diuretics
Venolators
Psychotrpoic drugs

46
Q

Favorable effects of anti-hypertensive drugs

A

Thiazide diuretics: slows osteoporosis
BBs: AF, thyrotoxicosis, perioperativee HTN
CCBs: Raynaud’s, arrhythmias
A-blockers: prostatism

47
Q

Unfavorable effects of anti-hypertensive drugs

A

Thiazide diuretics: cautious in gout, Hx of hyponatremia
BBs: avoid in pts with asthma, reactive airways disease, 2nd or 3rd degree block
ACEIs/ARBs: C/I pregnancy (incl. future)
ACEIs: not used if Hx of angioedema
Aldosterone antagonists and potassium-sparing diuretics can cause hyperkalemia.

48
Q

Causes of resistant HTN

A 
Improper BP measurement
Excess sodium intake
Inadequate medication
Drugs that worsen HTN
Excess alcohol intake
Identifiable causes of HTN

Cardio: T15 Dyslipidaemia And Hypertension (4 decks)

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