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JL Cardiovascular > Hypertension > Flashcards

Hypertension Flashcards

1
Q

What would a blood pressure greater than be classed as hypertension?

A

> 140/90

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2
Q

Name two types of hypertensikon that are related to normal variation in individuals?

A
  1. White coat hypertension

2. Stable or labile hypertension

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3
Q

What causes cardiac failure?

A

Hypertension

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4
Q

Give four conditions hypertension is a risk factor for?

A
  1. Cerebral haemorrhage
  2. Atheroma
  3. Renal failure
  4. Sudden cardiac death
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5
Q

What populations is hypertension higher in?

A

Black

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6
Q

According to consequences what are the two classes of hypertension?

A
  1. Benign

2. Malignant

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7
Q

What do heart rate, contracility and blood volume control?

A

Cardiac output

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8
Q

What do constrictors such as angiotensin II and catecholamines, and dilators such as NO and prostaglandins control?

A

Peripheral resistance

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9
Q

What does increase in dietary salt lead to?

A

Increase in BP

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10
Q

In renal disease, what is two year hypertension usually?

A

Salt sensitive

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11
Q

What do renal disease, endocrine disease, aortic disease, renal artery stenosis and drug therapy all have the potential to cause?

A

Secondary hypertension

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12
Q

What can renal artery stenosis, acute or chronic glomerulonephritis, chronic pyelonephritis, cystic diseases and interstitial nephritis all cause?

A
  1. Reduced renal blood flow
  2. Excess renin release
  3. Salt and water overload
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13
Q

Give 4 endocrine causes of secondary hypertension

A
  1. Adrenal gland hyperfunction/tumours
  2. Conn’s syndrome - excess aldosterone
  3. Cushing’s syndrome - excess corticosteroid
  4. Phaechromocytoma - excess noradrenaline
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14
Q

What can coarctation of the aorta lead to and what is it?

A

Congenital narrowing of segments of the aorta

Hypertensin

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15
Q

What can corticosteroids cause?

A

Secondary hypertension

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16
Q

What type of hypertension eventually causes, left ventricular hypertrophy, congestive cardiac failure, increased atheroma, increased aneurysm rupture (aortic dissection, Berry aneurysm) and renal disease?

A

Benign hypertension

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17
Q

What does hypertension eventually cause in the heart?

A

Left ventricular hypertrophy

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18
Q

What does increased left ventricular load, poor perfusion, intestitial fibrosis, micro-infarcts and diastolic dysfunction cause?

A

Left ventricular hypertrophy

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19
Q

What two major things can left ventricular hypertrophy cause?

A
  1. Sudden cardiac death - arrythmia and poor perfusion

2. Cardiac failure

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20
Q

What does hypertension eventually do to tissue?

A

Severe fibrosis

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21
Q

What can cause a subachnoid haemorrhage?

A

Rupture of Berry aneurysm

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22
Q

What is the term for plasma proteins being forced into vessel walls (clinical feature of ageing)?

A

Hyaline arteriosclerosis

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23
Q

What type of hypertension involves diastolic pressure above 130/140?

A

Malignant hypertension

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24
Q

What 5 things result from malignant hypertension?

A
  1. Cerebral oedema - seen as papilloedema (swelling of optic disc)
  2. Acute renal failure
  3. Acute heart failure
  4. Headache and cerebral haemorrhage
  5. Blood vessels show fibrinoid necrosis and endarteriris proliferans of their walls
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25
Q

What is pre-eclampsia?

A

Hypertension and proteinuria

26
Q

What is this a definition of - a disorder in which the level of sustained arterial pressure is higher than expected for the age, sex, and race of the individual?

A

Hypertension

27
Q

Before measuring the BP what should you check on the patient?

A

Pulse - for irregularity

28
Q

What should you offer if clinic BP is 140/90 or higher?

A

Abulatory blood pressure monitoring (ABPM) to confirm the daignosis of hypertension

29
Q

If the reading of BP is different between both arms by more than 20 mmHg what do you do?

A

Repear the measurements

30
Q

If the person is unable to tolerate ABPM what do you suggest?

A

Home blood pressure monitoring

31
Q

What must hypertension be diagnosed using?

A

ABPM

32
Q

When using ABPM to confirm hypertension diagnosis what should you ensure?

A

At least two measurements per hour during the person’s usual waking hours

33
Q

When diagnosis hypertension using HBPM, what three things should you ensure?

A
  1. Two consecutive seated measurements, 1 minute apart
  2. BP is recorded twice a day for at least 4 days and preferably for 7
  3. Measurements on hte first day are discarded - average value of all remaining is used
34
Q

In stage I hypertension - what is clinic BP and ABPM or HBPM?

A

Clinic BP - 140/90 or higher

ABPM or HBPM - daytime average is 135/85 or higher

35
Q

In stage II hypertension - what is clinic BP and ABPM or HBPM daytime average?

A

Clinic BP - 160/100 or higher

ABPM or HBPM daytime average is 150/95 or higher

36
Q

For severe hypertension - what is clinic BP?

A

Clinic BP - 180 mmHg or higher

Clinic diastolic is 110 mmHg or higher

37
Q

What 4 tests should be done for all patients with hypertension?

A
  1. Test urine for presence of protein
  2. Take blood to measure glucose, electrolytes, creatinine, estimated glomerular filtration rate and cholesterol
  3. Examine fundi for hypertensive retinopathy
  4. Arrange ECG
38
Q

Give 4 signs of end organ damage as a result of hypertension?

A
  1. Left ventricular hypertrophy
  2. Creatinine raised
  3. Albuminuria/microalbuminuria
  4. Retinopathy
39
Q

What four features can be seen in hypertensive retinopathy grade IV?

A

Flame haemorrhage
Hard exudate
Cotton wool spot
Papilloedema

40
Q

For people under 55 years, with hypertension - what treatment is offered?

A

Antihypertensive treatment with ACE inhibitor or ARB

41
Q

What two drugs should not be combined to treat hypertension?

A

ARB and ACE inhibitor

42
Q

For people over 55 years, with hypertension or black people (African/Caribbean) what treatment is given?

A

Calcium channel blocker, if not tolerated offer thiazide diuretic

43
Q

In stage 1 treatment, if it is not controlled offer stage 2 - what is stage 2?

A

Offer calcium channel blocker alongisde ACE inhibitor or ARB

44
Q

For black carribean and african hypertensive patients, what should be considered in combination with calcium channel blocker?

A

ARB

45
Q

In relation to monitoring drug treatment - what should be aimed for in people aged under 80?

A

140/90 mmHg

46
Q

For monitoring drug treatment, what should be aimed for in people over 80?

A

150/90 mmHg

47
Q

Is obstructive sleep apnoea a cause of secondary hypertension?

A

Yes

48
Q

When there is confirmed primary aldosteronism - what investigation should be done?

A

Adrenal CT scan

49
Q

What are the 5 main drugs used for hypertensive treatments?

A
  1. Thiazide diuretics
  2. ACE inhibitiors
  3. ARBs
  4. Calcium channel blockers
  5. Beta blockers
50
Q

What are two lesser used drugs for hypertension?

A

Spironolactone

Alpha blockers

51
Q

What drugs are used in angina?

A

Beta-blockers

52
Q

2 drugs used for congestive cardiac failure?

A
  1. ACE inbibitors

2. Beta-blockers

53
Q

What two drugs are used for hypertension in diabetic nephropathy?

A

ACE inhibitors and ARBs

54
Q

What antihypertensives are used in prostatism?

A

Alpha blockers

55
Q

What antihypertensives are used in the elderly?

A

Thiazide

56
Q

For step three treatment of hypertension what three drugs should be used?

A
  1. ACE inhibitor
  2. Calcium channel blocker
  3. Thiazide diuretic
57
Q

For step 4 hypertension treatment, what should be added in addition to ACE inhibitors, calcium channel blockers and thiazide diuretics?

A

Spironolactone low dose

58
Q

For step 4 treatment of hypertension, if further diuretic therapy is not tolerated what should be added?

A

Beta or alpha blockers

59
Q

What drug fits the phrase, “start low, go slow”?

A

Spironolactone

60
Q

What two conditions are dangerous when using spironolactone?

A

Diabetes

Low GFR

JL Cardiovascular (18 decks)

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