hypertension Flashcards

1
Q

what is the increase risk of mortality with each 2mmhg bp

A

7% heart disease

10% stroke

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2
Q

what proportion of the uk population have hypertension

A

25%

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3
Q

what proportion of people over 60 have hypertension

A

50%

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4
Q

what is stage one hypertension

A
clinic = 140/90
ABPM = 135/85
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5
Q

what is stage 2 hypertension

A

160/100

ABPM= 150/95

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6
Q

what is stage 3/ severe hypertension

A

clinic =180 syt or 110 diastolic

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7
Q

what people are not included in the definition of primary hypertension

A
diabetics
2ary hypertension
acute hypertension
pregnant people
children and young people
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8
Q

who should be offered ABPM

A

140/90

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9
Q

how is ABPM performed

A

at least two measurements per hour during the day, at least 14 measurements

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10
Q

How is HBPM performed

A

two consecutive seated measurements 1 min apart

record twice a day for 4 days
measurement on the first day is discarded and then take the average

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11
Q

who should be offered antihypertensive drug treatment

A

stage 1 hypertension below 80

stage 2 hypertension at any age

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12
Q

how should people under 40 with stage 1 hypertension be managed

A

investigate 2ary causes of hypertension

assess for target organ damage

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13
Q

what target blood pressure should be aimed for

A

140/90 in people aged below 80, else 150/90

ABPM should be 5 lower

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14
Q

in what cases should antihypertensive drugs be offered

A

stage 2 hypertension
or organ damage present
or 10 year cardiovascular risk >20%

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15
Q

what drugs should be offered to those under 55 who are not African/ caribbean

A

ACE or ARB

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16
Q

what should be offered to those over 55 or of African/ Caribbean descent

A

Calcium blocker

17
Q

what should be offered as a second antihypertensive

A

A and C

18
Q

what should be offered as a third antihypertensive

A

A, C, AND thiazide diuretic

19
Q

what should be offered as a 4th antihypertensive

A

further diuretic, alpha or beta blocker

seek expert advice

20
Q

what lifestyle interventions should be offered

A
diet and exercise
sodium and caffeine
alcohol 
smoking
patient organisations
pros and cons of medications
ANNUAL CARE REVIEW
21
Q

what part of the brain measures osmolality

A

hypothalamus

22
Q

what parts of the vascular system detect low stretch

A

atria and pulmonary vessels

23
Q

what parts of the vascular system detect high stretch

A

aortic arch, carotid sinus and juxtaglomerular apparatus

24
Q

how does the medulla oblongata regulate BP

A

varies ADH from pituitary

plus sympathetic activity

25
Q

what part of the nephron monitors stretch

A

granular cells of the afferent arteriole

26
Q

what does renin do

A

converts angiotensinogen to angiotensin 1

27
Q

what enzyme converts angiotensin 1 to 2

A

angiotensin converting enzyme

28
Q

how does angiotensin 2 raise BP

A

vasoconstriction
stimulating aldosterone production from the renal cortex
stimulating the thirst centre
stimulating ADH release

29
Q

what is a common side effect of ACE

A

dry cough

hyperkalaemia

30
Q

what are the side effects of thiazide diuretics

A
hypokalaemia
hyperuricaemia
hyperglycaemia
hypercalcaemia
ED
thrombocytopaenia
31
Q

what type of calcium channel blockers are used in hypertension

A

dihydropyridine derivatives

32
Q

what are the side effects of calcium blockers

A

headache and flushing
tachycardia
ankle swelling
gum hypertrophy

33
Q

how do beta blockers work

A

antagonise sympathetic system and catacholamines at beta one receptors in heart and kidney and beta 2 in lungs

34
Q

what are the side effects of beta blockers

A
bronchospasm 
bradycardia 
peripheral vasoconstriciton 
reduced cardiac output
hyperglycaemia
35
Q

where are granular cells found

A

afferent arteriole (stretch)

36
Q

what do macula densa cells detect

A

sodium

37
Q

what stimulates release of atrial naturetic peptide

A

high blood volume

reduces water and sodium loads and reduces blood pressure