Hypertension Flashcards
Which factors interfere with BP measurements?
Stress, caffeine, exercise, eating, smoking (acutely increases BP), arm position, clothing, size of cuff, crossed legs, room temperature, talking
Why is it important to treat high BP?
Reduces headaches
Prevents problems in future - stroke, MI, CHD, HF, kidney failure
What causes 85% of cases of high blood pressure?
Essential - no clue
What are the known causes of high BP?
Angiotensin Diabetes Oral contraceptives Physical inactivity Stress Lower education Small family size Obesity Race
What are the adrenal factors contributing to hypertension?
Conn’s syndrome - excess aldosterone
Phaeochromocytoma - excess catecholamines
Cushing’s - tumour producing excess cortisol
What is the name of an aldosterone antagonist used to treat bilateral hyperplasia?
Spironolactone
What is the clinical picture of phaeochromocytoma?
Hypertension
Sweating
Hyperglycaemia
Symptomatic episodes - pallor, palpitations, panic, chest pain
Which renal disease can cause hypertension?
Scarring
Polycystic renal disease
Renal artery stenosis
Fibro-muscular disease
Which lifestyle factors can cause an increase in BP?
Increased weight Increased salt intake Alcohol intake Cold environmental temperature Drugs - NSAIDs, combined oral contraceptive, corticosteroids, ciclosporin, cold cures, SNRI anti-depressants
How do thiazides work to reduce BP?
Block reabsorption of sodium at distal convoluted tubule
What are the contraindications to using thiazides?
Pre-existing gout/hypercalcaemia
What are the adverse effects of spironolactone?
Hyperkalaemia when given with ACE-I
What are the adverse effects of thiazides?
Gout Lower potassium Increased glucose Increased cholesterol Increased calcium
What are the adverse effects of beta-blockers?
Worsening asthma
Worsening HF
Heart block
Cold peripheries
What are the contraindications?
Unstable HF
Heart block
Asthma
Which other drugs interact with beta-blockers?
Verapamil
What is the mechanism by which ACE-I work?
Block conversion of angiotensin I to angiotensin II in lung
Which receptor do angiotensin receptor blockers act on?
Angiotensin II receptor
In which disease are ARBs superior to beta-blockers for treatment?
LVH
What are the adverse effects of ACE-I and ARBs?
Angio-oedema (ACE-I) - swelling of soft tissue
First dose hypotension - start with low doses at night
Renal failure
What are the contraindications to using ACE-I and ARBs?
Renal artery stenosis
Concurrent NSAIDs/potassium sparers
Pregnancy
What are the two subclasses of CCBs and the name of the drugs in each class?
Dihydropyridines - pure vasodilators - amlodipine
Rate limiting vasodilators - verapamil
What are the adverse effects of using dihydropyridines?
Flushing
Headache
Palpitations
Peripheral oedema
What are the adverse effects of using rate limiting vasodilators?
HF
Constipation
