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Study Notes - Cardiology > *Hypertension > Flashcards

*Hypertension Flashcards

1
Q

2 categories of hypertension according to cause?

Definition

A

Primary (essential) - not caused by another disease process - 90% of cases of hypertension
Secondary - caused by an underlying disease

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2
Q

What is the blood pressure value for hypertension?

A

Clinical B.P. > 140/90 mmHg

ABPM = 135/85 mmHg (24 hour average)

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3
Q

What are some of the factors associated with primary hypertension? (6)

A 
Genetics
Foetal factors
Obesity
Alcohol intake
sodium intake
stress
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4
Q

What are some underlying diseases that can cause secondary hypertension? (6 - with examples)

A

Fibromuscular dysplasia (abnormal growth within the wall of an artery)
Obstructive sleep apnoea
Renal disease e.g. renal artery stenosis
Drug therapy
Endocrine disease e.g. Cushing’s , hyperparathyroidism, phaeochromocyctoma, aldosteronism
Aortic disease e.g. coarctation

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5
Q

What is white coat syndrome?

A

Hypertension only in a clinical setting

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6
Q

What is masked hypertension?

A

Hypertension normal in clinical setting but patient is hypertensive outwith clinical setting

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7
Q

Classification of hypertension according to consequence?

Defintion?

A

Benign - often asymptomatic and develops over a relatively long period of time
Malignant - BP rises rapidly and is associated with severe hypertension, requires urgent treatment

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8
Q

Stage 1 hypertension?

A

Clinical = > or equal to 140/90

ABPM/ HBPM = > or equal to 135/85

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9
Q

Stage 2 hypertension?

A

Clinical = > or equal to 160/100

ABPM/ HBPM = > or equal to 150/95

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10
Q

Severe hypertension/ stage 3 hypertension?

A

Clinical = > or equal to 180 sys. OR 110 diast.

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11
Q

What does hypertension increase the risk of?

A

Vascular disease (ischaemic heart disease, peripheral vascular disease, cerebrovascular disease)
LVH -> Heart Failure
Retinopathy
Kidney disease
*for each increase in b.p. of 20mmHg systolic or 10mmHg diastolic, risk of CV disease doubles

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12
Q

What can be used to measure the risk of CVD? (2)

A

Assign score

UK JBS3 lifetime risk calculator

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13
Q

What can be used to look for retinopathy?

A

Fundoscopy

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14
Q

What can be used to look for kidney disease? (4)

A

Raised creatine
Proteinuria ( including Microalbuminuria)
Estimated glomerular filtrate rate
Urea and electrolytes

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15
Q

What tests should be carried out to look for signs of CVD due to hypertension?

A

12 lead ECG (looking LVH and signs of ischaemic heart disease)
Patients have their blood glucose and cholesterol levels measured

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16
Q

How is the diagnosis of hypertension confirmed?

A

If b.p. > 140/90mmHg, ambulatory (home blood pressure monitoring is also a suitable alternative) is carried out to confirm the diagnosis

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17
Q

What is involved in ABPM?

A

At least 2 measurements are taken per hour during patients normal waking hours (usually 14/day) + 1 measurement per hour for non-waking hours
(for 24 hours)

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18
Q

What is involved in HBPM?

A

Measurement taken twice a day by the patient at home for at least 4 days (preferentially 7 days)
Measurements for day 1 are disregarded and average value for remaining is taken
For each blood pressure reading, take 2 consecutive readings 1 minute apart
Take average of all readings (apart from day 1) to confirm diagnosis of hypertension

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19
Q

What is added to a home bp measurement to convert it to a clinical measurement

A

10/5

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20
Q

Can you use an automatic blood pressure monitor if the patients blood pressure is irregular?

A

No, measure it manualyl

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21
Q

What are the 4 blood pressure statuses that can be measured?

A

Normotesntion
Sustained hypertension
Masked hypertension
White coat hypertension

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22
Q

What is postural hypertension?

A

Increase in systolic bp by 20mmHg or more when standing

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23
Q

If patient has symptoms of postural hypertension, how should their blood pressure be measured?

A

Sitting/ supine and then again after 1min of standing

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24
Q

What are the 4 areas of change in a patients lifestyle that can help improve hypertension?

A

Smoking
Diet
Weight reduction and exercise
Alcohol consumption

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25
Q

What diet make be recommended to patients with hypertension

A

DASH diet (reduces BP in hypertemsive by approx. 11.4/5.5 mmHg)

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26
Q

Do calcium, magnesium, potassium or combination supplements have any evidence for BP reduction?

A

No

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27
Q

What is the major component of the diet that has to be decreased in hypertensives?
What other product should be especially minimised in hypertensives?

A

Salt (long term sodium reduction may also reduce long term risk of CV events)
No salt added diet reduced BP by 2-4mmHg
Coffee and caffeine rich products

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28
Q

What are some of the benefits of weight reduction/ exercise for hypertension?

A

15min/ day = 14% reduced mortality
Every extra 15 min/day = extra 4% reduced mortality
Aerobic exercise reduce blood pressure 3.8/ 2.6mmHg
1 mmHg reduction for every lkg of weight lost

29
Q

Look at hypertension care pathway

A

…

30
Q

What is the bp target for treated hypertension in 80 yo

A

80 yo = 150/90 mmHg (

31
Q

What hypertensive drug is given if the patient is under 55?

A

ACEI or low cost angiotensin II receptor blocker (ARB)

32
Q

What drug is considered if the patient is under 55 yo and younger with intolerance to ARB or ACEI or are of child-bearing age (women) or have evidence of increased sympathetic drive?

A

Bets blockers

33
Q

What is the first line hypertension drug used to treat patient over 55 years or of african or Caribbean family origin (of any age)?

A

Calcium channel blocker

34
Q

What is the second step of hypertension treatment?

A

Add A or C depending on the first treatment used

35
Q

What is the second line treatment given if the patient is coloured?

A

ARB (in preference to ACEI)

36
Q

What is the second a beta blocker was used as the first line treatment, what is the second line treatment?

A

Calcium channel blocker (not diuretic) to prevent diabetes

37
Q

What is the third line hypertension treatment?

A

Thiazide-like diuretic

38
Q

What is the 4th line treatment for hypertension?

A

Further diuretic or alpha or beta blocker if diuretic doesn’t work
This is resistant hypertension
Consider seeking expert advice if bp remains elevated after using maximum tolerated doses of 4 drugs

39
Q

What is resistant hypertension?

A

Clinical bp > 140/90 after treatment with A+C+D at highest tolerated dose

40
Q

What diuretics can be used for 4th line hypertension treatment?

A

Low dose spironolactone (25mg OD) if potassium level is 4.5 mol/l or lower - use with particular caution in patients with a reduced estimated glomerular filtration rate because they have an increased risk of hyerkalaemia
If potassium level is higher than 4.5mmol/l consider using a higher-dose thiazide-like diuretic
(when using further diuretics, monitor blood sodium and potassium levels as well as renal function within 1 month)
*consider alpha or beta blockers if diuretics don’t work

41
Q

What may be used in place of a calcium channel blocker?

A

A thiazide-like diuretic (if the patient has oedema or evidence/ risk of heart failure)

42
Q

Are ACEIs or ARBs used first?

A

ARBs

43
Q

What do all ACEIs end in?

A

-pril

44
Q

What other conditions are ACEIs/ ARBs also used to treat (2)

A

CCF

Diabetic nephropathy

45
Q

What type of kidney problems are ACEIs bad for?

A

Renal artery stenosis

46
Q

Side effects of ACEIs? (4)

A

Renal dysfunction
Oedema
Foetal abnormalities
Cough

47
Q

Side effects of ARBs? (2)

A

Cough (rarer than when using ACEIs)

Renal Dysfunction

48
Q

Are ACEIs/ ARBs vasodilators or vasoconstrictors?

A

Vasodilators

49
Q

What do ARBs end in?

A

-artan

50
Q

What type of drug should calcium channel blockers never be used with?

A

Beta blockers (both slow down the heart)

51
Q

Are calcium channel blockers vasodilator or vasoconstrictors?

A

Vasodilators

52
Q

What is a side effect of calcium channel blockers?

A

Ankle oedema

53
Q

What are calcium channel blockers also used to treat?

A

Angina

54
Q

What do beta blocker names end in?

A

-olol

55
Q

when are beta blockers used to treat hypertension? Examples?

A 
When hypertension is complicated e.g.
arrhythmias
increased sympathetic activity
Coronary artery disease
Congestive heart failure
56
Q

What conditions are beta blockers also used to treat?

A

CCF

Angina

57
Q

Side effects of calcium channel blockers?

A

Asthma
Tiredness
Heart failure
Cold peripheries

58
Q

In what age group of patents are thiazide like diuretics especially used in?

A

Elderly

59
Q

Side effects of thiazide like diuretics? (4)

A

Impotence
Hypokalaemia
Hyperglycaemia
Gout

60
Q

What is the most effective treatment for resistant hypertension?

A

Spirolactone

61
Q

When using spirolactone, what patients should particular caution be taken in?

A

Patients with diabetes and low GFR (start low, go slow)

62
Q

How do alpha blockers cause vasodilation?

A

They block alpha adrenoceptors

63
Q

What is a side effect of alpha blockers?

A

Postural hypotension

64
Q

Which type of drugs have side effects that are to dose dependent? (3)

A

Diuretics
Calcium blockers
Beta blockers

65
Q

Is adding or titrating a drug more effective?

A

Adding = 5X more effective

66
Q

Are combo therapies or mono therapies more effective for treating bp?

A

Combo therapies + no increase in adverse effects

67
Q

What is pseudo hypertension?

A

Falsely elevated bp due to non-compressible vessels (mainly seen in the elderly)

68
Q

What are some reasons for resistant hypertension?

A 
Non-cocordance
White coat effect
Lifestyle factors
Drug interactions
Secondary hypertension
Pseudohypetension
True resistance
69
Q

What are some examples of new technology used to treat hypertension?

A 
Baro-receptor stimulation
Renal denervation (no red. in BP after 6 months)
Rox coupler (fistula created between coronary artery and vein - used also to treat COPD)

Study Notes - Cardiology (25 decks)

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