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Cardiovascular System > Hypertension > Flashcards

Hypertension Flashcards

1
Q

How is hypertension defined.

A

Defined as blood pressure > 140/90mmHg.

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2
Q

What are the two main categories of hypertension. (2)

A

Essential hypertension.

Secondary hypertension.

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3
Q

What is essential hypertension.

A

Arterial hypertension with no specific cause.

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4
Q

What percentage of cases of hypertension are due to essential hypertension.

A

> 90%

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5
Q

What are the causes of secondary hypertension. (5)

A 
Endocrine causes. 
Renal disease. 
Acute porphyria. 
Coarctation of the aorta. 
Iatrogenic.
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6
Q

What are the endocrine causes of hypertension. (5)

A 
Cushing's syndrome. 
Phaeochromocytoma. 
Acromegaly. 
Conn's syndrome. 
Thyrotoxicosis.
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7
Q

What are the renal causes of hypertension. (2)

A

Chronic renal failure.

Renal artery stenosis.

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8
Q

What are the iatrogenic causes of hypertension. (3)

A

Ciclosporin.
Contraceptives.
Steroids.

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9
Q

What are the risk factors for hypertension. (5)

A 
Obesity. 
Increased salt intake. 
Alcohol. 
Diabetes mellitus. 
Genetic inheritance.
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10
Q

What are the symptoms of hypertension. (9)

A 
Asymptomatic unless malignant. 
Headaches. 
Dizziness. 
Blurred vision. 
Epistaxis. 
Angina. 
Syncope. 
Signs of heart failure. 
And symptoms related to the underlying cause.
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11
Q

What are the signs of hypertension. (6)

A 
LV heave. 
4th heart sound. 
3rd heart sound. 
Hypertensive retinopathy. 
Carotid/renal bruits.
Proteinuria.
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12
Q

What investigations should be carried out in a patient with hypertension. (9)

A 
FBC. 
UandEs. 
Fasting glucose.
Lipid profile. 
Haemoglobin A1c (HbA1c). 
Urine for sugar/protein/blood/creatinine clearance. 
ECG (for LV hypertrophy and strain). 
CXR. 
Other investigations to rule out secondary causes.
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13
Q

What tests should you do to rule out Cushing’s as a cause of hypertension. (4)

A

Calcium.
TFTs.
Cortisol.
Dexamethasone suppression test.

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14
Q

What test should you do to rule out a phaeochromocytoma as a cause of hypertension.

A

24 hour urine for catecholamines.

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15
Q

What test should you do to rule out a renal carcinoid as a cause of hypertension.

A

24 hour urine for hydroxyindoleacetic acid (HIAA).

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16
Q

What test should you do to rule out Conn’s as a cause of hypertension.

A

Aldosterone:renin ration.

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17
Q

What tests should you do to rule out renal artery stenosis as a cause of hypertension. (2)

A

Renal Doppler flow studies.

Renal MRA.

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18
Q

What are the complications of hypertension. (5)

A 
Atherosclerosis. 
Heart failure. 
Cerebral infarct. 
Cerebral haemorrhage. 
Renal impairment.
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19
Q

What are the main aspects of treatment of hypertension. (2)

A

Lifestyle changes.

Medical treatment.

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20
Q

What aspects of a patient’s lifestyle should be changed if they have hypertension. (5)

A 
Stop smoking. 
Weight loss. 
Salt restriction. 
Reduce alcohol intake. 
Optimize glycaemic control.
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21
Q

What are the medical therapies for patient with hypertension. (7)

A 
Diuretics (thiazide).
ACE inhibitors (Lisinopril).
Angiotensin receptor blockers (candesartan). 
Calcium channel blockers (nifedipine). 
Beta blockers (bisoprolol). 
Aspirin when BP controlled if age>55. 
Statin.
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22
Q

What is malignant hypertension considered.

A

A medical emergency.

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23
Q

What is malignant hypertension.

A

Fibrinoid necrosis of small arteries/arterioles and dilatation of cerebral arteries.

24
Q

Who is most affected by malignant hypertension.

A

Men more than women.

Usually in the 5th decade.

25
Q

What are the clinical signs of malignant hypertension. (5)

A 
Headache. 
Vomiting. 
Visual disturbances. 
Convulsions. 
Papilloedema.
26
Q

What is the treatment of malignant hypertension. (2)

A

IV labetalol/GTN.

Slow reduction of blood pressure.

27
Q

What are the complications of malignant hypertension. (7)

A 
Microangiopathic haemolytic anaemia. 
Acute renal failure. 
Cerebral haemorrhage. 
Heart failure. 
Encephalopathy. 
Coma. 
Death.
28
Q

Who gets treatment for hypertension.

A

Everyone above 160/100.
For those with BP 140/90, the decision to treat depends on the risk of coronary events, presence of diabetes or end-organ damage.

29
Q

What did the HYVET study show.

A

That there is a substantial benefit in treating those with hypertension over 80s.

30
Q

What is isolated systolic hypertension.

A

It is the most common form of hypertension in the UK.

31
Q

What is the prevalence of isolated systolic hypertension.

A

It affects 50% of those over 60.

32
Q

What is isolated systolic hypertension caused by.

A

It results from stiffening of the large arterial vessels (arteriosclerosis).

33
Q

Is isolated systolic hypertension malignant.

A

Yes.

34
Q

What does isolated malignant hypertension increase the risk of. (2)

A

It doubles the risk of MI.

It triples the risk of CVA.

35
Q

What is the aetiology of malignant hypertension.

A

It refers the a rapid rise in BP, leading to vascular damage (pathological hallmark is fibrinoid necrosis).

36
Q

What are the hallmark features of malignant hypertension. (3)

A

Severe hypertension (systolic>200, diastolic >130).
Bilateral retinal haemorrhages and exudates.
Papilloedema may or may not be present.

37
Q

What are some hypertensive emergencies. (3)

A

Acute renal failure.
Heart failure.
Encephalopathy.

38
Q

What is the mortality for malignant hypertension. (2)

A

Untreated, 90% die in one year.

70% survival 5years.

39
Q

Who is malignant hypertension most common in. (2)

A

Younger patients.

Black patients.

40
Q

What percentage of hypertensive cases are due to secondary hypertension.

A

5%.

41
Q

What is the most common secondary cause of hypertension.

A

Renal disease.

42
Q

What indicates severity and duration of hypertension.

A

If there are any signs of end organ damage.

43
Q

What are some signs of end organ damage in hypertension. (3)

A

LVF.
Retinopathy.
Proteinuria.

44
Q

What test helps in a borderline hypertensive patient.

A

24h ambulatory BP monitoring.

It is now recommended for all newly diagnosed hypertensive cases.

45
Q

Why are tests done in a patient with hypertension. (3)

A

To help quantify overall risk.
To look for end-organ damage.
To ‘exclude’ secondary causes.

46
Q

What are some other causes of secondary hypertension. (5)

A 
Coarctation. 
Pregnancy. 
Steroids. 
MAOI. 
The Pill.
47
Q

What are the grades of retinopathy.

A

Grade 1 to 4.

48
Q

What is grade 1 retinopathy characterized by.

A

Tortuous arteries with thick shiny walls (silver or copper wiring).

49
Q

What is grade 2 retinopathy characterized by.

A

A-V nipping (narrowing where arteries cross veins).

50
Q

What is grade 3 retinopathy characterized by.

A

Flame haemorrhages and cotton wool spots.

51
Q

What is grade 4 retinopathy characterized by.

A

Papilloedema.

52
Q

What is stage 1 hypertension.

A

ABPM>135/85.

53
Q

What is stage 2 hypertension.

A

> ABPM>150/95.

54
Q

What are the signs of encephalopathy. (4)

A

Headache.
Focal CNS.
Seizures.
Coma.

55
Q

What is the pattern of adding drugs for hypertensive patients. (4)

A

ACEi and Calcium channel blocker.
Add thiazide diuretic.
If a fourth is needed add a higher dose thiazide diuretic or another diuretic (spironolactone).

56
Q

If only a beta blocker and another drug is needed to control hypertension, what drug should be added.

A

Calcium channel blocker, not a thiazide, to reduce the risk of developing diabetes.

57
Q

How long does it usually take for anti-hypertensive drugs to take effect.

A

4-8weeks.

Cardiovascular System (31 decks)

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