Hypertension Flashcards
Name the four main groups of aetiology of primary/essential hypertension
Major genes, Polygenes, Environment, Individual factors
List major genes contributing to hypertension
Angiotensinogen mutation, Diabetes, Hyperlipidemia
List polygenetic factors in hypertension
OBESITY, Race - particularly afro-caribbean, Familial history
Environmental causes of hypertension
AGE - reduced arteriolar compliance DIET - high fat, salt, calorie High alcohol intake SMOKING - adds 20/10 High caffeine consumption Oral contraceptive Low exercise
List individual factors contributing to hypertension
Previous MI, Male (2x MI risk), LV hypertrophy (2x MI risk), Stress, Low birthweight
What are the two likely mechanisms of primary hypertension
increased arteriolar reactivity and constriction, caused by genetic defects and/or environmental factors, causing increased TPR.
Impaired ability to secrete appropriate amounts of Na at any conc. resulting in retention and increased plasma volume.
List the categories of the main causes of 2ndry hypertension
Renal disease Endocrine causes OSAD Drug induced - oral contraceptive, NSAIDs Pregnancy - preeclampsia Vascular - coarctation of aorta
List renal causes of 2ndry hypertension
Chronic pylonephritis
Polycystic kidney disease
Renal artery stenosis
Fibromuscular dysplasia
Common endocrine causes of 2ndry hypertension
Conn’s disease - adrenal gland disease causing hyoeraldesteronism
Cushings syndrome - hypercortisolism
Acromegaly
Hypo and Hyperthryroidism
Outline stages of hypertension
Stage one: clinic BP 140/90 or ABPM 135/85
Stage 2: Clinic BP 160/100 or ABPM 150/95
Stage 3: Clinic BP systolic >/= 180 or diastolic >/=110
Outline the effects of untreated hypertension
Cognitive effects - Increased likelihood of stroke, more rapid cognitive decline
MI, LVF, Coronary heart disease, Congestive heart failure,
Renal damage, causing proteinuria - requiring dialysis, transplant
Peripheral vascular disease - intermittent claudication
Retinopathy
Outline investigation and diagnosis of HT
- Clinic or ABPM
If patient is 55 or older, or of afro-caribbean descent, begin treatment, - If patient is younger than 55, refer to specialist to investigate
- end organ damage - renal, cognitive, cardiac, vascular
- secondary causes - Cardio, renal, endocrine, vascular, OSAD
Outline treatment of hypertension in >55 and people of afro-caribbean descent
- CCB. if not tolerated/effective thiazide like diuretic
- CCB+TLD.
ACEI or ARB if TLD not tolerated/already in use - CCB+TLD+ACEI/ARB
- Consider further diuretic therapy
- if K conc.4.5mmol consider higher conc. TLD use
If further diuretic use is contradicted/not tolerable - a/B blocker
- If hypertension still uncontrolled trial less commonly used agent: Central acting, alpha adrenoreceptor
Outline treatment of hypertension in patients >55
- ACEI or ARB
- above + CCB or TLD
- ACEI/ARB+CCB+TLD
- Consider further diuretic therapy
- if K conc.4.5mmol consider higher conc. TLD use
If further diuretic use is contradicted/not tolerable - a/B blocker
- If hypertension still uncontrolled trial less commonly used agent: Central acting, alpha adrenoreceptor
name 2 commonly used ACEI and their action
Ramipril and Perondipril
Inhibit conversion of Angiotensin I to II by ACE.
Angiotensin II acts on AT1 receptors and is a potent stimulator of vasoconstriction, vascular and LV hypertrophy, vascular and myocardial fibrosis.
Contraindications of Ramipril and Perondipril use
Renal failure/artery stenosis
hyperkalemia
Possible ADRs of Ramipril and Perondipril
COUGH
Renal impairment/damage
first dose hypotension
Drug-drug interactions of Ramipril and Perondipril
NSAIDs - renal damage/failure
TLD - hyperkalemia
List the 4 commonly used Angiotensin II antagonsists, outline action
SARTANs - Losartan, Valsartan, Irbesartan, Candesartan.
Binding A1 angiotensin receptors, prevents vasoconstriction, LVH, vascular and myocardial hypertrophy and fibrosis.
Types of CCB’s and examples
Vascular specific - Nifedipine, Amlodipine. Reduce contractility/TPR
Cardiac specific - Verapamil, Diltiazem. Reduce rate and contractility, therefore CO
Both act on L type calcium channels
what is the advantage of ARB use over ACEI
no cough, better compliance
List advantages, contraindications and ADRs of CCB’s
Advantages- high compliance, low side effects
Contra’s - MI, Heart failure, bradycardia (rate limiting CCBs)
ADR – Headache, Ankle oedema, Indigestion and reflux oesophagitis, constipation.
What are Chlortalidone and Indapamide
Thiazide like Diuretics
Describe mech of TLD’s
Block reabsorption of Na, increase diuresis
