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Year 1: Cardiovascular > Hypertension > Flashcards

Hypertension Flashcards

1
Q

with every increase of 20/10 mmHg in BP, how much does CV mortality risk increase?

A

it doubles

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2
Q

why must you take many readings and average them when using electric BP monitors?

A

they are less accurate than manual ones

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3
Q

Automated BP devices might not measure BP properly if there’s a pulse irregularity. True/ false?

A

True - so palpate pulse first to ensure it’s regular

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4
Q

how should BP be checked in people with symptoms of postural hypotension?

A
  • measure BP supine or seated
  • measure BP again after standing for 1 minute
  • if systolic BP falls by 20mmHg or more: review medication, measure subsequent BPs with person standing, consider referral if symptoms persist
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5
Q

at what level of BP should ABPM be offered

A

clinic BP of 140/90mmHg (to confirm the diagnosis)

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6
Q

what should be done when considering diagnosis of hypertension?

A
  • measure BP in both arms
  • if difference is more than 20mmHg, repeat measurements.
  • if it remains more than 20 difference - take 2 more readings in the arm with the higher reading
  • if BP in clinic is over 140/90mmHg - take a second measurement. If this is substantially different - take a third. Record the lower of the last two measurements as the clinic BP.
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7
Q

what can be offered if person cannot tolerate ABPM?

A

HBPM

If severe hypertension - start treatment before getting ABPM/ HBPM results

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8
Q

how should ABPM be used?

A

take at least 2 measurements per hour during the person’s waking hours to confirm hypertension

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9
Q

how should HBPM be used?

A
  • should be 2 consecutive seated measurements, 1 minute apart
  • BP recorded twice daily (ideally morning and evening)
  • BP recording continues for at least 4 days (ideally 7)
  • discard the measurements of the first day and use the average of all the remaining measurements to confirm hypertension
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10
Q

what should be done if hypertension is not diagnosed, but there is evidence of target organ damage e.g. LV hypertrophy, albuminuria, proteinuria?

A

carry out investigations for alternative causes for the target organ damage

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11
Q

what is hypertension is not diagnosed after ABPM/ HBPM?

A

measure the person’s clinic BP every 5 years, maybe more often if BP is close to 140/90mmHg

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12
Q

define stage I hypertension?

A

clinic BP 140/90mmHg
AND
ABPM/ HBPM is 135/85mmHg

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13
Q

define stage II hypertension?

A

clinic BP 160/100mmHg

AND ABPM/ HBPM is 150/95mmHg

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14
Q

define severe hypertension?

A

clinic BP is 180mmHg
OR
clinic diastolic is 110mmHg

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15
Q

what tests should be offered to all with hypertension?

A
  • test urine for protein
  • test blood to measure glucose, electrolytes, creatinine, estimated glomerular filtration rate and cholesterol
  • examine fundi for hypertensive retinopathy
  • 12 lead ECG
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16
Q

what tool can be used to calculate risk?

A

assign score

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17
Q

what should be included in the assessment of the patient?

A
  • medical history
  • FH premature CV disease
  • smoking
  • repeated BPs (or ABPM or HBPM)
  • examine fundi?
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18
Q

grade I hypertensive retinopathy?

A

slight / modest narrowing of the retinal arterioles, with an arteriovenous ratio > / = 1:2

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19
Q

grade II hypertensive retinopathy?

A

modest to severe narrowing of retinal arterioles (focal / generalised) with an arteriovenous ratio<1:2 OR arteriovenous nicking

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20
Q

grade III hypertensive retinopathy?

A

bilateral soft exudates or flame-shaped haemorrhages

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21
Q

grade IV hypertensive retinopathy?

A

bilateral optic nerve oedema

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22
Q

should ACE inhibitors ever be combined with ARBs?

A

No

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23
Q

what is first line anti-hypertension drug in those under 55 (white)?

A

ACE inhibitor

ARBs if can’t tolerate cough

24
Q

what is the first line anti-hypertension drug in those over 55/ black?

A

calcium channel blockers
(if this is not suitable e.g. oedema/ intolerance/ heart failure/ risk of heart failure) –> offer a thiazide-like diuretic

25
Q

what’s the target BP in those under 80

A

140/90mmHg

135/85 at home

26
Q

what’s the target BP in those over 80?

A

150/90mmHg

145/85 at home

27
Q

what does a discrepancy of more than 20/10mmHg between clinic and home BPM suggest?

A

white coat effect

28
Q

by what percentage does a 5mmHg drop in DIASTOLIC BP have on stroke risk and CHD risk?

A

stroke risk decreases by 40%

CHD risk decreases by 25%

29
Q

how can polycystic kidney disease (genetic condition) contribute to hypertension?

A

means you cannot excrete Na - so blood volume increases too

30
Q

what tool can be used to detect obstructive sleep apnoea?

A

the Epworth Sleepiness scale

31
Q

how can Conn’s syndrome (primary hyperaldosteronism) cause hypertension?

A

RAAS system excessive due to increased aldosterone
severe hypertension
severe hypokalaemia too

32
Q

how can phaeochromocytoma cause hypertension?

A

releases too much adrenaline and noradrenaline

33
Q

how can renal artery stenosis cause hypertension?

A

restricts blood flow to the kidney (proven now that there’s no benefit in stenting these people)

34
Q

how can fibromusclar dysplasia cause hypertension?

A

It’s a non-atherosclerotic, non-inflammatory disease of the blood vessels that causes abnormal growth within the artery wall (any artery in the body). Most common are the renal and carotid arteries.

35
Q

what lifestyle advice to lower CVS risk can be given?

A
  • diet (reduce salt and caffeine intake), weight reduction and exercise
  • alcohol
  • smoking
36
Q

what education can you provide to the patient to encourage adherence to drugs?

A
  • information about benefits of drugs and side effects
  • details of patient organisations
  • an annual review of care
37
Q

how much is BP reduced by for every 1kg of weight lost?

A

1mmHg

38
Q

what is the minimum amount of physical activity a day for reduced mortality and extended life expectancy?

A

15 minutes a day (14% reduced mortality)

an extra 15min on top of this gives an extra 4% reduced mortality

39
Q

how much does a “no salt added” diet lower BP by?

A

2-4mmHg

40
Q

how much does the DASH (Dietary Approaches to Stop Hypertension) diet reduce BP by?

A

11.4 / 5.5 mmHg

41
Q

how much does aerobic exercise reduce BP by?

A

3/8/2.6mmHg

42
Q

if people are high risk for CVS disease, but are normotensive - would they still benefit from BP and cholesterol lowering?

A

Yes

43
Q

aside from hypertension, what can B-blockers also be used for?

A

angina

44
Q

aside from hypertension, what can ACE-inhibitors/ ARBs also be used for?

A

diabetic nephropathy

45
Q

aside from hypertension, what can ACE-inhibitors / B-blockers also be used for?

A

diabetic nephropathy

46
Q

aside from hypertension, what can a-blockers also be used for?

A

benign prostatic hyperplasia

47
Q

aside from hypertension, what can thiazides also be used for?

A

use in the elderly

48
Q

why are ACE-inhibitors not given to fertile women? What is given instead?

A

they are teratogenic

consider an a/ B-blocker instead

49
Q

adding drug combinations is more effective than increasing the doses. True/ false?

A

True

reduced BP more and reduces side effects

50
Q

reasons for resistant hypertension?

A 
non-concordance
white coat effect
pseudo-hypertension
lifestyle factors
drug interactions
secondary hypertension
true resistance
51
Q

what drug class is spironolactone and how does it work?

A

it’s a potassium sparing diuretic
it blocks aldosterone receptors
very effective at reducing BP

52
Q

how should spironolactone be used?

A
  • start low, go slow
  • use with caution in diabetics and low GFR (risk of hyperkalaemia)
  • tolerate a 25% increase in K and creatinine
53
Q

what is renal de-nervation?

A

the nerves are ablated (reducing sympathetic and efferent connections) so BP reduced in those with resistant hypertension

54
Q

carotid baroreceptor stimulation

A

baroreceptors stimulated to increase parasympathetic activity (and decrease sympathetic) and so decrease BP

55
Q

ROX AV fistula device?

A

new method of BP reduction

Year 1: Cardiovascular (16 decks)

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