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Hypertension Flashcards

1
Q

what end organ damage can high blood pressure cause?

A 
> brain: stroke, cognitive decline, haemorrhage
> eye: retinopathy
> veins: peripheral vascular disease
> kidneys: renal failure, proteinuria
> heat: MI, LVH, CHD, CHF
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2
Q

what is the definition of hypertension?

A

Blood pressure above which the benefits of treatment outweigh the risks of morbidity and mortality

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3
Q

what is the parameters for stage one hypertension?

A

clinical blood pressure of 140/90 mmHg or higher and an ABPM daytime average 135/85 mmHg or higher

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4
Q

what is stage 2 hypertension?

A

clinical blood pressure is 160/100 mmHg or higher and ABPM daytime average is 150/95 mmHg or higher

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5
Q

what is severe hypertension?

A

a clinic systolic blood pressure is 180mmHg or higher or the diastolic pressure is 110mmHg or higher.

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6
Q

what is the cause of primary hypertension?

A

there is no cause that can be found

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7
Q

name some causes of hypertension?

A

> chronic renal disease
renal artery stenosis
endocrine disease

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8
Q

how do risk factors affect the morbidity from blood pressure

A

they increase in exponentially but and there is a baseline risk for all ages

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9
Q

name some factors that increase the risk form hypertension

A 
> smoking
> diabetes mellitus
> renal disease
> hyperlipidaemia
> previous MI/stroke
> left ventricular hypertrophy
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10
Q

what are the prime contributors to blood pressure?

A

> cardiac output: stroke volume and heart rate

> peripheral vascular resistance

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11
Q

how does the sympathetic system increase blood pressure?

A

> vasoconstriction
tachycardia
increased cardiac output

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12
Q

what happens if the sympathetic effect is maintained for long periods of time?

A

it can become permanent resulting in a higher blood pressure

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13
Q

what is the renin-angiotensin-aldosterone system responsible for controlling?

A

> sodium balance
blood pressure
blood volume

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14
Q

what stimulates the renin-angiotensin-aldosterone system?

A

> fall in blood pressure
fall in circulating volume
sodium depletion

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15
Q

where is renin released from?

A

the jaxtaglomerular apparatus

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16
Q

what are the properties of angiotensin 2?

A

> vasoconstrictor
it is an anti-natriuretic peptide and anti-diuretic peptide
stimulator of aldosterone release from adrenal glands

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17
Q

angiotensin 2 is also a hypertrophic agent. what is the effect of this?

A

this stimulates myocyte and smooth muscle hypertrophy in arterioles. this creates narrow lumens that cannot dilate and become stiff. this could result in them splitting.

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18
Q

give 4 examples of the aetiology of hypertension

A

> polygenic: major genes and poly genes

> polyfactorial: environment and individual/shared

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19
Q

how would a hereditary defect in the smooth muscle lining of arterioles affect the blood pressure?

A

it is likely to cause increased reactivity of resistance vessels and resultant increase in peripheral resistance

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20
Q

describe the sodium homeostatic effect

A

in essential hypertension the kidneys are unable to excrete the appropriate amounts of sodium for any given blood pressure. sodium and fluid are then retained causing an increase in blood pressure.

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21
Q

why does blood pressure tend to increase with age?

A

there is decreased arterial compliance

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22
Q

in what family relations does the closest correlation of hypertension exist?

A

between siblings

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23
Q

how many genes are important to hypertension?

A

> 30 but they only account for 0.5mmHg each

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24
Q

what is the effect of salt intake reduction to blood pressure?

A

it does lower BP in hypertensive patients but has no real effect on people with normal blood pressure

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25
how does alcohol effect the blood pressure?
small amounts decrease the blood pressure but large amounts increase the blood pressure.
26
what is the average fall in blood pressure due to reduction in alcohol consumption?
5/3mmHg
27
by how much would an untreated patients BP fall if they were to lose 9kg?
by 19/18 mmHg
28
what is the effect of birth weight on hypertension?
low birth weight creates a higher likelihood of developing hypertension and heart disease
29
what can sustained hypertension lead to?
end-organ damage to blood vessels, heart and kidneys
30
name some renal disease that cause secondary hypertension
> chronic pyelonephritis > fibromuscular dysplasia > renal artery stenosis > polycystic kidneys
31
what drugs can cause secondary hypertension?
> NSAIDs > oral contraception > corticosteriods
32
name some endocrine conditions that can cause secondary hypertension
``` > conn's syndrome > cushings > phaeochromocytoma > hypo/hyper thyroidism > acromegaly ```
33
what vascular problem can lead to high blood pressure?
coarctation of the aorta
34
what causes radial delay?
the aorta narrows, and depending where it is there is a difference in time between the radial or femoral pulses as the narrowing slows and weakens the pulse.
35
what must be used to identify true hypertension?
> ambulatory blood pressure monitoring | > home blood pressure monitoring
36
give some examples of treatable causes of hypertension?
> renal artery stenosis > cushings' disease > Conn's syndrome > sleep apnoea
37
what would you do to assess end organ damage?
``` > ECG > echocardiogram > proteinuria > kidney > renal function ```
38
what is the BHS suggested target blood pressure?
below 135/85 mmHg
39
why do we treat hypertension?
it reduces cerebrovascular disease by 40-50% and MI by 16-30%
40
why is hypertension treated with a stepped approach using several low doses of drugs?
to minimise adverse events and maximise patient compliance
41
what sort of drugs are used to treat hypertension in young people?
ACE inhibitors/ARB
42
why should ACE inhibitors not be used in young women?
due to the risk of pregnancy as they are highly teratogenic
43
what two types of drugs are used to treat hypertension in elderly patients?
> calcium channel blockers | > thiazide type diuretics
44
stage one hypertension treatment: antihypertension drug treatmen is offered to people under 80 with ABPM of >135/85 and.......
``` one or more of the following: > target organ damage > established cardiovascular disease > renal disease > diabetes > a 10 year cardiovascular risk equivalent to 20% or greater ```
45
what should you do if someone is under 40 and has stage 1 hypertension?
seek specialist evaluation of secondary causes and a more detailed assessment of potential target organ damage
46
why are patients over 80 treated with the same drug treatment as 55-80 year olds?
the medication can lead to falls so if they break something it can lead to a loss of confidence. the larger target pressure benefits from the lower risk of a fall
47
what is the blood pressure target of people over 80?
<145/85
48
describe step 1 treatment
a calcium-channel blocker is given to people over 55 years and black people of African/Caribbean origin of any age.
49
what should be given in step 1 treatment of hypertension if calcium channel blocker are not suitable?
thiazide-like diuretic
50
what is step one treatment for people under 55 years?
ACE inhibitor or ARB
51
what is step 2 treatment of hypertension?
a thiazide-type diuretic such as clortalidone or indapamide is added
52
what is step 3 treatment of hypertension?
add: calcium channel blocker, ACE inhibitor and diuretic together
53
step 4 treatment: if the blood potassium level is 4.5mmol/l or lower what treatment is given?
diuretic therapy with low dose spironolactone (25mg once daily)
54
step 4 treatment of hypertension: if the blood potassium is higher than 4.5mmol/l what treatment should be given?
higher dose thiazide like diuretic treatment
55
in what people should you use caution when giving low-dose diuretic therapy such as spironolactone?
people with reduced GFR due to the increased risk of hyperkalaemia
56
what are the effects of Ramipril and Perindopril?
they competitively inhibit the actions of angiotensin converting enzyme (ACE)
57
what is the function of ACE?
it converts angiotensin 1 into angiotensin 2
58
name 4 results of organ damage that angiotensin 2 can lead to
> stroke > heart failure > myocardial infarction > renal failure
59
what are the negative effects of angiotensin 2 on the kidney?
it decreases glomerular filtration rate, decreases proteinuria and increase aldosterone release. it also causes glomerular sclerosis
60
what are the negative effects of angiotensin 2 on the heart?
> left ventricular hypertrophy > fibrosis > remodelling > apoptosis
61
state some adverse drug reaction from ACE inhibitors
``` > cough > first dose hypotension > taste disturbance > renal impairment > angioneurotic oedema ```
62
what are the contraindications for ACE inhibitors?
> renal artery stenosis > renal failure > hyperkalaemia
63
what drug-drug interactions can occur with ACE inhibitors?
> NSAIDs can precipitate acute renal failure > potassium supplements = hyperkalaemia > potassium sparing diuretics = hyperkalaemia
64
name some angiotensin 2 antagonists?
losartan valsartan candesartan irbesartan
65
what is the action of angiotensin 2 antagonists?
they competitively block the actions of angiotensin 2 at the angiotensin AT1 receptor
66
what is the advantage of using angiotensin 2 antagonists over ACE inhibitors?
there is no cough
67
how do calcium channel blocker work?
they block the L type calcium channels but are selective between vascular and cardiac channels. they relax the large and small arteries and reduce peripheral resistance. they reduce cardiac output
68
in what patients are vaso-dilating calcium-channel blockers the treatment of choice?
> 55 years and in women of child bearing age
69
what are the benefits of vaso-dilating calcium channel blockers?
> high compliance > good in elderly patients with systolic hypertension > rarely cause postural hypotension
70
what are the contraindications of vaso-dilating calcium channel blockers?
> acute myocardial infarction > heart failure > bradycardia
71
what adverse drug reactions may occur due to vaso-dilating calcium channel blockers?
``` > flushing > headache > ankle oedema > indigestion > reflux oesophagitis ```
72
name some thiazide type diuretics
> indapamide | > clortalidone
73
with what other hypertensive drugs can thiazide type diuretic be used with?
any other anti-hypertensive drugs
74
in what are thiazide type diuretics a benefit?
stroke patients and with myocardial infarctions
75
what is the mechanism of thiazide type diuretics?
they block the reabsorption of sodium and enhance sodium urinary loss
76
what ADRs may be caused by thiazide type diuretics?
gout and incompetence
77
name some less commonly used agents in hypertensive treatment
> alpha-adrenoceptor antagonists > centrally acting agents > vasodilators
78
name an alpha-adrenoceptor antagonist
doxazosin
79
name some centrally acting agents
methyldopa | maxnidine
80
name some vasodilators
hydralazine | minoxidil
81
what is the action of doxazosin?
it is an alpha-adrenoceptor antagonist which selectively blocks synaptic alpha 1 adrenoceptors to oppose vascular smooth muscle contraction in arteries
82
what adverse drug reactions are associated with alpha-adrenoceptor antagonists?
> first dose hypotension > dizziness > dry mouth > headache
83
what is the action of methyldopa?
it is a centrally acting agent that is converted to alpha-methylnoradrenaline which acts on the central nervous system alpha adrenoreceptors decreasing the central sympathetic outflow
84
what are the adverse drug reactions associated with centrally acting agents?
sedation and drowsiness dry mouth and nasal congestion orthostatic hypotension
85
what is moxonidine?
it is a centrally acting imidazoline agonist
86
what drug would you prescribe at a pre-pregnancy clinic?
``` methyldopa nifedipine MR atenolol labetalol NOT ACE inhibitor or ARB ```
87
what is the risk with hypertension during pregnancy?
it is the second most common cause of maternal and fetal death and there is a common risk for pre-eclampsia
88
what is gestational hypertension?
this is when the blood pressure rises during pregnancy so the patient develops hypertension but there is no pronteinuria
89
describe the changes that would occur if the patient developed pre-eclampsia
BP rises from about 20 weeks >140/90 mmHg and proteinuria is >300mg/24h
90
what is prescribe during pregnancy?
a thiazide diuretic and/or amlodipine is added
91
why must labetalol be given in high doses during pre-pregnancy?
it has a major first pass metabolism
92
what is pre-eclampsia treated with?
the current medication plus intravenous esmolol, labetalol and hydralazine

Cardiovascular system (34 decks)

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