Hypertension Flashcards
Define hypertension
over 140/90mmHg based on > 2 readings on separate occasions
All patients with >160/100mmHg require treatment. If patient is above 140/90mmHg what factors will mean they require treatment?
risk of coronary events, have diabetes or end organ damage.
What are the causes of primary hypertension?
Genetic component Low birth weight Obesity Excess alcohol intake, High salt intake The metabolic syndrome
What are the two main causes of secondary hypertension?
Renal disease (80%) Endocrine disease (20%)
What kidney diseases may cause hypertension?
Adult polycystic kidneys, Chronic glomerulonephritis, diabetic nephropathy
Chronic tubulointerstitial nephritis and renovascular disease
What 5 endocrine diseases are associated with hypertension?
Conn’s syndrome (hyperaldosteronism)
Phaeochromocytoma (rare tumor of adrenal gland tissue.
–> release of too much epinephrine and norepinephrine)
Adrenal hyperplasia
Cushing’s syndrome (too much cortisol)
Acromegaly (too much growth hormone)
Other than endocrine and renal causes what are other causes of secondary hypertension?
Coarctation of the aorta (genetic narrowing) Pregnancy Steroids MAOI (monoamine oxidase inhibitors) Oestrogen containing oral contraceptive
What ethnicities are at greater risk of hypertension?
Afro-caribean
In hypertension, what diagnostic tests are carried out to assess overall risk?
Fasting glucose and cholesterol
In hypertension, what diagnostic tests are carried out to assess end organ damage?
ECG (LVH? MI?) urine analysis (blood? protein?)
In hypertension, what diagnostic tests are carried out to exclude secondary causes?
U&Es eg K+ is decreased in conns
calcium is increased in hyperparathyroidism
Aside bloods and urine analysis what other tests are carried out in hypertension?
Renal ultrasound/arteriography 24h urinary metanephrines (measures adrenal tumour) Urinary free cortisol Renin Aldosterone MR aorta (for coarctation)
What is the target BP for patient with hypertension?
For patients with diabetes, CKD or CVD?
140/85
130/80
What medication is taken for patients with hypertension , to reduce risk of CVS disease
Statins
Glycemic control for diabetics
In patients with hypertension below the age of 55, what is the 1st line therapy?
ACE inhibitors
In patients with hypertension over the age of 55 or afro-caribean, what is the first line therapy?
CCB or Thiazide diuretics
What is 2nd line therapy for hypertension?
CCB + ACEi OR Thiazide+ ACEi
What may be used if patient is intolerant to ACE inhibitors
ARB
Name 4 ACE inhibitors
catopril, enalapril, ramipril, lisonipril
How do ACE inhibitors work?
Block conversion of angiotensin I to angiotensin II
Angiotensin II is a potent vasoconstrictor
Also prevent degradation of bradykinin (a vasodilator) – causes COUGH
Name a thiazide medication commonly used?
bendroflumethiazide
Name a loop diuretic?
furosemide
