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Cardiovascular system > Hypertension > Flashcards

Hypertension Flashcards

1
Q

What is the effect of hypertension on brain?

A

Hypertension can lead to haemorrhage, stroke, cognitive decline

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2
Q

What is the effect go hypertension on heart?

A

Left ventricular hypertrophy, congenital heart failure, MI, coronary heart disease

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3
Q

What is the effect of hypertension on eyes?

A

Retinopathy

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4
Q

What is the effect of hypertension on kidneys?

A

Renal failure, proteinuria)

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5
Q

What type of monitoring should be used for diagnosing hypertension?

A

ABPM ambulatory blood pressure monitoring, HBPM home blood pressure monitoring

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6
Q

Describe the variation of BP

A

It varies throughout the day, also with age and ethnicity, it has bell shaped curve distribution

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7
Q

HBP increases risk of what?

A

exponential increase in the risk of stroke, more linear increase in the risk of heart disease

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8
Q

What is stage I hypertension?

A

clinics BP of 140/90, day time average 135/85 mmHg

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9
Q

What is stage II hypertension?

A

clinics BP of 160/100, day time average of 150/95 mmHg

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10
Q

What is severe hypertension?

A

Clinics systolic pressure of 180, or diastolic pressure 110 or higher

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11
Q

Is hypertension more prevalent in males or females?

A

Males

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12
Q

What is the aetiology of hypertension?

A

idiopathic 95% , also called primary, the rest has secondary underlying cause

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13
Q

Give empales of secondary underlying causes of hypertension

A

chronic renal disease, renal artery stenosis, endocrine disease, Cushing’s syndrome, Conn’s syndrome, diabetes mellitus, post MI, fibromuscular dysplasia, polycystic kidneys, hypo and hyperthyroidism, acromegaly, coarctation of aorta, sleep apnoea, pregnancy and pre-eclampsia, dug induced such as NSIADs, oral contraceptive pills

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14
Q

What are the risk factors ?

A

polygenic and polyfactorial, risk factors are smoking,alcohol, obesity, low birth weight, age, male, race, diabetes mellitus, renal disease , hyperlipidaemia, previous stroke or MI, left ventricular hypertrophy, low fitness, stress, genetics and family history

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15
Q

What is the pathology of hypertension?

A

hypertrophy of smooth muscles due to persistent contraction, arteries get stiffer and are unable to respond to relaxation, less complaint

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16
Q

What are the likely causes of hypertension?

A

increased activity of resistance vessels (hereditary defect of smooth muscles), Na+ homeostatic effect (kidneys can’t excrete the appropriate amount of sodium, or water or abnormality in the sodium pump)

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17
Q

Describe the genetic component of hypertension

A

It tends to run in families, there are more than 30 genes recognised, they have cumulative effects, very high correlation between siblings, also between mother and child

18
Q

What is the significance of lower birth weight?

A

Increased likelihood of development of CVD and hypertension

19
Q

Describe the link between obesity and HBP

A

Obesity is associated with activation of sympathetic system, sleep apnoea, obese patients have therefore high BP

20
Q

What organs are affected by end organ damage caused by hypertension?

A

Blood vessels, heart and kidneys

21
Q

What are the symptoms of hypertension?

A

usually asymptomatic, but when stressed the BP can rise to extreme and the patients can appear flushed with bad headaches, blurry vision, fatigue, tinnitus and feeling light headed

22
Q

What are the signs of hypertension?

A

usually no signs, residual effects on the organs that can be damages

23
Q

What are the investigations ?

A

ABPM, ECG, ECHO, proteinuria, renal ultrasound, urea and electrolytes (fundoscopy, thyroid function test, fasting blood lipids)

24
Q

Why is ECG and ECHO performed?

A

To test for LV hypetrophy

25
Q

Why is proteinuria performed?

A

To test for kidney damage, damaged kidneys will show increased amounts of protein in urine, albumin creatine ratio

26
Q

Why is fundoscopy performed?

A

To examine retinal blood vessels

27
Q

What does urea and electrolytes show?

A

They can show abnormal function of kidneys

28
Q

How can be the risk of CVD assessed?

A

Using assign risk calculator or Q risk

29
Q

When should be the treatment started?

A

Where the risk of developing CVD is 20% over 10 years

30
Q

What is target BP in young and elderly ?

A

In young it is 135/85 and in elderly it is 140/85

31
Q

What is the step I in the treatment for over 55?

A

Calcium channel blockers are the first line, if no suitable due to risk of heart failure, oedema, intolerance thiazide-like diuretics should be used

32
Q

What is the step I for under 55 ?

A

ACE inhibitors which should not be used if there is potential of pregnancy or Afro Caribbean, or ARB

33
Q

What is the step II ?

A

Add thiazide-like diuretics

34
Q

What is step III?

A

Add CCB, ACE inhibitors and thiazide-like diuretics together

35
Q

What is step IV?

A

if potassium is below 4.5mmol/L spironolactone, if higher use higher dose if the diuretics, beta blockers

36
Q

Give examples of ACE inhibitors ?

A

Ramipril, perondopril

37
Q

Give examples of ARB drugs?

A

Losartan, valsartan, candesartan, irbesartan

38
Q

Give example of rate liming CCB?

A

verapamil, diltiazem

39
Q

Give example of vasodilating CCB

A

amlodipine, felodopine

40
Q

Give example of thiazide-like diuretics

A

andamapide, clortalidone

41
Q

What are the less commonly sed agents in treatment of hypertension?

A

methyldopa, daxazosin, minoxidil, hydralazine

42
Q

What treatment can be used for pregnant women?

A

methyl dopa, atenolol, labetolol, nifedipine modified release

Cardiovascular system (18 decks)

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