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MD2 Foundation > Hypertension > Flashcards

Hypertension Flashcards

1
Q

What are we trying to achieve with controlling hypertension?

A

Reduction in mortality and morbidity

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2
Q

What is the optimal blood pressure?

A

Less than 120/75 mmHg

Stricter in diabetes or those with microalbuminuria

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3
Q

What should you consider when managing hypertension?

A

How hypertension interacts with other risk factors
Other factors; eg: frail patients
When do treatment benefits outweigh side effects?

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4
Q

What contributes to primary or essential hypertension?

A

RAAS
Sympathetic nervous system = stress
Salt

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5
Q

What are some causes of secondary hypertension?

A 
Renal artery stenosis
Pregnancy
Hyperaldosteronism
Cushing's disease
Phaeochromocytoma
Sleep apnoea
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6
Q

What is the importance of early blood pressure control?

A

To prevent progression of hypertension, as relative risk doubles with every increase of 20/10 mmHg

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7
Q

What is the relationship between blood pressure and the progression of chronic kidney disease?

A

Patients with heart failure with blood pressures that are normal/low are at serious risk of developing chronic kidney disease

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8
Q

What does an increase pulse pressure suggest?

A

Arteries stiffened

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9
Q

What are non-dippers?

A

At night, most people’s blood pressure drops = dippers
Non-dippers’ blood pressure doesn’t drop at night
- Very bad sign
- Suggests left ventricular hypertrophy
- Increased risk of sudden death

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10
Q

What does microalbuminuria predict?

A

If you have albumin leaking in renal arterial bed, then it’s likely that it’s leaking in another arterial bed too
Predicts coronary artery disease independent of diabetes

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11
Q

What is therapeutic inertia?

A

Failure of physicians to commence new medications/increase dose when abnormal clinical parameter recorded/becomes evident
Involves patient and physician factors

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12
Q

What are the lifestyle modifications that can be made in the treatment of hypertension?

A 
Reduce salt
Exercise
Cease smoking
Reduce weight
Reduce alcohol intake
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13
Q

What is a common side effect of ACE inhibitors and angiotensin II receptor inhibitors?

A

Dry cough because of bradykinin inhibition

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14
Q

Are ACE inhibitors and angiotensin II receptor inhibitors safe in pregnancy?

A

No

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15
Q

What can happen with dehydration if you’re on ACE inhibitors or angiotensin II receptor inhibitors?

A

Severe reduction in GFR

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16
Q

What are the indications for beta blockers?

A

Acute coronary syndrome
Ischaemic heart disease
Heart failure

17
Q

What are the contraindications for beta blockers?

A

Peripheral vascular disease

Asthma

18
Q

Why is the use of beta blockers avoided, if possible?

A

Increases impaired glucose tolerance

19
Q

What is a common side effect of calcium channel blockers?

A

Ankle swelling

20
Q

Which diuretics are best used in hypertension?

A

Thiazide diuretics, rather than frusemide

21
Q

What conditions does hypertension predispose you to?

A 
Coronary heart disease
Stroke
Cardiac hypertrophy
Heart failure
Kidney failure
22
Q

What are the relevant points in the history concerning hypertension?

A 
Family history
Past coronary/cerebrovascular events
Heart failure symptoms
Renal disease symptoms
Smoking
Diabetes
High cholesterol
23
Q

What are the relevant points in the examination concerning hypertension?

A 
Blood pressure
Pulse rate/rhythm
Weight and height for BMI
Full cardiovascular exam
Fundal inspection
Renal mass/bruits
Stigmata of secondary causes
24
Q

What are the drug treatments for hypertension?

A 
A = ACE inhibitors and ARBs
B = beta blockers
C = Ca channel blockers
D = diuretics
25
Q

What is the drug treatment algorithm for hypertension?

A

1: ACE inhibitor/Ca channel blocker/diuretic
2: ACE inhibitor + Ca channel blocker or diuretic
3: ACE inhibitor + Ca channel blocker + diuretic

26
Q

When are ACE inhibitors preferred as first line treatment of hypertension?

A

Less than 55 years

27
Q

When are Ca channel blockers preferred as first line treatment of hypertension?

A

Over 55 years

Of African origin

28
Q

When are diuretics preferred as first line treatment of hypertension?

A

Fluid retention

29
Q

What are the general considerations when prescribing ACE inhibitors?

A

Useful in coronary disease and heart failure

Reno-protective in diabetes

30
Q

What calcium channel blockers should be avoided in heart failure?

A

Verapamil

Diltiazam

31
Q

What are the general considerations when prescribing diuretics?

A

Thiazide-like drugs have fewer metabolic side effects

MD2 Foundation (42 decks)

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