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4 Finals > Hypertension > Flashcards

Hypertension Flashcards

1
Q

What is considered optimal blood pressure?

A

<120/75mmHg

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2
Q

What is considered normal blood pressure?

A

120-129/75-84mmHg

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3
Q

What is considered high normal blood pressure?

A

130-139/85-89mmHg

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4
Q

What is considered mildly high blood pressure?

A

140-159/90-99mmHg

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5
Q

What is considered moderately high blood pressure?

A

160-179/100-109mmHg

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6
Q

What is considered severely high blood pressure?

A

> 180/110mmHg

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7
Q

What is the definition of hypertension?

A

BP of >140/90 without an identifiable cause

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8
Q

What are the possible causes of hypertension?

A 
Disturbance of auto-regulation
Excess sodium intake
Renal sodium retention
Dysregulation of RAAS with high Renin activity in plasma
Increased sympathetic drive
Increased peripheral resistance
Endothelial dysfunction
Cell membrean transporter perturbations
Insulin resistance/hyperinsulinaemia
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9
Q

What is involved in the pathophysiology of hypertension?

A

Structural changes, remodelling and hypertrophy in resistance arterioles
Small vessel atherosclerosis

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10
Q

What are the recommended lifestyle modifications in hypertension?

A

Dietary
Smoking cessation
Increased activity
Reduced alcohol

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11
Q

When should people be screened for hypertension?

A

Every 2 years

If high normal BP then every year

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12
Q

What are the common diagnostic factors in hypertension?

A

Presence of risk factors
BP >140/90
Retinopathy

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13
Q

What are the uncommon diagnostic factors in hypertension?

A 
Headache
Visual changes
Dyspnoea
Chest pain
Sensory/motor deficit
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14
Q

What are the strong risk factors for hypertension?

A 
Obesity
<3days/week aerobic exercise
Mod-high alcohol intake
Metabolic syndrome
DM
Black
Age >60
FH HTN/CAD
Sleep apnoea
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15
Q

What are the weak risk factors for hypertension?

A

Sodium intake >2.4g/day
Low fruit and veg intake
Dyslipidaemia

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16
Q

What are the investigations recommended for hypertension?

A

ECG
Fasting metabolic panel with eGFR
Fasting lipid panel
Urinalysis

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17
Q

What other investigations may be considered in hypertension?

A 
Hb
Plasma renin
Plasma aldosterone
Renal duplex USS
24-h urine phaeochromocytoma screen
24-h urine free cortisol
TSH
Sleep study
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18
Q

What is the DDx of hypertension?

A 
Drug-induced
CKD
Aortic coartation
Renal artery stenosis
Obstructive sleep apnoea
Hyperaldosteronism
Hypothyroidism
Hyperthyroidism
Hyperparathyroidism
Cushings syndrome
Phaeochromocytoma
Acromegaly
Collagen vascular disease
Gestatonal HTN
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19
Q

3 main objectives in the diagnostic approach to hypertension are?

A

Assess risk factors
Reveal identifiable causes
Detect target-organ damage incl CVD

20
Q

What things should be examined when assessing a patient with new hypertension?

A 
BP
Optic fundi
BMI
Carotid, abdo, femoral bruits
Palpation of thyroid
Examination of heart and lungs
Abdo exam
Palpation of lower extremities for oedema and pulses
Neuro assessment
21
Q

What features on examination would indicate evidence of end-organ damage from hypertension?

A 
Retinopathy
Vascular bruits
Signs of CHF
Evidence of AA
LVH
Absence of femoral pulses
Abdominal bruits
Secondary HTN
22
Q

If a patient is white/Asian and <55 what is the 1st line treatment for hypertension?

23
Q

If a patient is black or >55 what is the 1st line treatment for hypertension?

A

CCB or thiazide diuretic

24
Q

What is second line therapy in hypertension?

A

ACEI/ARB + CCB or ACEI/ARB + thiazide diuretic

25
Q

What is 3rd line therapy in hypertension?

A

ACEI/ARB + CCB + diuretic

26
Q

What is 4th line therapy in hypertension?

A 
ACEI/ARB + CCB + thiazide diuretic 
PLUS
- further diuretic
- alpha-blocker
- beta-blocker
27
Q

What is 1st line therapy in an individual with hypertension, with concomitant CAD without CHF with stage 1 HTN (BP140-159/90-99)

A

Beta Blocker

+ lifestyle modification

28
Q

What is 2nd line therapy in an individual with hypertension, with concomitant CAD without CHF with stage 1 HTN (BP140-159/90-99)

29
Q

What is 1st line therapy in an individual with hypertension, with concomitant CAD without CHF with stage 1 HTN (BP140-159/90-99) not at goal with monotherapy or stage 2 HTN (BP>160/100)

A

Beta blocker + CCB

30
Q

What is 2nd line therapy in an individual with hypertension, with concomitant CAD without CHF with stage 1 HTN (BP140-159/90-99) not at goal with monotherapy or stage 2 HTN (BP>160/100)

A

beta blocker + ACEI/ARB

31
Q

What is 3rd line therapy in an individual with hypertension, with concomitant CAD without CHF with stage 1 HTN (BP140-159/90-99) not at goal with monotherapy or stage 2 HTN (BP>160/100)

A

Beta blocker + thiazide diuretic
OR
ACEI/ARB + thiazide diuretic

32
Q

What is 1st line therapy in an individual with hypertension, with concomitant CHF with ejection fraction <40%?

A 
ACEI/ARB + beta-blocker
PLUS
- diuretic
- aldosterone agonists
- isosorbide dinitrate/hydralazine
33
Q

What is 1st line therapy in an individual with hypertension, with concomitant LVH without CAD?

34
Q

What is 1st line therapy in an individual with hypertension, with concomitant chronic renal disease without CVD; with stage 1 HTN?

35
Q

What is 2nd line therapy in an individual with hypertension, with concomitant chronic renal disease without CVD; with stage 1 HTN?

A

CCB
OR
Thiazide diuretic

36
Q

What is 1st line therapy in an individual with hypertension, with concomitant chronic renal disease without CVD; with stage 1 HTN not at goal with monotherapy or stage 2 HTN?

A

ACEI/ARB + thiazide diuretic

37
Q

What is 2nd line therapy in an individual with hypertension, with concomitant chronic renal disease without CVD; with stage 1 HTN not at goal with monotherapy or stage 2 HTN?

A

ACEI/ARB + CCB

38
Q

What is 1st line therapy in an individual with hypertension, with concomitant AF without other comorbidity?

A

Beta blocker

39
Q

What is 2nd line therapy in an individual with hypertension, with concomitant AF without other comorbidity?

40
Q

What is 1st line therapy in an individual with hypertension, with refractory/resistant hypertension at any stage, without CHF?

A

Individualised therapy

41
Q

What is 1st line therapy for a pregnant woman <37 weeks gestation with mild-mod hypertension?

A

Lifestyle modification

Delivery if increased risk

42
Q

What is 2nd line therapy for a pregnant woman <37 weeks gestation with mild-mod hypertension?

A

Antihypertensives (methyldopa/labetalol/nifedipine)

Delivery if increased risk

43
Q

What is 1st line therapy for a pregnant woman <37 weeks gestation with severe hypertension?

A

Antihypertensives (methyldopa/labetalol/nifedipine)

44
Q

What is 1st line therapy for a pregnant woman >37 weeks gestation with mild-mod hypertension?

A

Induction of labour/delivery

45
Q

What is 1st line therapy for a pregnant woman >37 weeks gestation with severe hypertension?

A

Antihypertensives (methyldopa/labetalol/nifedipine)
+
Induction of labour/delivery

4 Finals (20 decks)

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