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Cardiovascular Conditions (JBR) > Hypertension > Flashcards

Hypertension Flashcards

1
Q

What is hypertension?

A

Sustained level of arterial BP above expected relative to age, sex and race

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2
Q

What causes primary hypertension?

A

Idiopathic
Genetic
RAAS - salt
Sympathetic Activity

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3
Q

Which renal conditions can cause secondary hypertension?

A

Renal artery stenosis
Glomerulonephritis
Chronic pyelonephritis
Cystic disease

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4
Q

How can renal pathology cause hypertensioN?

A

Increase rennin release leads to vasoconstriction + salt/water overload

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5
Q

Which endocrine conditions can cause hypertension?

A 
Excess adrenaline (tumour) 
Aldosterone (Conn's disease) 
Corticosteroid (Cushing's)
Noradrenaline (Phaeochromocytoma)
Hyperparathyroidism
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6
Q

Which congenital hear disease can cause hypertension?

A

Coarctation of the aorta

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7
Q

Which drug class can cause hypertension?

A

Corticosteroids

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8
Q

Which respiratory disease can cause hypertension?

A

Obstructive sleep apnoea

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9
Q

Which neural condition can cause hypertension

A

Intracranial tumour

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10
Q

What causes benign hypertension?

A

Increased LV load and decreased perfusion leading to LVH

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11
Q

What occurs in LVH?

A

Interstitial fibrosis
Micro-infarcts
Diastolic dysfunction

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12
Q

Fibrosis of cardiac muscle can lead to?

A

Cor pulmonale
Aortic dissection
Stroke
+/- subarachnoid haemmorhage

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13
Q

Benign hypertension causes what to happen to the small arteries and arterioles in retina and kidneys?

A

Tunica media thickens

Hyaline atherosclerosis

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14
Q

What is defined as malignant hypertension?

A

Diastolic BP >130-140

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15
Q

Malignant hypertension can arise de novo or …?

A

Progression of benign/secondary hypertension

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16
Q

What are causes of malignant hypertension?

A

Cerebral oedema (papilloedema)
Acute renal failure
Acute heart failure
Headache and cerebral haemmorhage

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17
Q

What is seen in the blood vessels with malignant hypertension?

A

Fibrinoid necrosis and endarteritis proliferation of walls

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18
Q

Pregnancy related hypertension is often secondary to?

A

Silent renal or systemic disease

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19
Q

What are possible complications of pregnancy-related hypertension?

A

Pre-ecmaplsia and proteinuria

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20
Q

What is the main risk factor for hypertension?

A

Age

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21
Q

What are other risk factors for hypertension besides age?

A

End-organ damage
Established vascular disease
Peripheral vascular disease
Diabetes

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22
Q

What is defined as stage I hypertension?

A

Clinic BP >140/90 + ABPM/HBPM daytime average >135/85

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23
Q

What is defined as stage II hypertension?

A

Clinic BP >160/90 + ABPM/HBPM daytime average >150/95

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24
Q

What is defined as severe hypertension?

A

Clinic BP systolic >180 or diastolic > 110

25
Which examinations allow determination of CVS risk?
``` Urine- proteins? Glucose Electrolytes Creatinine eGFR Cholesterol Examine funds for hypertensive retinopathy 12-lead ECG ```
26
Which lifestyle interventions are recommended for hypertensive patients?
``` Low sodium & caffeine diet Lose weight Exercise Decrease alcohol intake (moderate drinking is good) Stop smoking ```
27
What is the initial anti-hypertensive management for a <55 year old?
ACEI/ARB
28
What is the initial anti-hypertensive management for an Afro-Carribian +/- >55 year old?
CCB
29
What is the stage 2 treatment for hypertension?
ACEI/ARB + CCB
30
What is the 3rd stage of hypertension treatment?
ACEI + CCB + Thiazide Diuretic
31
What are options for stage 4 hypertension management?
Alpha blocker Beta blocker Increase diuretic dose Consult specialist
32
Is it more effective to add another drug to the regimen or increase the dose of one that's already prescribed?
Adding a drug is more effective
33
What is an example of an ACEI?
Lisinopril
34
What is the mechanism of Lisinopril?
Blocks angiotensin I to II conversion + stops degradation of bradykinin
35
What is the effect of an ACEI?
``` Venous dialtion (reduce preload) + arteriolar dilation (decrease after load and TPR) Reduce aldosterone release - decrease MABP + reduce direct growth action of aldosterone on the heart ```
36
ACEI have a possible suppressive effect on the proliferation of?
Smooth muscle cells in media of resistance vessels
37
What are side effects of ACE inhibitors?
``` Hypotension (especially if on diuretic) Dry cough (bradykinin stimulates nerves in airway) ```
38
What is an example of an ARB?
Losartan?
39
What is the mechanism of an ARB?
AT1 receptor blocker - prevents angiotensin II from binding
40
Why does an ARB not cause the same cough as an ACEI?
Doesn't inhibit bradykinin metabolism
41
ACEI and ARB are contraindicated in?
Pregnancy | Renal artery stenosis
42
Why are ACEI and ARB contraindicated in pregnancy?
Foetal toxicity
43
What is an example of a CCB?
Verampamil
44
What is the mechanism of Verampamil?
Selective for heart | Prevent opening of L-type calcium channels
45
What is the effect of Verampamil?
General arteriolar dilation decreasing TPR and MABP
46
What are side effects of CCBs?
Hypotension Dizziness Flushing Ankle oedema
47
What is an example of a thiazide diuretic?
Bendroflumethiazide
48
What is the mechanism of a thiazide diuretic?
Inhibit NaCl reabsorption in dital tubule | Sodium and water is excreted
49
What are the side effects of thiazide diuretics?
``` Hypokalaemia - tiredness Arrythmias Hyperglycaemia - Diabetes Increase uric acid - gout Impotence ```
50
What is an example of a beta-blocker?
Atenolol
51
What is the mechanism of Atenolol?
Block GPCR adrenoceptor activation by noradrenaline
52
What is the effect of beta-blockers?
Decrease CO Decrease renin-release from kidneys CNS action decreases sympathetic activity
53
With beta-blocker treatment, what happens to the CO and MABP over time?
CO returns to normal | MABP remains depressed by "resetting" TPR at lower level
54
What are 2 examples of alpha blockers?
Prozobin/Doxazosin
55
What is the mechanism of alpha blockers?
Reduce sympathetic transmission
56
What is the effect of alpha blockers?
Decrease MABP
57
What are the side effects of alpha blockers?
Postural hypotension
58
What are the ECG changes of LVH?
R and S waves are REALLY tall

Cardiovascular Conditions (JBR) (20 decks)

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