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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
Q

Which examinations allow determination of CVS risk?

A 
Urine- proteins?
Glucose
Electrolytes
Creatinine
eGFR
Cholesterol
Examine funds for hypertensive retinopathy
12-lead ECG
26
Q

Which lifestyle interventions are recommended for hypertensive patients?

A 
Low sodium & caffeine diet
Lose weight
Exercise
Decrease alcohol intake (moderate drinking is good) 
Stop smoking
27
Q

What is the initial anti-hypertensive management for a <55 year old?

A

ACEI/ARB

28
Q

What is the initial anti-hypertensive management for an Afro-Carribian +/- >55 year old?

A

CCB

29
Q

What is the stage 2 treatment for hypertension?

A

ACEI/ARB + CCB

30
Q

What is the 3rd stage of hypertension treatment?

A

ACEI + CCB + Thiazide Diuretic

31
Q

What are options for stage 4 hypertension management?

A

Alpha blocker
Beta blocker
Increase diuretic dose
Consult specialist

32
Q

Is it more effective to add another drug to the regimen or increase the dose of one that’s already prescribed?

A

Adding a drug is more effective

33
Q

What is an example of an ACEI?

A

Lisinopril

34
Q

What is the mechanism of Lisinopril?

A

Blocks angiotensin I to II conversion + stops degradation of bradykinin

35
Q

What is the effect of an ACEI?

A 
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
Q

ACEI have a possible suppressive effect on the proliferation of?

A

Smooth muscle cells in media of resistance vessels

37
Q

What are side effects of ACE inhibitors?

A 
Hypotension (especially if on diuretic)
Dry cough (bradykinin stimulates nerves in airway)
38
Q

What is an example of an ARB?

A

Losartan?

39
Q

What is the mechanism of an ARB?

A

AT1 receptor blocker - prevents angiotensin II from binding

40
Q

Why does an ARB not cause the same cough as an ACEI?

A

Doesn’t inhibit bradykinin metabolism

41
Q

ACEI and ARB are contraindicated in?

A

Pregnancy

Renal artery stenosis

42
Q

Why are ACEI and ARB contraindicated in pregnancy?

A

Foetal toxicity

43
Q

What is an example of a CCB?

A

Verampamil

44
Q

What is the mechanism of Verampamil?

A

Selective for heart

Prevent opening of L-type calcium channels

45
Q

What is the effect of Verampamil?

A

General arteriolar dilation decreasing TPR and MABP

46
Q

What are side effects of CCBs?

A

Hypotension
Dizziness
Flushing
Ankle oedema

47
Q

What is an example of a thiazide diuretic?

A

Bendroflumethiazide

48
Q

What is the mechanism of a thiazide diuretic?

A

Inhibit NaCl reabsorption in dital tubule

Sodium and water is excreted

49
Q

What are the side effects of thiazide diuretics?

A 
Hypokalaemia - tiredness
Arrythmias
Hyperglycaemia - Diabetes
Increase uric acid - gout
Impotence
50
Q

What is an example of a beta-blocker?

A

Atenolol

51
Q

What is the mechanism of Atenolol?

A

Block GPCR adrenoceptor activation by noradrenaline

52
Q

What is the effect of beta-blockers?

A

Decrease CO
Decrease renin-release from kidneys
CNS action decreases sympathetic activity

53
Q

With beta-blocker treatment, what happens to the CO and MABP over time?

A

CO returns to normal

MABP remains depressed by “resetting” TPR at lower level

54
Q

What are 2 examples of alpha blockers?

A

Prozobin/Doxazosin

55
Q

What is the mechanism of alpha blockers?

A

Reduce sympathetic transmission

56
Q

What is the effect of alpha blockers?

A

Decrease MABP

57
Q

What are the side effects of alpha blockers?

A

Postural hypotension

58
Q

What are the ECG changes of LVH?

A

R and S waves are REALLY tall

Cardiovascular Conditions (JBR) (20 decks)

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