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Cardiovascular - exam style qs > Hypertension > Flashcards

Hypertension Flashcards

1
Q

Definition

A

that blood pressure above which the benefits of treatment outweigh the risks in terms of morbidity and mortality

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2
Q

Complications of hypertension

A

Haemorrhage, stroke, cognitive decline
Retinopathy
Peripheral vascular disease
Renal failure, dialysis, transplantation, proteinuria
Left ventricular hypertrophy, coronary heart disease, congestive heart failure, myocardial infarction

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3
Q

What are the clinical systolic and diastolic blood pressures for stage 1, stage 2 and severe hypertension?

A

Stage 1 - 140/90 mmHg
Stage 2 - 160/100 mmHg
Severe - systolic: 180mmHg or higher
diastolic: 110mmHg or higher

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4
Q

Primary and secondary?

A

Primary - no obvious cause

Secondary - underlying cause eg chronic renal disease, renal artery stenosis, endocrine diseases

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5
Q

How is blood pressure normally controlled?

A

Integrated system - sympathetic and renin-angiotensin-aldosterone.

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6
Q

How does the sympathetic system increase blood pressure?

A

Increases heart rate by activating sinoatrial node
Increased stroke volume by increased contractility of myocytes
Increases peripheral vascular resistance by vasoconstriction
Increases cardiac output

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7
Q

How can the sympathetic system, which normally controls blood pressure in the short term, cause hypertension?

A

If it is over activated on a daily basis then it will remain high

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8
Q

What does renin do?

A

Convert angiotensinogen to angiotensin I.

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9
Q

How does angiotensin II increase blood pressure?

A

Potent venoconstrictor
Anti-natriutretic peptide
Stimulator of aldosterone from adrenal glands

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10
Q

What are the two likely pathological causes of high blood pressure?

A

A sodium homeostatic effect - kidneys unable to excrete appropriate amounts of sodium and fluid is retained
Increased reactivity of resistance vessels so increased peripheral resistance

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11
Q

Risk factors

A 
Age
Genetics
Environment
Weight
Alcohol intake
Smoking
Race
Sodium intake and diet
Birth weight
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12
Q

Secondary hypertension risk factors

A 
Renal disease
Diabetes
Previous MI or stroke
Drug induced - oral contraceptive, NSAIDS, corticosteroids
Pregnancy
Endocrine diseases
Vascular - coarctation of the aorta
Sleep apnoea
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13
Q

Symptoms

A

Asymptomatic

Flushed, headaches, syncope, tinnitus, fatigue, blurred vision

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14
Q

Investigations

A

ABPM (ambulatory blood pressure monitoring)
HBPM (home blood pressure monitoring)
ECG, fasting blood lipids, U&Es, creatine, urine, fundoscopy (looks at eye), TFTs, renal ultrasound

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15
Q

When you think someone has high blood pressure, what do you do before treatment?

A

Assess risk factors
Assess end organ damage
Screen for treatable causes
If under 40 then specialist evaluation

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16
Q

Why do we treat hypertension if generally no symptoms?

A

Reduces cerebrovascular disease by 40-50%

Reduce MI by 15-30%

17
Q

What is the difference in blood pressure target between young and old?

A

Old has higher target as if too low there is a risk of falls

18
Q

Lifestyle modification?

A 
Weight loss
Reduce salt
Smoking cessation
Increase omega 3
More exercise
19
Q

Stepped approach treatment for those under 55 years old

A
  • ACEI/ ARB (but not to Afro-Caribbean or women of child bearing age)
  • Add thiazide-type diuretic
  • Add calcium channel blocker
  • Consider further diuretic therapy with low dose spironolactone if potassium lower than 4.5mmol/l or higher-dose thiazide diuretic if high potassium
20
Q

Stepped approach treatment for those over 55 years of age

A 
Start CCB
Add Thiazide-type diuretic
Add ACE inhibitor
Add Beta-blocker
Add one of the less commonly used agents
21
Q

Angiotensin converting enzyme inhibitor example

A

RAMIPRIL

perindopril

22
Q

Contraindications of ACEI

A

renal artery stenosis
renal failure
hyperkalemia

23
Q

Angiotensin II antagonists

A

LOSARTAN, VALSARTAN, CANDESARTAN, IRBESARTAN

24
Q

Calcium channel blockers

A

Vasodilator - Amlodipin, Felodipine

Rate limiting - Verapamil, Diltiazem

25
Q

Contraindications of CCB

A

Acute MI

Heart failure, bradycardia

26
Q

Thiazide-type duiretics

A

Indapamide

Clortalidone

27
Q

Dangers of hypertension in pregnancy

A

Preeclampsia

28
Q

How is high blood pressure represented in children

A

BP > 98th centile

29
Q

What is accelerated/malignant hypertension?

A

Increase in levels >180mmHg in systolic or >110mmHg diastolic. Hypertensive emergency.

30
Q

Commonest cause of accelerated hypertension

A

Non-adherence to medication

Cardiovascular - exam style qs (20 decks)

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