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Cardiovascular > Hypertension > Flashcards

Hypertension Flashcards

1
Q

What are the complications of hypertension for the brain?

A

Haemorrhage, stroke and cognitive decline

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2
Q

What are the complications of hypertension for the heart?

A

LVH, coronary heart disease, congestive heart failure and MI

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3
Q

What are the complications of hypertension for the kidneys?

A

Renal failure, dialysis, transplantation and proteinuria

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4
Q

What is the complication of hypertension for the vascular system?

A

Peripheral vascular disease

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5
Q

What is the complication of hypertension for the eyes?

A

Retinopathy

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6
Q

What is the definition of hypertension?

A

The blood pressure at which the benefits of treatment outweigh the risks in terms of morbidity and mortality

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7
Q

What is the definition of stage 1 hypertension?

A

Clinic blood pressure 140/90 mmHg or higher

ABPM average 135/85 mmHg or higher

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8
Q

What is the definition of stage 2 hypertension

A

Clinic blood pressure 160/100 mmHg or higher

ABPM average 150/95 mmHg or higher

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9
Q

What is the definition of severe hypertension?

A

Clinic systolic blood pressure is 180mmHg or higher or diastolic blood pressure is 110mmHg or higher

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10
Q

What are the possible causes of secondary hypertension?

A

Chronic renal disease, renal artery stenosis, endocrine disease (Cushing’s and Conn’s syndrome, phaeochromocytoma and GRA)

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11
Q

What health factors increase the risk of developing hypertension?

A

Smoking, diabetes, renal disease, male, hyperlipidaemia, previous MI/stroke and LVH

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12
Q

What are the likely causes of hypertension?

A

Increased reactivity of the resistance vessels and a sodium homeostatic effect

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13
Q

What factors can cause hypertension?

A

Age, genetics and FH, environment, weight, alcohol intake and race

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14
Q

In genetics, which relations have the closest correlation for hypertension?

A

Siblings

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15
Q

What effect does lowering sodium intake have on blood pressure?

A

It lowers blood pressure in those who are hypertensive but has little effect on those whose blood pressure is already normal

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16
Q

What effect does alcohol have on blood pressure?

A

Small amounts tend to decrease BP

Large amounts tend to increase BP

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17
Q

What effect does weight have on blood pressure?

A

Obese patients have a higher BP

Losing weight can reduce BP

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18
Q

What is the correlation between birth weight and blood pressure?

A

The lower the birth weight the higher the likelihood of developing hypertension and heart disease

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19
Q

What is the correlation between race and blood pressure?

A

Caucasians have a lower BP than black populations living in the same environment

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20
Q

What drugs can cause secondary hypertension?

A

NSAIDs, oral contraceptive and corticosteroids

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21
Q

What health conditions can cause hypertension?

A

Pregnancy, sleep apnoea, endocrine disorders and coarctation of the aorta

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22
Q

What investigations are used to diagnose hypertension?

A

Ambulatory blood pressure monitoring (ABPM) or Home blood pressure monitoring (HBPM)

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23
Q

What investigations would be used to assess for end organ damage?

A

ECG, echocardiogram, proteinuria, renal ultrasound and renal function tests

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24
Q

Which treatable causes should be screened for?

A

Renal artery stenosis/FMD, Cushing’s disease, Conn’s syndrome and sleep apnoea

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25
Q

What is the approach to treating hypertension?

A

A stepped approach which uses low doses of several drugs

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26
Q

What are the BHS Guidelines for treating hypertension?

A

A - ACE Inhibitor/ARB (Young)
C - Calcium Channel Blocker (Elderly)
D - Thiazide Type Diuretic (Elderly)

27
Q

What are the criteria for treating someone with stage 1 hypertension?

A

An ABPM greater than 135/85 mmHg with one of the following:

Target organ damage, established CVS disease, renal disease, diabetes or a 10yr CVS risk equivalent to 20% or greater

28
Q

What is the criteria for treating someone with stage 2 hypertension?

A

If there ABPM is greater than 150/95 mmHg then start an anti-hypertensive drug regardless of age

29
Q

What other measure should be taken for those under 40yrs with stage 1 or greater hypertension?

A

Referral to a specialist for evaluation of secondary causes and a more detailed evaluation of potential target organ damage

30
Q

What is the blood pressure target for those aged 80yrs or over?

A

A blood pressure of less than 145/85 mmHg

31
Q

What is the step 1 treatment for hypertension?

A

Calcium Channel Blocker to those aged over 55yrs and to those of African/Caribbean family origin of any age
If a CCB is not suitable or there is evidence/high risk of heart failure then offer a thiazide like diuretic
If a patient is under 55yrs offer an ACE Inhibitor/ARB (not to Afro-Caribbean or woman of child bearing age)

32
Q

What is step 2 treatment for hypertension?

A

Add in a thiazide type diuretic (e.g. clortalidone or indapamide) or an ACE inhibitor/ARB

33
Q

What is the step 3 treatment for hypertension?

A

CCB, ACE Inhibitor and Diuretic combined

34
Q

What is step 4 treatment for hypertension?

A

Consider further diuretic therapy with low-dose spironolactone if the blood potassium is lower than 4.5mmol/l or lower and the GFR is normal.
consider higher dose thiazide like diuretic treatment if the blood potassium level is higher than 4.5mmol/l

35
Q

What type of anti-hypertensive drug is Ramipril?

A

ACE Inhibitor

36
Q

What are the contraindications for Ramipril?

A

Renal artery stenosis, renal failure and hyperkalaemia

37
Q

What are the adverse drug reactions for Ramipril?

A

Cough, first dose hypotension, taste disturbance, renal impairment and angioneurotic oedema

38
Q

What drugs will have interactions with Ramipril?

A

NSAIDs - precipitate acute renal failure

Potassium supplements and potassium sparing diuretics cause hyperkalaemia

39
Q

What are the ARBs that are commonly used to treat hypertension?

A

Losartan, valsartan, candersartan and irbesartan

40
Q

How do angiotensin 2 antagonists (ARB) work?

A

They competitively block the actions of angiotensin 2 at the angiotensin AT1 receptor

41
Q

What is the advantage of using ARBs over ACE inhibitors?

A

They don’t produce a cough

42
Q

What are the calcium channel blockers used as vasodilators?

A

Amlodipine/Felodipine

43
Q

What are the calcium channel blockers used to limit heart rate?

A

Verapamil/Diltiazem

44
Q

How do calcium channel blockers work?

A

They block the L type calcium channels, relaxing large and small arteries and reducing the peripheral resistance and reducing cardiac output

45
Q

In which groups of people are calcium channel blockers the anti-hypertensive of choice?

A

Those aged over 55yrs and women of child bearing age

46
Q

What are the contraindications of calcium channel blockers

A

Acute MI, heart failure and bradycardia (rate limiting CCBs)

47
Q

What are the adverse reactions of CCBs?

A

Flushing, headache, ankle oedema, indigestion and reflux oesophagitis

48
Q

What additional adverse reactions do rate limiting CCBs cause?

A

Bradycardia and constipation

49
Q

What are the common thiazide type diuretics used to treat hypertension?

A

Indapamide/Clortalidone

50
Q

In which group of people are thiazide type diuretics used as first line treatment/

A

Afro-Caribbean’s with mild-moderate hypertension

51
Q

What are the benefits of thiazide type diuretics?

A

They can be used in combination with any other hypertensive agents and have a proven benefit in stroke and MI reduction

52
Q

How do thiazide type diuretics work?

A

They effect the urinary excretion of sodium

53
Q

How long does the full effect of thiazide type diuretics take to come into effect?

A

It make take weeks to fully come into effect

54
Q

What are the adverse drug reactions of thiazide type diuretics?

A

They are uncommon but include gout and impotence

55
Q

What are the less commonly used agents?

A

Alpha-adrenoceptor antagonists (doxazosin), centrally acting agents (methyldopa and moxonidine) and vasodilators (hydralazine and minoxidil)

56
Q

How do alpha-adrenoceptor antagonists work?

A

They selectively block post synaptic adrenoceptors and oppose vascular smooth muscle contraction in arteries

57
Q

What are the adverse drug reactions of alpha-adrenoceptor antagonists?

A

First does hypotension. dizziness, dry mouth and headaches

58
Q

When is methyldopa used as a hypertensive?

A

Its main use is during pregnancy

59
Q

How does methyldopa work

A

It is converted to alpha-methylnoradrealine which acts on the CNS alpha adrenoceptors which decrease central sympathetic outflow

60
Q

What are the adverse drug reactions for methyldopa?

A

Sedation, drowsiness, dry mouth, nasal congestion and orthostatic hypotension

61
Q

What is moxonidine?

A

a centrally acting imidazoline agonist

62
Q

What is preeclampsia

A

When the patient is pregnant and their blood pressure rises severely from about 20 weeks (BP>140/90 mmHg) and they have proteinuria

63
Q

What antihypertensives are not suitable for use during pregnancy?

A

ACE Inhibitors and ARBs are not suitable for use during pregnancy

64
Q

What additional treatment is needed to treat preeclampsia?

A

IV hydralazine, esmolol and labetalol

Cardiovascular (23 decks)

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