Hypertension

Question 1

what are the minimum ABPM for stage 1, 2 and severe hypertension?

Answer 1

stage 1 = 135/85mmHg
stage 2 = 150/95 mmHg
severe =either 180mmHg systolic or 110mmHg diastolic or above.

Question 2

what are the minimum CBP for stage 1, 2 and severe hypertension?

Answer 2

stage 1 = 140/90mmHg
stage 2 = 160/100mmHg
severe = either 180mmHg systolic or 110mmHg diastolic or above.

Question 3

what other factors increase mortality from hypertension?

Answer 3

if the patient is male and/or suffers from:

diabetes, left ventricular hypertrophy, renal failure, hyperlipidaemia, previous MI or stroke, smoking

Question 4

what hereditary effect may be the cause of someones hypertension?

Answer 4

hereditary defect of the smooth muscle lining arterioles.

this causes increased reactivity of restrictive arteriolar which increases TPR and therefore pressure.

Question 5

describe the physiology of how primary hypertension occurs (not what causes it but how it occurs).

Answer 5

the Na homeostatic effect:
in essential hypertension (primary) the kidneys aren’t able to excrete Na at any given BP.
therefore Na is retained which draws in water thereby increasing blood pressure.
(the driving force of Na excretion in the urine is blood pressure)

Question 6

state factors which put people at risk of developing hypertension.

Answer 6

sex (male), age, smoking, alcohol intake, weight, race, genetics/family history, environment, salt intake (NaCl), birth weight (low birth weight increases risk of hypertension)

Question 7

list main causes of secondary hypertension.

Answer 7

renal disease i.e. chronic pyelonephritis, fibromuscular dysplasia, renal artery stenosis, polycystic kidneys
drug induced i.e. NSAID’s, amphetamines, coccaine, oral contraceptive, corticosteroids
pregnancy i.e. preeclampsia
endocrine i.e. acromegaly, conns syndrome, cushings disease, pheocromocytoma, hypo/hyperthyroidism
vasculature - coarctation of aorta
sleep apnoea

Question 8

the main complication of hypertension is end organ damage. list some of the organ damage it causes.

Answer 8

brain - haemorrhage, stroke, cognitive impairment,
vasculature - peripheral vascular disease
renal - kidney failure, proteinuria- may need dialysis or transplant
heart - MI, left ventricular hypertrophy, congestive heart failure, chronic heart disease
eyes - retinopathy

Question 9

what is criteria for treating someone with stage 1 hypertension?

Answer 9

treatment to someone >80 years old with bp of 130/85mmHg or greater and have one or more of the following:
target organ damage, diabetes, CV disease, renal disease, 10yr cardiovascular risk = 20% or greater

Question 10

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

Answer 10

treat with antihypertensive drug to any age .

ABPM 150/95mmHg or above

Question 11

what is step 1 in choosing antihypertensive drug?

Answer 11

if they are younger than 55yrs then treat with ACE inhibitor or ARB.
If they are older than 55yrs then treat with CCB or if they cannot continue due to side effects etc then give thiazide like diuretic.

Question 12

what has to be considered when treating people with ACE inhibitors?

Answer 12

cannot be used in women of child bearing age

also cannot be used in people of afro-carribean race of all ages

Question 13

what are the 3 steps in treating hypertension?

Answer 13

Step 1 give ACEI/ARB or CCB
Step 2 add thiazide like diuretic
step 3 add CCB, ACEI and diuretic together

Question 14

with resistant hypertension, what is the treatment for stage 4?

Answer 14

if they have a low plasma K then continue thiazide like diuretic therapy and add spironolactone
with a high potassium concentration treat with high dose thiazide like diuretic
Could also add an alpha blocker or beta blocker

Question 15

name an ACE Inhibitor drug.

Answer 15

Rimapril

Question 16

name a CCB drug.

Answer 16

amlodipine (vasodilator)

verapamil (rate limiting)

Question 17

Name a thiazide like diuretic.

Answer 17

indapamide / clortalidone

Question 18

what are the contraindication for treating with ACE inhibitors?

Answer 18

renal failure, renal artery stenosis, hyperkalaemia, pregnancy

Question 19

what are the side effects of ACE inhibitors?

Answer 19

cough
first dose hypotension
taste disturbance
renal impairment
angioneurotic oedema

Question 20

ACE inhibtors have drug drug interactions with what type of drugs?

Answer 20

NSAIDS, K supplements and K sparing diuretics

Question 21

what are the condraindications for treating with CCB’s?

Answer 21

is someone has heart failure, bradycardia, acute MI

Question 22

what are the side effects of treating with CCB’s?

Answer 22

flushing, headache, oedema indigestion reflux oesophagitis

rate limiting CCB’s may also cause bradycardia and constipation

Question 23

what advantage does angiotensin II antagonists have over ACE inhibitors?

Answer 23

they don’t cause a cough

Question 24

what is the action of the angiotensin II antagonists?

Answer 24

they block the Angiotensin II action at the AT-1 receptor

Question 25

what adverse effects may thiazide like diuretics cause?

Answer 25

side effects are uncommon but can cause gout and incompetence

Question 26

why might thiazide like diuretics be the first line of treatment for afrocarribeans before CCB’s?

Answer 26

afro carribeans are prone to high Na levels therefore giving a diuretic will treat that too.

Question 27

what are the 3 types of less commonly used agents?

Answer 27

alpha adrenoreceptor antagonists
centrally acting agents
vasodilators

Question 28

how is the diagnosis of pre eclampsia during pregnancy assessed?

Answer 28

bp usually spikes after 20 weeks gestation

bp >140/90 mmHg and proteinuria >300mg/24hrs.

Question 29

by how much rise in blood pressure can cause a 7% increase risk of ischaemic heart disease and 10% increased risk from stroke?

Answer 29

rise in 2mmHg blood pressure

Question 30

what percentage of cases of hypertension are primary?

Answer 30

90% of cases of hypertension are due to an unknown cause

Question 31

what are the prime contributors to blood pressure?

Answer 31

cardiac output (which is determined by stroke volume and heart rate) and peripheral vascular resistance

Question 32

does the activation of the sympathetic system cause a rise or decrease in blood pressure?

Answer 32

The sympathetic system causes reflect tachycardia, vasoconstriction and increased cardiac output and therefore causes an increase in blood pressure.

Question 33

what does the RAA System stand for and what is it stimulated by?

Answer 33

the renin angiotensin aldosterone system is stimulated by a fall in bp and circulatory volume and sodium depletion.
It therefore stimulates a rise in bp.

Question 34

in the RAAS system, where is renin released from?

Answer 34

the juxtaglomerular apparatus

Question 35

what are the actions of angiotensin II?

Answer 35

vasoconstrictior
anti-natriuretic peptide
stimulator of aldosterone
potent hypertrophic agent which stimulates myocyte and smooth muscle hypertrophy in arteries

Question 36

what is a consequence of hypertrophy of the smooth muscle and myocytes causing hypertension?

Answer 36

hypertrophy caused by angiotensin II can be a reason for not responding to anti-hypertensive treatment

Question 37

why does blood pressure seem to rise with age?

Answer 37

due to reduced arterial compliance

Question 38

What is malignant hypertension?

Answer 38

Bp raised to severe levels with papiloedema and/or retinal haemorrhage

Question 39

What is essential hypertension?

Answer 39

Bp raised by no identifiable cauze

Question 40

In a patient under 55 years who is intolerant to ACE inhibitors, what would the first line of treatment be?

Answer 40

Angiotensin II receptor antagonist