Hypertension Flashcards
WHO defines hypertension as a blood pressure greater than 120/80. True/False?
False
Hypertension is classically BP greater than 140/90
How does eating salt increase blood pressure?
Increases release of aldosterone, which causes salt and fluid retention [part of RAAS]
What are some common causes of secondary hypertension?
Renal disease/stenosis Endocrine disease Coarctation of aorta Obstructive sleep apnoea Drug therapy inc. CCSs
How can renal disease lead to hypertension?
Reduced renal flow causes excess renin release, ultimately leading to fluid overload
Conn’s syndrome is an endocrine cause of hypertension - what happens?
Excess production of aldosterone, leading to fluid overload
What is Cushing’s syndrome?
Excess production of corticosteroid, usually cortisol
What are the clinicopathological classifications of hypertension?
Benign
Malignant
What is meant by benign hypertension?
Generally “asymptomatic” but this does not take away from the danger it poses and should be treated as aggressively as normal
Every __ mm Hg above diastolic pressure of 85 mm Hg doubles the risk of an MI
10 mm Hg
What blood vessel changes occur in hypertension?
Thickening of media (smooth muscle) layer
Arteriosclerosis (hardened arteries)
Define malignant hypertension
Life-threatening condition where diastolic pressure greater than 130
CVD mortality doubles with every __/__ mm Hg blood pressure increase
20/10 mm Hg
Automated BP-measuring devices can still measure BP accurately even if the pulse is irregular. True/False?
False
Measure BP manually if pulse is irregular
When considering a diagnosis of hypertension, does BP need to be measured in both arms?
Yes
If clinic BP is measured at 140/90, what are the next steps?
Measure again: if different, measure 3rd time and use lowest reading as clinic BP
Then offer ABPM/HBPM to confirm diagnosis
When using ABPM to confirm hypertension diagnosis, what must be ensured?
At least 2 measurements are take per hour during 14 hours;
Use average of these hours to diagnose hypertension (or not)
When using HBPM to confirm hypertension diagnosis, what must be ensured?
Take 2 consecutive measurements while seated, 1 min apart;
Record twice daily for 4-7 days;
Discard 1st day measurements, use average of rest to diagnose hypertension (or not)
Define Stage 1 hypertension
Clinic BP = 140/90+ ABPM/HBPM = 135/90
Define Stage 2 hypertension
Clinic BP = 160/100+ ABPM/HBPM = 150/95
Define Stage 3 (severe) hypertension
Clinic systolic BP = 180
ORClinic diastolic BP = 110
For all hypertensive patients, which tests would you offer to better assess CVD risk?
Test urine (for protein) Take bloods (glucose, electrolytes, creatinine) Examine fundi (retinopathy) Do an ECG
What is hypertensive retinopathy?
Narrowing of retinal arterioles, increasing the risk of haemorrhage, hard exudates and papilloedema
For patients under 80, what is the target BP in response to drug treatment?
Less than 140/90
For patients over 80, what is the target BP in response to drug treatment?
Less than 150/90
What is the drug treatment algorithm for hypertension?
If under 55: ACEi/ARB If over 55 or Black: CaCB ---> + ACEi/ARB/CaCB ---> + Diuretic ---> + Further diuretic/Alpha/B blocker ---> + Spirinolactone ---> Refer to expert
Which drug would you prescribe to a 54 year old with hypertension?
ACEi
Which drug would you prescribe to a black guy with hypertension?
Ca++ blocker
Which drug would you add onto a black guy already on an ACEi and Ca++ blocker whose hypertension is still not controlled?
Thiazide diuretic
Treating hypertension is cheaper than doing nothing. True/False?
True, apparently
Give some examples where “resistant hypertension” may occur
Non-concordance
White coat hypertension
Poor lifestyle
Secondary hypertension
What are the two types of pulmonary hypertension?
Primary (rare) - increased BP with unknown secondary cause
Secondary - increased BP with known secondary cause
What is cor pulmonale?
Right heart failure caused by chronic pulmonary arterial hypertension
Secondary to lung disease e.g. COPD
In pregnancy, what are the potential complications of hypertension?
Preclampsia - hypertension + proteinuria
Eclampsia - seizures from increased BP
