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CR2 > Hypertension > Flashcards

Hypertension Flashcards

1
Q

How do you calculate blood pressure?

A

CO X SVR

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2
Q

What is high normal BP?

A

130-139/85-89 so you wouldn’t intervene but could suggest lifestyle changes

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3
Q

What is Grade 1 and grade 2 hypertension?

A

systolic + 20
diastolic + 10
so stage 1 - 140-159/90-99
stage 2 - 160-179/100-109

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4
Q

What to do when a patient has isolated systolic hypertension?

A

systolic is > 140 and diastolic is <90
less serious unless in the elderly
lifestyle interventions then drugs is not effective

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5
Q

what is the difference between systolic and diastolic bp?

A

systolic is max bp during ventricular contraction, diastolic is min bp during relaxation

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6
Q

what is hypotension?

A

<90/<60

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7
Q

what is postural hypertension?

A

if systolic decreases by 20 or diastolic by 10 when you stand

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8
Q

who is postural hypotension more common in?

A

older patients, especially with diabetes or if on some antihypertensives

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9
Q

What are some CNS effects of hypotension?

A

dizziness
impaired cognition
fatigue
visual disturbances

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10
Q

what are some muscle effects of hypotension?

A 
paracervical ache (upper back)
general fatigue
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11
Q

what are some heart effects of hypotension?

A

angina

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12
Q

how many people have hypertension?

A

16 million

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13
Q

how many women compared to men have high blood pressure?

A

30% of women, 32% of men

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14
Q

what is the main reason why systolic bp increases with age?

A

loss of compliance if arteries

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15
Q

what is the framingham heart study?

A

study of factors that contribute to cardiovascular disease, intensive monitoring of framingham study led to identification of major CVD risk factors

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16
Q

what did the framingham studies conclude?

A

hypertensives are a cause for concern as have 6 fold increase in stroke, 3 fold increase in cardiac death and peripheral arterial disease is twice as common

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17
Q

what can hypertension cause?

A

major RF for much more serious conditions - stroke, coronary heart disease, renal impairment and peripheral vascular disease

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18
Q

Who is particularly vulnerable to hypertension?

A

diabetics and the obese

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19
Q

how does chronic hypertension damage the heart?

A

thickened left ventricle due to myocardial hypertrophy to increase pressure in systole overcoming raised end diastolic aorta pressure

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20
Q

why is concentric hypertrophy bad?

A

stroke volume decreased so tachycardia is required, also hypertrophic cardiac muscle has poor blood supply leading to ischemic damage

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21
Q

Why is eccentric hypertrophy bad?

A

whole ventricle enlarges, wall may or may not thicken, heart is enlarged so lower systolic pressure produced, reduced SV, weaker heart, maybe heart failure

22
Q

what is hypertensive retinopathy?

A

damage to retinal blood vessels as they are particularly sensitive to chronic hypertension

23
Q

what are ‘silver/copper wire’ arteriolar?

A

where centre of arteriole shines due to reflected light as get narrowing at points where arteriolar and venules cross?

24
Q

what are some signs of retinal damage?

A 
silver copper wire arterioles
cotton wool spots
blot and flame haemorrhages
microaneurysms
swelling of optic disc
25
Q

what is the difference between primary and secondary hypertension?

A

primary we don’t know the cause when secondary is due to renal disease, endocrine disease, coarctation of the aorta, iatrogenic (due to drugs), thyroid disease

26
Q

is primary or secondary hypertension more common?

A

primary - 90-95% of cases

secondary - only 5%

27
Q

how is blood pressure controlled!

A 
baroreceptors in carotid artery (neuronal) for rapid response
RAAS system (hormonal) which provides a more steady response
28
Q

what system is normally defected in chronic hypertension?

A

RAAS hormonal

29
Q

what system could be defected in aneurysms or haemorrhagic strokes?

A

neuronal system as controls moment to moment BP fluctuations preventing sudden spikes

30
Q

What are the possible causes of hypertension?

A

impaired production of NO as acts as a vasodilator but when endothelium is damaged by free radicals or cytokines NO production is decreased

raised renin release due to kidney damage

reduced ANP release which is released from the atrial wall heart muscle cells, reduces ECF volume by increasing renal sodium excretion hence increasing water excretion so if lost salt and water retention

31
Q

what should the treatment be for high renin hypertension

A

dietary salt restriction

diuretics as water retention

32
Q

which ethnicity is more sensitive to salt intake?

A

afro-caribbean

33
Q

what happens if you reduce salt intake too much?

A

hyponatremia, brain swelling

34
Q

what are the symptoms of mild and severe hyponatremia?

A

loss of energy and fatigue, confusion, muscle weakness

nausea, vomiting, headache, spasms, restlessness, seizures, coma

35
Q

why are green vegetables in diet important?

A

foods high in potassium means dietary potassium is increase and helps sodium potassium balance, potassium just as important as sodium

36
Q

what percentage of 45 year olds type 2 diabetics have hypertension?

A

40%

37
Q

what percentage of type 2 diabetics aged 75 have hypertension?

A

60%

38
Q

why is hypertension common in diabetics?

A

damages endothelium and reduces NO production

39
Q

what causes the link between obesity and hypertension?

A

high lepton levels as fat cells so increased symp vasoconstriction
hyperinsulinaemia and insulin resistance

40
Q

what drug treatment should be given for stage 1 hypertension?

A

antihypertensive if also have organ damage, CD, renal disease, diabetes

41
Q

what treatment should be given for patients with stage 2 hypertension?

A

antihypertensives to those of any age

42
Q

what lifestyle changes should be encouraged?

A

lose weight
moderate exercise
diet rich in vegetables
low salt diet

43
Q

what is the first step of treatment?

A

ACE inhibitors or ARB unless they are Afro Carrib give CCB

44
Q

What treatment do you give if CCB causes oedema or intolerance or high risk of heart failure?

A

Thiazide like diuretic

45
Q

what thiazide like diuretics should be offered?

A

chlortalidone

indapamide

46
Q

when should beta blockers be used?

A

in young people if intolerance to ACE inhib or ARB’s, increased symp drive
otherwise don’t use as risk of diabetes developing

47
Q

what treatment should be given in step 2 if step 1 doesn’t work?

A

CCB with ACE inhib/ARB

if can’t use CCB use thiazide like diuretic

48
Q

what treatment should be given in step 3?

A

3 drug combo of ACE inhibitor/ARB, CCB and thiazide like diuretic

49
Q

what treatment should be given in step 4?

A

resistant hypertension

consider adding 4th antihypertensive or seek expert advice, make sure patient is taking drug

50
Q

how do CCB’s work?

A

block entry of calcium, reduce electrical conduction of the heart, reduce force of contraction of muscle cells and dilate arteries

51
Q

how do thiazide like diuretics work?

A

block thiazide sensitive sodium chloride symp peter in DCT inhibiting reabsorption so more water moves in DCT and leaves body - increases urinalysis output and decreases body water and salt volume

CR2 (35 decks)

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