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Week 5 - Phase 3 > Hypertension > Flashcards

Hypertension Flashcards

1
Q

Define systemic hypertension?

A

Persistent high arterial BP of >140/90 mmHg.

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2
Q

Describe the pathophysiology of hypertension?

A

Combo of genetics and environment contribute.

  • Defects in renal sodium homeostasis leads to inadequate sodium excretion and water retention. This causes an increase in plasma and ECF volume, increasing CO.
  • Functional vasoconstriction occurs. Increased plasma and ECF cause increased naturetic hormone release, and increased vascular reactivity.
  • Defects in vascular SM growth and structure lead to increased vascular wall thickness.
  • Increased vascular reactivity + increased wall thickness leads to increased total peripheral resistance.
  • Increased CO and TPR lead to hypertension!
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3
Q

What is the prevalence of hypertension?

A

45% worldwide.

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4
Q

What is the relationship between blood pressure and risk of CV disease?

A

Risk of CV disease double for every 20mmHg increase in systolic pressure.
Risk of CV disease doubles for every 10mmHg increase in diastolic pressure.

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5
Q

What is ‘high normal’ BP?

A

130-139/85-89 mmHg

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6
Q

What is Grade 1 hypertension?

A

140-159/90-99 mmHg

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7
Q

What is Grade 2 hypertension?

A

160-179/100-109 mmHg

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8
Q

What is Grade 3 hypertension?

A

> 180/>110 mmHg

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9
Q

What is isolated systolic hypertension?

A

> 140/<90 mmHg.

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10
Q

Who normally gets isolated systolic hypertension?

A

Elderly people are their blood vessels are stiffer.

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11
Q

What % of hypertension patients have primary hypertension?

A

90%

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12
Q

What is primary hypertension?

A

No identifiable cause, but many risk factors.

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13
Q

List non-modifiable risk factors of primary hypertension?

A
  • age
  • gender (More males <50, but equal males and females after menopause)
  • ethnicity (more common in afro carribeans)
  • genetic factors.
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14
Q

List modifable risk factors for primary hypertension?

A
  • poor diet (high fat, high salt)
  • low physical activity
  • obesity
  • excess alcohol
  • stress.
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15
Q

What % of hypertension cases are secondary hypertension?

A

5-10%

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16
Q

What is secondary hypertension?

A

Hypertension secondary to another medical condition.

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17
Q

List endocrine causes of secondary hypertension?

A
  • Hyperaldosteronism: excess aldosterone from adenoma so greater salt and water retention.
  • Phaechromocytoma: excess catecholamines.
  • Hyperthyroid: Systolic hypertenson.
  • Hypothyroid: Diastolic hypertension.
  • Cushings: due to excess cortisol.
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18
Q

What vascular causes are there of secondary hypertension?

A

Co-arctation of the aorta.

19
Q

What Renal causes of secondary hypertension are there?

A
  • Renal artery stenosis

- Renal parenchymal disease.

20
Q

What other causes of secondary hypertension are there?

A

Obstructive sleep aponea.

21
Q

What drugs can cause secondary hypertension?

A
  • NSAID’s like ibuprofen
  • Herbel remedies
  • Cocaine as it mimics the sympathetic NS.
  • Exogenous steroid use.
22
Q

What are the consequences of uncontrolled hypertension?

A
  • Retinopathy
  • PVD
  • TIA or stroke
  • Renal failure
  • LV hypertrophy, coronary heart disease, or heart failure.
23
Q

How do patients usually present with hypertension?

A

Normally asymptomatic and is an incidental finding.

If severe, may have headaches or visual disturbance.

24
Q

How do we diagnose hypertension ‘in office’?

A

Hypertension of over 140/90mmHg on 2 or more readings 5 minutes apart, on 2 separate visits.

25
Q

How do we diagnose hypertension ‘at home’?

A

Average hypertension of 135/85 mmHg

26
Q

How can we monitor someones BP at home?

A
  • Use a portable measurement device where they wear a BP cuff and the device takes their BP every 20-30 minutes though out the day, and every 2 hours overnight.
    Useful as we can classify someone as a ‘dipper’ or ‘non-dipper’.
    Annoying for patient having to wear the cuff.
  • Do 2+ readings twice a day over 4-7 days.
27
Q

What is the significance of someone being a ‘dipper’ or ‘non-dipper’?

A

A dipper means you drop your BP by >10% at night.

If you don’t dip, you have a higher CV risk.

28
Q

Once someone is diagnosed with hypertension, what must we assess?

A
  • Assess CV risk
  • Assess any end organ damage or associated complications (CKD, PVD, CVA, IHD)
  • Assess if it could be secondary hypertension, especially if <40 years old.
29
Q

Why can liquorice affect BP?

A

Has weak mineralocorticoid activity so promotes salt n water reabsorption.

30
Q

How would we examine a hypertension patient (physical exam)?

A
  • BP on both arms
  • Weight and BMI
  • Xanthalsma, oedema, rashes.
  • Assess pulses
  • Chuck for murmurs
  • Check for renal masses
  • Any vascular bruits (carotids, kidneys)
  • Fundoscopy for eye assessment
31
Q

How would we investigate a hypertension patient?

A
  • Glucose/Hba1c: To check for diabetes/diabetic control
  • Lipid profile: To see if they need statin treatment.
  • TFT’s
  • LFT’s
  • U&E’s, urine dipstick, albumin:creatinine ratio, proteins in urine: Assess renal function.
32
Q

What additional tests could be done in specialist clinic for hypertension patients?

A
  • renin and aldosterone: Rule out hyperaldosteronism.
  • 24h urine catecholeamines: Rule out phaechromocytoma.
  • echo: Assess any LV hypertrophy.
  • Renal ultrasound or MRA (angiogram): Check renal artery stenosis.
33
Q

How do we assess CV risk in hypertension patients?

A

Sign guidelines reccomend ASSIGN score.

Based on BP category, presence of end-organ damage, presence of diabetes, CV or renal disease.

34
Q

What would an ASSIGN score of >20 indicate?

A

20% chance of CVD over next ten years.

35
Q

What lifestyle measures can be take to reduce hypertension?

A
  • Lose weight (can decrease SBP by 20 mmHg)
  • Exercise (can decrease SBP by 10 mmHg)
  • Reduce sodium intake
  • Reduce alcohol intake
  • DASH diet
  • Smoking cessation.
36
Q

What device based therapies are available for hypertension treatment?

A
  • Renal denervation

- Baroreceptor stimulation

37
Q

What would be the order of drug treatment for patients <55 years old?

A
  • ACEi/ARB
  • Ca channel blocker
  • Diuretic
  • B-blocker
38
Q

What would be the order of drug treatment in patients >55 years or black?

A
  • Calcium channel blockers
  • ACEi/ARB
  • Diuretic
  • B-blocker
39
Q

Give examples of drugs used in hypertension treatment?

A
  • ACEi: Captopril
  • ARB: Losartan
  • Calcium channel blocker: Amlodipine
  • Diuretic:
    • Loop: frusemide
    • Thiazide: Bendrofluothiazide
    • K+ sparring: Spironolactone.
40
Q

What is the target BP for hypertension?

A

Wan <140/90mmHg

Ideally try get <130/80 mmHg if patient can tolerate it.

41
Q

How do we treat ‘high normal’ BP?

A

Lifestyle advice

May consider drugs in patients with high CAD risk.

42
Q

How do we treat grade 1 hypertension?

A

Lifestyle advice
Immediate drug is high CAD risk or patients with renal disease.
Drug treatment in low risk patients after 3-6 months lifestyle advice.

43
Q

How do we treat grade2/3 hypertension?

A

Lifestyle advice
Immediate drug treatment in all patients
Aim for BP control within 3 months.

Week 5 - Phase 3 (7 decks)

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