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CVS > Hypertension > Flashcards

Hypertension Flashcards

1
Q

What is stage 1 hypertension

A

140 / 90

ABPM 135 / 85

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2
Q

What is stage 2 hypertension

A

160 / 100

ABPM 150 / 95

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3
Q

What is severe hypertension

A

> 180 / >100

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4
Q

What are the essential causes of hypertension (95%)

A

No cause

  • Age
  • Genetics
  • Low birth weight
  • Obesity
  • Alcohol
  • Stress
  • High salt
  • Excessive sympathetic
  • Renin angio system dysfunction
  • Insulin resistance
  • Abnormalities in Na excretion
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5
Q

What are secondary causes (more common in <40)

A 
Chronic renal disease = most common
Endocrine disease
Coartication of aorta
Drugs - NSAIDs, pill, steroid
Sleep apnoea 
Pregnancy - CO inc but drop in resistance so low BP
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6
Q

What are renal causes

A

Renal artery stenosis
Pyelonephritis
GN - cause increased BP
PCKD

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7
Q

What are endocrine causes

How do you Dx Phaeochromocytoma

A

Cushing’s
Acromegaly
Phaeochromocytoma - 24 hour urine catelcoamine
Primary hyperaldosteronism - Conn’s (most common) - do renin-aldosterone ratio
HyperPTH
Hyperthyroid

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8
Q

How should you monitor BP

A

Every 5 years by GP
Lying and standing if elderly or DM
Isolated systolic hypertension common in elderly but treat as normal

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9
Q

How do you investigate hypertension when Dx

A

Home blood pressure reading
24 hour ABPM if BP found to be abnormal >140 / >90
Both arms and lying and standing
Blood - FBC, U+E, LFT, TFT, lipids, BM or HBA1c
Urinanalysis - renal - blood and protein
ECG

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10
Q

How do you assess end-organ damage / other tests that could be done to look for cause

A 
CXR - cortication 
Renal USS - stenosis 
Renin aldosterone for Conn's 
Urine catecolamine 
Urinanlysis - blood / protein 
Blood glucose 
Sleep study 
End-organ
Fundoscopy for retinopathy 
ECHO - LVH 
ECG - LVH 
ACR - proteinuria
Urinanalysis - haematuria 
U+E for renal damage
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11
Q

What treatable causes can you screen for

A 
Renal stenosis
Cushing's
Conn's - if K low 
Hyperthyroid 
Sleep apnoea
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12
Q

What are RF for hypertension

A 
Age – lose arterial compliance
FH 
Race
Male   
Smoking
Alcohol 
Hyperlipidaemia 
Obesity 
DM 
Renal disease 
Previous MI / stroke
Left ventricular hypertrophy 
Environment
Low birth weight
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13
Q

What are symptoms of hypertension

A 
Asymptomatic unless very high 
Headache
Epistaxis
Nocturia
SOB due to LVF
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14
Q

What are signs of malignant hypertension

A

Visual disturbance
Seizure
Loss of consciousness
HF

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15
Q

What do you look for in examination

A 
CVS
Retinopathy - cotton wool / haemorrhage/ papilloedema 
Look for signs of HF 
- 3rd HS
- 4th HS
- Murmur
- Pulses 
- Loud 2nd
- Sinus tachy 
Signs of underlying cause - obesity / Cushing / Xanthelomata / anaemia of renal 
Abdo exam - PCKD / stenosis
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16
Q

What do you use to assess risk in hypertension

A 
ASSIGN
Previous MI
IHD
Smoking
DM
Hyperlipid
FH
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17
Q

When do you start RX

A

CVD 10 year risk = 20%

Sometimes start at 10%

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18
Q

What is target BP

A

135 / 80
Higher in elderly = 150
Lower in type I DM or end organ = 130

19
Q

What are lifestyle changes

A 
Lose weight
Reduce salt 
Exercise
Diet 
Stop smoking
20
Q

What do you do for diabetics
What is common issue in DM
What drug should you avoid

A

Aim 130 / 80 if end organ damage or type II
140 / 90 otherwise
ACEI = 1st line as protects renal even if >55
Thiazide + CCB
Postural hypo due to neuropathy
BB avoided as cause insulin resistance with diuretic

21
Q

What are complications of hypertension

A 
Commonest cause of cardiac failure
Atherosclerosis RF
IHD
Stroke
Peripheral arterial disease
Renal failure due to reduced perfusion
Haemorrhage 
Retinopathy
Nephropathy
22
Q

What are complications of hypertension in pregnancy

A

PET

Treat if >160 to protect mother

23
Q

What happens in chronic hypertension

A

CO normal
Increased HR to maintain CO ( CO = SV x HR)
Further increases BP
Sympathetic activated = tachy / constriction = increased BP
Difficult to bring BP down

24
Q

What is hypertension in children

A

> 98th centile

25
Q

What causes hypertension in children

A

Congenital renal malformation
Fibromuscular dysplasia
Cortication

26
Q

What are complications of hypertension in children

A 
Hypertension in adult + risks 
Organ damage
LVH
Decreased vascular response 
Decreased GFR
Cognition
27
Q

What is accelerated hypertension

A

Increase to >180 / >110

IMMEDIATE RX if signs of organ damage

28
Q

What is accelerated hypertension associated with

A 
Vascular damage
Papilloedema
Retinal haemorrhage
Headache
Nausea
Raised ICP signs
Seizure 
Chest pain
LOC
29
Q

What is malignant hypertension

A

Accelerated + grade IV fundal changes

30
Q

What requires urgent assessment

A

Papilloedema

Retinal haemorrhage

31
Q

What does pheochromocytoma chase

A 
Hypertension
Postural hypo 
Headache
Palpitations
Diaphoresis - sweating
32
Q

How do you treat malignant / what agents

A

Must treat ASAP or consider referral
Reduce arterial pressure by <25% for 1st hour then reduce slowly after that
BB / long act CCB
Then to 160/100 2-6 hours
Then to normal over 24
Once stabilised = oral
Treat anxiety to Rx as often due to poor control as afraid of hypo

33
Q

Why do you reduce slowly

A

Lose cerebral autoregulation

May cause stroke

34
Q

When do you use IV

A

Signs of encephalopathy or CCF

35
Q

What causes postural hypotension

A 
Autonomic neuropathy - Parkinson / DM (no compensatory tachycardia) 
Dehydration 
Aortic stenosis 
A blocker in BPH
Diuretic
Nitrates / vasodilator
Anti-cholinergic - TCA / histamine / psychotic / dopamine agonist 
Anti-hypertensive
L-dopa
Sedatives
Hypovolaemia
Alcohol
36
Q

How do you treat postural

A 
Increase fluid and salt 
Discontinue vasodilator drugs - diuretic/. nitrate / anti-hypertensive
Compression
Fludrocortiosne
Midoderine
37
Q

What should you be careful of in DM

A

Autonomic neuropathy may increase risk of postural hypo

38
Q

What suggest renal artery stenosis

A

Vascular disease
Proteinuria
Asymmetrical

39
Q

What does midoderine do

A

A adrenergic so increases arterial resistance

40
Q

What is hypertension urgency

A

Marked elevation in BP with no end organ damage

41
Q

What do you do

A

Take BP both sides
Fundoscopy
U+E
ECG

42
Q

How do you Rx

A

Add in more BP medication to reduce BP

43
Q

What does everyone on BP meds need

A 
Annual review
BP
U+E etc
Urine dip + urine ACR if protein found
Reasses CVD risk using QRISK
44
Q

What is orthostatic hypo

A

Drop in SBP of 20 or DBP of 10 after 3 mins standing

CVS (30 decks)

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