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Cardiovascular > Hypertension > Flashcards

Hypertension Flashcards

1
Q

what is stage 1 hypertension?

A

clinic blood pressure of 140//90 mmHg or higher and home blood pressure monitoring blood pressure of 135/85 mmHg or higher.

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2
Q

what is stage 2 hypertension?

A

clinic blood pressure of 160/100 mmHg or higher and home blood pressure of 150/95 or higher.

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3
Q

what is severe hypertension?

A

clinic systolic blood of 180mmHg or higher or clinic diastolic blood pressure of 110 mmHg or higher.

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4
Q

what causes hypertension?

A

walls of larger arteries lose their elasticity and become rigid, and the smaller vessels constrict.

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5
Q

what effect does hypertension have on the brain?

A
  • most important risk factor for stroke.
  • very high blood pressure can cause a leak in a weakened blood vessel, which then bleeds in the brain (cerebral haemorrhage)
  • if a blood clots blocks one of the arteries narrowed by atheroma, it can result in cerebral infarction which causes a stroke.
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6
Q

what effect does hypertension have on the eyes?

A

high blood pressure can cause one of the vessels to leak or bleed (hypertensive retinopathy) vision may become blurred due to this.

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7
Q

what effect does hypertension have on the heart?

A
  • risk of myocardial infarction - if the blood flow to the heart is blocked.
  • congestive heart failure (CHF) - at first the heart can compensate for the increased work of pushing against the elevated pressure in the vessels by becoming thick (hypertrophic) at a later stage the heart may no longer be able to pump enough for the heart needs.
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8
Q

what effect does hypertension have on the kidneys?

A

kidney damage - persistent high blood pressure over time can Cause narrowing and thickening of the renal arteries. this causes the kidneys to filter less fluid and results in waste in the blood.

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9
Q

what effect does hypertension have on the arterial tree?

A
  • atherosclerosis - speeds up the hardening and narrowing of arteries in the body.
  • aortic aneurysm - the wall of the aorta may weaken due to dilatation of the aorta with risk of rupture.
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10
Q

what effect does hypertension have on peripheral vascular resistance (PVR)?

A

PVR increases. this in turn results in further increase in blood pressure.

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11
Q

what is another cause of increased PVR?

A

atherosclerosis

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12
Q

what are the two types of hypertension?

A

essential and secondary.

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13
Q

what is essential hypertension?

A

raised blood pressure without obvious cause.

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14
Q

what % of cases does essential hypertension account for?

A

90-95%

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15
Q

what is essential hypertension also known as?

A

primary or idiopathic hypertension

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16
Q

what is secondary hypertension?

A

raised blood pressure when there is an identifiable cause

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17
Q

when does secondary hypertension often develop?

A

before the age of 35
or
after the age of 55.

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18
Q

what is a rare but severe type of hypertension?

A

accelerated hypertension

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19
Q

what group of people is accelerated hypertension most common in?

A

african-americans

20
Q

what is the pathological hallmark of accelerated hypertension?

A

accelerated microvascular damage. the small arteries and arterioles show fibrinoid necrosis and thrombus, including those of the optic fundi and the kidneys.

21
Q

what does accelerated hypertension cause?

A

oedema and swelling of the brain.

22
Q

what would happen in the absence of effective lowering of blood pressure in accelerated hypertension?

A

most likely death.

23
Q

what are the risk factors of hypertension?

A
  • race - african-americans more likely.
  • gender - men more likely.
  • age - higher risk when old
  • environment
  • obesity
  • diabetes
  • too much salt in diet
  • stress
  • abnormalities in the nervous and circulatory system and kidneys
  • inactive lifestyle
24
Q

what does the term ‘metabolic syndrome’ describe?

A

a group of cardiovascular risk factors - abdominal obesity, dyslipidaemia and insulin resistance.

25
Q

how does ‘metabolic syndrome’ risk increase?

A

4x increase in risk of fatal coronary disease and 2x greater of cardiovascular disease.

26
Q

what is the key feature of accelerated hypertension?

A

accelerated (grade IV) retinopathy

27
Q

what are examples of causes of secondary hypertension (not renal or endocrine)?

A
  • conn’s syndrome
  • coarctation of the aorta - usually associated with a biscuspid aortic valve.
  • Glucocorticoids
  • NSAIDs
  • pregnancy
  • combined oral contraceptive pill
28
Q

What are examples of renal disease causes of secondary hypertension??

A
  • Glomerulonephritis
  • chronic pyelonephritis
  • adult polycystic kidney disease
  • renal artery stenosis
29
Q

What are examples of Endocrine disorders causes of secondary hypertension?

A
  • Primary hyperaldosteronism
  • Phaeochromocytoma
  • Cushing’s Syndrome
  • Liddle’s syndrome
  • Congenital adrenal hyperplasia (11-beta hydroxylase deficiency)
  • Acromegaly
30
Q

What symptoms may cause hypertension cause if it is very high (>200/120 mmHg)?

A
  • headache
  • visual disturbance
  • seizures
31
Q

What test might be done on a patient with hypertension to check for end-organ damage?

A
  • Fundoscopy: to check for hypertensive retinopathy
  • urine dipstick: to check for renal disease
  • ECG: to check for ventricular hypertrophy or ischaemic heart disease
32
Q

What test do patients usually have following diagnosis?

A
  • urea and electrolytes: to check for renal disease
  • HbA1c: chest for co-existing diabetes mellitus
  • Lipids: check for hyperlipidaemia
  • ECG
  • urine dipstick
33
Q

What is the first-line treatment for hypertension in younger patients(<55 years old)?

A

Angiotensin-converting enzyme (ACE) inhibitor

34
Q

What are common side effects of ACE inhibitors?

A
  • Cough
  • Angioedema
  • Hyperkaleamia
35
Q

What group of patients are ACE inhibitors less effective in?

A

Afro-Caribbean

36
Q

What types of patients must ACE inhibitors be avoided in?

A

pregnant woman

37
Q

What must be checked (and when) in patients with renovascular disease after starting ACE inhibitors?

A

renal function - 2-3 after starting.

38
Q

What is the first-line treatment for hypertension in Older patients(>/= 55 years old)?

A

Calcium channel blocker

39
Q

How do ACE inhibitors work?

A

inhibit conversion of angiotensin I to angiotensin II

40
Q

How do calcium channel blockers work?

A

block voltage-gated calcium channels relaxing vascular smooth muscle and force of myocardial contraction

41
Q

What are side effects of calcium channel blockers?

A
  • Flushing
  • ankle swelling
  • headache
42
Q

How do thiazide type diuretics work?

A

inhibit sodium absorption at the beginning of the distal convoluted tubule.

43
Q

What are side effects of Thiazide type diuretics?

A
  • Hyponatremia
  • hypokalaemia
  • dehydration
44
Q

How do angiotensin II receptor blockers (A2RB) work?

A

Block effects of angiotensin II at the AT1 receptor

45
Q

When are angiotensin II receptor blockers generally used?

A

when patients have not tolerated ACE inhibitors, usually due to the development of a cough

46
Q

what is the side effect of angiotensin II receptor blockers?

A

hyperkalaemia

Cardiovascular (16 decks)

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