Hypertension Flashcards
Complication of hypertension:
Kidney - Renal disease, dialysis, protein in the urine
Heart- MI, left ventricular hypertrophy, coronary heart disease
Brain - Stroke, haemorrhage
Eye - Retinopathy
Vasculature - Peripheral vascular disease
What types of stress cause BP to fluctuate during the day?
Physical and mental
A small increase in BP increases the risk of what conditions?
Stroke and cardiovascular disease (heart attack)
According to the BHS, what blood pressure is considered hypertensive?
140/90 mm Hg
Define stage 1 hypertension clinically
140/90 or higher
Define stage 2 hypertension clinically
160/100 or higher
Define severe hypertension clinically
180 systolic or higher OR 110 diastolic or higher
Primary hypertension:
No known cause (95%)
Secondary hypertension causes:
Chronic renal disease, renal artery stenosis, endocrine conditions (Cushing’s syndrome, Conn’s syndrome, acromegaly)
Risk factors have hypertension:
- Cigarette smoking
- Diabetes mellitus
- Renal disease
- If you are male
- Hyperlipidaemia
- Previous MI or stroke
- Left ventricular hypertrophy
Prime contributors to blood pressure:
Cardiac output (stroke volume, heart rate) and peripheral vascular resistance
Activation of the sympathetic nervous system produces:
- Vasconstriction
- Reflex tachycardia
- Increased cardiac output
(In this way, blood pressure is increased)
What does renin do?
Converts angiotensinogen to angiotensin I
What does renin do?
Converts angiotensinogen to angiotensin I and causes water retention in the kidneys
What does angiotensin converting enzyme (ACE) do?
Converts angiotensin I to angiotensin II
What does angiotensin II do?
It is a potent hypertrophic agent which stimulates myocyte and smooth muscle hypertrophy in the arterioles
Describe the aetiology of hypertension
- Polygenic
- Polyfactorial
- Age
- Genetics and family history
- Environment
- Weight
- Alcohol intake
- Ethnicity
- Salt intake and diet
Causes for secondary hypertension which are drug induced:
- NSAIDs
- Oral contraceptive
- Corticosteroids
Other causes of secondary hypertension (not already mentioned):
Narrowing of the aorta, pregnancy and sleep apnoea
Symptoms of hypertension:
- Syncope
- Tinnitus
- Usually asymptomatic
- Flushed
- Fatigue
- Blurred vision
How do we first confirm the diagnosis of hypertension?
ABPM - Ambulatory blood pressure monitoring (more common)
HBPM - Home blood pressure monitoring
How else do we diagnose hypertension?
- Assess the risk (look at the risk factors)
- Access end organ end damage (ECG, echocardiogram, renal ultrasound, proteinuria etc)
- Screen for treatable causes (renal artery stenosis, cushings, conn’s and sleep apnoea)
BHS taget pressure:
< 135/80-85 mm Hg
Why do we treat hypertension?
- Reduce MI
- Reduce cerebrovascular disease
How do we treat hypertension?
- Look for and treat the underlying cause
- Stepped approach (add medications to current therapies until the target BP is achieved)
- Use low doses of several drugs
(this approach minimises adverse events and maximises patient compliance)
According to the BHS guidelines, what drugs should be used for different age groups?
- ACE inhibitor for young people because they have a lot of renin (< 55 years)
- Calcium channel blocker and thiazide for old people as they have little renin (>=55 years)
Step 1 treatment for hypertension:
- If the patient is >= 55 years old or is black African/Caribbean, 1st choice is a calcium channel blocker. If CCB not suitable (oedema, intolerance, heart failure) then offer thiazide like diuretic.
- If the patient is <55, and is not African/Caribbean and is not a women of child baring age, then offer ACE inhibitor/Angiotensin II receptor blocker
Step 2 treatment for hypertension:
Add thiazide type diuretic such as chlortalidone or indapamide to CCB or ACEI/ARB
Ramipril:
- Angiotensin converting enzyme inhibitor (ACEI)
