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Cardiovascular System > Hypertension > Flashcards

Hypertension Flashcards

1
Q

Brain complications

A

Haemorrhage
Stroke
Cognitive decline

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2
Q

Eye complications

A

Retinopathy

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3
Q

Blood vessel complications

A

Peripheral vascular disease

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4
Q

Heart complications

A

Left ventricular hypertrophy
Coronary Heart Disease
Congestive Heart Failure

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5
Q

Renal Complications

A

Renal Failure
Dialysis
Transplantation
Proteinuria

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6
Q

Framingham Study

A

Increase in blood pressure is associated with progressive increase in the risk of stroke and CV disease

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7
Q

At what blood pressure is a patient hypertensive

A

Diastolic pressure is normal (less than 80 mmHg)

Systolic pressure is high (greater or equal to 130 mmHg)

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8
Q

ABPM

A

Ambulatory Blood Pressure Monitoring- when your BP is measured as you move around living your normal life

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9
Q

Stage 1 Hypertension

A

Clinic BP 140/90 or higher

ABPM 135/80 mmHg or higher

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10
Q

Stage 2 Hypertension

A

Clinic BP 160/100 mmHg or higher

ABPM is 125/95 mmHg or higher

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11
Q

Severe Hypertension

A

Clinic systolic pressure is 180 mmHg or higher or diastolic pressure is 110 mmHg or higher

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12
Q

5-10% of cases of secondary hypertension is caused by (7)

A 
Chronic renal disease
Renal artery stenosis
Endocrine disease
Cushing's
Vonn's Syndrome
Pheochromocytoma
GRA
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13
Q

Risk of morbidity from hypertension increases exponentially with what factors (7)

A 
Smoking
Diabetes Mellitus
Hyperlipidaemia
Renal disease
Male
Previous MI or stroke
Left ventricular hypertrophy
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14
Q

Prime contributors to blood pressure

A

Cardiac output

Peripheral vascular resistance

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15
Q

Sympathetic system activation produces

A

Vasoconstriction
Reflex tachycardia
Increased cardiac output

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16
Q

The Renin-Angiotensin-Aldosterone System is responsible for (4)

A

Long-term BP control
Sodium balance
Control of blood volume
Control of blood pressure

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17
Q

RAAS is stimulated by (3)

A

Fall in BP
Fall in circulating volume
Sodium depletion

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18
Q

Where is renin released from

A

Juxtaglomerular apparatus

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19
Q

What is the function of Renin

A

Converts angiotensin to angiotensin I

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20
Q

What converts angiotensin I to angiotensin II

A

ACE

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21
Q

Function of Angiotensin II (3)

A

Vasoconstrictor
Anti-natriuretic peptide
Stimulator of aldosterone release from the adrenal glands

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22
Q

What stimulates the release of aldosterone and where from

A

Angiotensin II

Adrenal glands

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23
Q

Function of Aldosterone

A

Anti-natriuretic

Anti-diuretic peptide

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24
Q

Angiotensin stimulates what

A

Potent hypertrophic agent and stimulates myocyte and smooth muscle hypertrophy in the arterioles

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25
Q

Key targets in the treatment of hypertension

A

Sympathetic system

RAAS

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26
Q

Why may the risk of hypertension increase with age?

A

Decreased arterial compliance

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27
Q

The closest correlation exists between siblings or parent and child

A

Siblings

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28
Q

Does hypertension run in families (Y/N)

A

Yes

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29
Q

How many genes account for how much mmHg

A

> 30

0.5 mmHg

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30
Q

Low levels of daily potassium consumption

A

High systolic pressure

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31
Q

The lower the birth rate the__

A

higher the likelihood of developing hypertension and heart disease

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32
Q

Why are black populations more sensitive to an increase in dietary salt intake

A

Genetically selected to be salt retainers

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33
Q

Causes of Secondary Hypertension (6)

A 
Renal disease
Drug induced
Pregnancy
Endocrine
Vascular- coarctation of the aorta
Sleep apnoea
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34
Q

Renal disease

A

– chronic pyelonephritis
– fibromuscular dysplasia
– renal artery stenosis
– polycystic kidneys

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35
Q

Drugs linked to secondary hypertension

A

– NSAIDs
– Oral contraceptive
– Corticosteroids

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36
Q

Endocrine diseases related to hypertension (5)

A 
–	Conn’s Syndrome
–	Cushings disease
–	Phaeochromocytoma
–	Hypo and hyperthyroidism
–	Acromegaly
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37
Q

True hypertension

A

Must use ABPM or HBPM

38
Q

Treatment of hypertension (5)

A
  1. Identify true hypertension
  2. Assess risk
  3. Asses end organ damage
  4. Screen for treatable causes
  5. Stepped approach
39
Q

Treatment for young (high renin)

A

ACE Inhibitor/ARB

40
Q

Treatment for elderly (low renin) (2)

A

CCB

Thiazide-type diuretic

41
Q

Aged under 40 with stage 1

A

Specialist evaluation of secondary causes of hypertension and a more detailed assessment of potential target organ damage

42
Q

White coat effect

A

When your blood pressure is higher in a medical setting

43
Q

How would you overcome the white coat effect

A

consider ABPM or HBPM as an adjunct

44
Q

Anti-hypertensive treatment with CCB

A

People aged over 55

People of african or caribbean descent

45
Q

Treatment with ACEI/ARB (3)

A

Young people

Not of caribbean descent or of child bearing age

46
Q

If single agent doesn’t work what can you do

A

CCB and ACEI/ARB

47
Q

CCB is not suitable for

A

Patients with oedema, intolerance

Evidence of Heart Failure

48
Q

What can be offered as an alternative to CCB

A

Thiazide-like diuretic

49
Q

Examples of thiazide-like diuretic (2)

A

Chlortalidone

Indapamide

50
Q

Treatment for resistant hypertension

A

Further diuretic therapy with low-dose spironolactone if the potassium levels are 4.5 mmol.l or lower

51
Q

ACEIs

A

Ramipril

52
Q

Contraindication of ACEIs (3)

A

Renal artery stenosis
Renal failure
Hyperkalemia

53
Q

Adverse drug reactions of ACEIs (5)

A
  • Cough
  • First dose hypotension
  • Taste disturbance
  • Renal Impairment
  • Angiogenic oedema
54
Q

NSAIDs and ACEIs

A

Precipitate acute renal failure

55
Q

Potassium supplements and ACEIs

A

Hyperkalaemia

56
Q

Potassium sparing diuretics

A

Hyperkalaemia

57
Q

ARB examples

A

Losartan
Valsartan
Candesartan
Irbesartan

58
Q

Mechanism of ARB

A

competitively block the actions of angiotensin II at the angiotensin AT1 receptor

59
Q

What is the advantage of ARB over ACEI

A

No cough

60
Q

What is Atenolol

A

Beta blocker

61
Q

What is Enalpril

A

ACEI

62
Q

Vasodilator CCB

A

• Amlodipine/Felodipine

63
Q

Rate-limiting CCB

A

Verapamil/Diltiazem

64
Q

How do CCB work (4)

A
  • Blocking the L type calcium channels
  • Selectivity between vascular and cardiac L type channels
  • Relaxing large and small arteries and reducing peripheral resistance
  • Reducing CO
65
Q

Vasodilating CCBs are the best choice with what type of patients (2)

A

– over 55years.

– women of child bearing age

66
Q

Contraindications of CCBs (3)

A

Acute MI

Heart failure, bradycardia

67
Q

Adverse drug reactions of CCB (5)

A 
–	Headache
–	Ankle oedema
–	Indigestion and reflux oesophagitis
- Bradycardia 
- Constipation
68
Q

Examples of Thiazide-type diuretics

A
  • Indapamide

* Chlortalidone

69
Q

Alpha-adrenoreceptor antagonists examples

A

Doxazosin

70
Q

Mechanism of alpha-adrenoreceptor antagonists (2)

A

– Selectively block post-synaptic alpha 1 adrenoreceptors

– Oppose vascular smooth muscle contraction in arteries

71
Q

Adverse drug reactions of alpha-adrenoreceptor antagonists (4)

A

Hypotension
Dizziness
Dry mouth
Headache

72
Q

Example of centrally acting agents

A

Methylodopa

Moxonidine

73
Q

Mechanism of methyldopa

A

used in hypertension within pregnancy

Converted to a-methylnoradrenaline and decreases sympathetic outflow

74
Q

Mechanism of Moxonidine

A

Centrally acting Imidazoline agonist

75
Q

Pre pregnancy hypertension treatment

A

– Nifedipine MR, Methyl dopa, Atenolol, Labetalol

76
Q

During pregnancy hypertension treatment

A

– Add thiazide diuretic and/or amlodipine

77
Q

What is preeclampsia and how is it treated

A

High blood pressure during pregnancy

IV hydralazine, esmolol, labetalol

78
Q

Stage 1 hypertension in children

A

BPs from the 95th-99th percentile plus 5mmHg

79
Q

Stage 2 hypertension in children

A

BP above 99th percentile plus 5mmHg

80
Q

Childhood hypertension is associated with (6)

A

LVH
• Decreased vascular responsiveness
• Increased carotid artery intimal medial thickness
• Increased atheroma deposition
• Reduced cognitive scored in hypertensive children
reduced GFR

81
Q

Commonest cause of hypertension in newborn infants (4)

A

– Renal artery thrombosis
– Renal artery stenosis
– Congenital renal malformations
– Coarctation

82
Q

Commonest cause of hypertension in infants-6 years (3)

A

– Renal parenchymal disease
– Coarctation
– Renal artery stenosis

83
Q

Commonest cause of hypertension in 6-10 years (3)

A

– Renal parenchymal disease
– Renal artery stenosis
– Primary hypertension (diet, obesity, lifestyle)

84
Q

Commonest cause of hypertension 10-18 years (2)

A

– Primary hypertension (diet, obesity, lifestyle)

– Renal parenchymal disease

85
Q

Causes of accelerated hypertension

A

Lack of primary care and healthcare
Non-adherence to medication
Ilicit drug use

86
Q

Malignant Hypertension

A

cases where papilloedema grade IV fundal changes

87
Q

Hypertensive Urgency

A

• Severe hypertension with no evidence of target organ damage. “urgency” rather than “emergency”

88
Q

How is a hypertensive urgency manages

A

continuous infusion of a short acting, titratable antihypertensive agent.

89
Q

Hypertensive emergencies treatment

A

reducing mean arterial pressure by <25% for the first hour and then to 160/100-110 mmHg by 2-6 hours with subsequent gradual normalisation over 24-48 hours

90
Q

Goal of accelerated hypertension treatment

A

reduce DBP by 15-20% or to about 110mmHg over a period of 30-60 minutes
• Set a 2 hour and 6-hour BP target to be achieved
• Once stabilised with IV agents oral therapy can be initiated and the IV agents slowly titrated down

91
Q

What does excessive correction of the BP cause

A

Further reduces organ perfusion and produce multiorgan infarction

Cardiovascular System (42 decks)

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