hypertension Flashcards
what does a 2mmHg rise in blood pressure lead to
7% - increase risk of mortality for IHD (ischemic heart disease)
10% - increase risk mortality from stroke
what is special about the treatment of hypertension
it is the most cost effective treatment ever reviewed
roughly £30 per year
what are the complications of hypertension on organs (late stage)
brain - stroke, haemorage, cognitive decline
retinopathy - eye damage
reanaly failure, dialysis
peripherial vascular disease
heart - Left ventrical failure, coronary heart disease, congestive heart failure, MI
what is the definition of hypertension
That blood pressure above which the benefits of treatment outweigh the risks in term of morbidity and mortality
very personal per person
what is the rough guide for when a patient is hypertensive
140/90
what is the optimum - why is this important
<120/<80
this should be the target for young people
what is stage 1 hypertension
clinic reading 140/90
ambulatory blood pressure monitoring - 135/85
what is stage 2 hypertension
clinic reading 160/100
ABPM - 150/95
what is severe hypertension
when systolic pressure is 180 or higher
when diastolic is 100 or higher
what is primary hypertension - what percentage of cases is this
hypertension that doesn’t have a secondary cause
90% of cases
what are the casues of 2econdary hypertension - percentage
5-10% of cases secondary hypertension
chronic renal disease renal artery stenosis endocrinde disease cushings conns syndrome
how many deaths does hypertension cause
no 1 killer
> 20% of deaths are directly/indirectly related
why do people who have hypertension and are under 40 see a specalits
as there is often a underlying cause
and its a secondary hypertension diagnosis
what factors increase the likely hood of hypertension
ciggaret smoke diabetes mellitus renal disease male hyperlididaemis previous MI or stroke Left ventricular Hypertrophy fitness
what is diabetes mellitus
a group of metabolic disorders in which there are high blood sugar levels over a prolonged period.
what factors contribute to blood pressure
CO - cardiac out put
SV - stroke volume
HR - heart rate
TPR - total peripheral resistance
drugs can target each of these factors
what accounts for second to second blood pressure changes
sympathetic system
- vasocontstiction
- reflex tachycardia
- increased cardiac output
what is pivotal in long term blood pressure control
the renin-angiotensisn-aldosterone system
RAAS
what is the retin-angiotension-aldosterone system responsible form
mananing Na balance
control of blood volume
controll of blood pressure
what is the RAAS stimulated by
fall in BP
fall in circulating volume
sodium depletion
what happens once the RAAS system is stimulated
renin is released from the juxtaglomerular apparatus (kindey bulitding blocks)
what is the function of renin
to conver angiotensinogen to angiotensin 1
what does angiotensin 1 do
it is converted into angiotensisn 2 converting enzyme (ACE - ahhhhhhh!)
what is angiotensin 2
its a potent vasoconstrictor
anti-naturiuretic peptide (reduces overfilled ECF volume by increasing renal sodium excretion)
simulator of aldosterone release form the adrenal glands
when the RAAS is stimulated what does this mean
that there is a drop in BP
how does angiotensin 2 effect the arterioles
its a potent hypertophic agent (makes cells big) which stimulates myocyte and smoothe muscle hypertrophy in the arterioles
what is the function of aldosterone
its a potent anti-naturutetic
and anti-deretic (retain water)
what are myocyte and smooth muscle hypertrophy
poor prognostic indicators in hypertensive patients
explains the risks from hypertension stay after treatment
the aetiology of hypertension is
examples?
polygenic
- genes (GRA, angiotensinogen)
- poly genes (race, obesity)
polyfactorial
- oral contraceptives
- stress
- lower education
what other factors effect hypertension
age faliy genetics environment weight alchol race
what should the treatment of hypertension generally be
AGRESSIVE
but be pragmatic - if the elderly cant withstand the treatment don’t give it to them
what is the best link between family membrers to suggest genetics plays a factor in BP
the cosest correlation exists between siblings
rather than parent to child
what effects does alcholo have on BP
small amounts = lowers BP
largere amounts = rasies BP
what is 30% of hypertension attributed to
obesity - more likely to have sleep aponea - cause hypertension
what factors does bith weight have on hypertension
the lower the birth weigh the greater chance of hypertension
what effects does race have on BP
caucasioan have a lower BP than black populations living in the same environments
what drugs can induce secondary hypertension
NSAIDS - nonsteroidal antiinflammatory drugs
oral contraceptions
cortocsteroids
what pregnancy related illness can cause hypertension
pre-eclampsia
what aortic defect can lead to hypertension
coarctation of the aorta
what are the steps in diagnosis of hypertension
identify true hypertension = using ambulatory blood pressure monitor
assess risk
asses end organ damage
screen for treatable causes
what are the steps of treatment
set target - <135/80-85 mmHg (depends om patient should be lower for younger patients)
how do we treat hypertension
stepped approach
use low doses of several drugs - minimuses adverse effects
slow reduction to stop fainting and other problems
what should you treat the elderly (low renin) with
calcium channel blocker
then thiazide-like diuretic if there is heart failure, oedema, intolerance
what should you treat young individuals (high renin) with
ACE inhibitors/ ARB
what peple should treatment not be offered to if they have stage 1 hypertension
people over the age of 80 - they are doing just fine
how should not get ACE inhibitors
afro-caribean people
females of child bearing age (could lead to tertarogenisi)
if the ACE inhibitor/ARB or CCB is not getting the desired effect what should you do - then whaty
add thiazide-like diuretic
if that dosent help add all 3 together
2 examples of thiazide-like diuretic
chlortalidone
indapamide
what should be used for resistant hypertension
low dose spironolactone (careful about K)
higher dose thiazide-like diuretic
what is an example of a ACE inhibitor
Ramipril
when should ACE inhibitors not be used
Renal artery stenosis
Renal failure
Hyperkalaemia
what are ARBs
angiotensin 2 antagonists
what are some examples of ARBs
losartan , valsartan
vasodilating CCBs are the hypertensive of choice in which populations
people over 55 years old
women of child bearing age
what are examples of vasodilationg CCBs
amlodipine/felodipine
what are exampels of rate limiting CCBs
verapamil
diltiazem
how do CCBs work
blocking the L type calcium channels
reducing TPR by relaxing arteries
reducing CO
when should CCBs not be used
acute MI
heart failure, bradycardia (rate limiting CCBs)
what side effects occur due to rate limiting CCBs
bradycardia
constibation
what are exampels of thiazide type diuretics
INDAPAMIDE
clortalidone
when are thiazide type diuretics used
the first line treatment in mild-moderate hypertension in Afro-Caribbean
in combination with anyother antihypertensive
what is important to know aboyt thiazide type diuretics
antihypertensive effect may take weeks
if a women is of child bearing age what should be prescribed
CCB or beta blocker
what is hypertension in relation to pregnancy
the second most common cause of fetal and maternal death
what is the treatmen for pregnant woment
PRE PREGNANCY atenolol (beta blocker)
then during pregnancy add thiazide diuretic
