hypertension Flashcards
what is the normal BP
120/80
what are the values for hypertension
140/90
what can high BP cause
haemorrhage, atheroma, renal failure, cardiac death
what is the equation for BP
BP = CO (HR x SV) x SVR
describe the RAAS system
reduced blood flow to kidneys causes the release of renin. coverting angiotensinogen –> angiotensin I. ACE in lungs converts ANGT 1 –> ANGT 2. ANGT 2 causes vasoconstriction and release of aldosterone from adrenal medulla.
what is primary hypertension
no obvious cause, vast majority of cases. Nothing ‘wrong’ with body by itself
what is secondary hypertension
has an underlying cause such as renal disease, endocrine disease, drug therapy and aortic disease
how can renal disease cause hypertension
reduced flow to kidneys causes more renin to be released which causes fluid and salt retention
name 2 endocrine syndromes and what they produce
Conn’s syndrome = excess aldosterone
Cushing’s = excess corticosteroid
what is benign hypertension
usually asymptomatic, may lead to more serious factors in the future
for every ___ mmHg over diastolic ___ mmHg the risk of ___ doubles
10, 85, MI
for every ___ mmHg over diastolic ___ mmHg the risk of ___ doubles
8, 85, stroke
what is malignant hypertension
life threatening condition where diastolic is over 130
what changes take place in arteries due to hypertension
tunic media thickens and arteries become hard
how do you diagnose using ABPM
at least 2 measurements per hour in a waking day
how do you diagnose using HBPM
2 measurements 1 minute apart twice a day. record for 4-7 days and discard first day, then take average
what is the white coat effect
higher BP in clinical setting
what are the values for stage 1 hypertension
clinical: 140/90
ABPM/ HBPM: 135/85
what are the values for stage 2 hypertension
clinical: 160/100
ABPM/ HBPM: 150/95
what are the values for sever hypertension
systole over 180
or
diastole over 110
what tests can be done to test CVD risk/ damage
urine (for proteins), blood (for glucose, electrolytes), fundi (retina) and ECG
for patients under 80 what is drug target BP
under 140/90
for patients over 80 what is drug target BP
under 150/90
what is the drug algorithm for hypertension
A/C
A + C
A + C + D
A + C + D (+ spirolactone or a blocker or B blocker)
in first line who should be prescribed ACEi and who should be prescribed Ca++ blockers
ACEi = under 55 Ca++ = black or over 55
when would ARB’s be prescribed first over ACEi
if ACEi had caused a cough
give an example of an ACEi
lisinopril
give an example of an ARB
losartan
give an example of a Ca++ antagonist, what side effect can occur
verapamil (ankle oedema)
give an example of a diuretic
thiazide diuretic
what type of drug is spirolactone, when may you not prescribe it
aldosterone blocker, diabetes
give an example of a beta blocker, when would you not prescribe it
bisoprolol, asthma and not with beta
give an example of an alpha blocker, when would you not prescribe it
doxazosin, not with beta
what would you prescribe in women trying to have children
beta blockers (others can harm fetus)
