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Cardiovascular System > Hypertension > Flashcards

Hypertension Flashcards

1
Q

Define hypertension

A

The blood pressure above which the the benefits of treatment outweigh the risks in terms of morbidity and mortality.

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2
Q

Know the pathologic aetiology of hypertension

A

Primary hypertension;

  • 90% of cases
  • No known cause

Secondary hypertension;

  • 5-10% of cases
  • Chronic renal disease: fibromuscular dysplasia (in women), renal artery stenosis (in elderly), polycystic kidneys
  • Pregnancy: pre-eclampsia
  • Endocrine disease: Cushing’s, Conn’s, phaechromocytoma, hypo/hyperthyroidism, acromegaly
  • Vascular: coarctation of the aorta
  • Sleep apnoea
  • Drug-induced: NSAIDs, oral contraceptive, corticosteroids
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3
Q

Be able to discuss the outcome of untreated hypertension

A
  • Brain: stroke, haemorrhage, cognitive decline (dementia)
  • Eyes: retinopathy
  • Vascular: peripheral vascular disease
  • Kidneys: renal failure
  • Heart: LVH, CHD, CHF, MI
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4
Q

Describe the stages of hypertension

A
  • Stage 1: 140/90mmHg
  • Stage 2: 60/100mmHg
  • Severe: 180/110mmHg
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5
Q

Describe the risk factors of hypertension

A
  • Smoking
  • DM
  • Renal
  • Sex: male
  • Hyperlipidaemia
  • Previous MI or stroke
  • LVH
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6
Q

How does drug therapy affect the SNS to reduce BP?

A
  • Vasoconstriction
  • Reflex tachycardia
  • Increased CO
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7
Q

Know the aetiology of hypertension

A
  • Increase reactivity of resistance vessels, thus increased TPR
  • Sodium homeostatic effect (kidneys cannot excrete right amount of sodium in primary HBP)
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8
Q

Know the aetiology of hypertension

A
  • Increase reactivity of resistance vessels, thus increased TPR
  • Sodium homeostatic effect (kidneys cannot excrete right amount of sodium in primary HBP)
  • Age
  • Family history
  • Environment
  • Diet
  • Weight
  • Alcohol intake
  • Race
  • Birth weight
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9
Q

Know the aetiology of hypertension

A
  • Increase reactivity of resistance vessels, thus increased TPR
  • Sodium homeostatic effect (kidneys cannot excrete right amount of sodium, retained fluid so BP increases)
  • Age
  • Family history
  • Environment
  • Diet
  • Weight
  • Alcohol intake
  • Race
  • Birth weight
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10
Q

Know the aetiology of hypertension

A
  • Increase reactivity of resistance vessels, thus increased TPR
  • Sodium homeostatic effect (kidneys cannot excrete right amount of sodium, retained fluid so BP increases)
  • Age
  • Family history
  • Environment
  • Diet
  • Weight
  • Alcohol intake
  • Race
  • Birth weight
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11
Q

Describe the stages of hypertension

A 
- Stage 1: 140/90mmHg
ABPM: 135/85mmHg
- Stage 2: 160/100mmHg
ABPM: 155/95mmHg
- Severe: 180/110mmHg
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12
Q

Describe the diagnosis of hypertension

A
  • Must use ABPM/HBPM

- Assess risk

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13
Q

Describe the diagnosis of hypertension

A
  • Must use ABPM/HBPM
  • Assess risk: history and examination
  • Assess end organ damage: ECG, echocardiogram, Proteinuria, renal USS/function
  • Screen for treatable causes
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14
Q

Describe the basic outline of the treatment of hypertension

A
  • Assign target BP
  • Stepped approach
  • Use low doses of several drugs: minimises adverse events and maximises patient compliance
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15
Q

Describe the basic outline of the treatment of hypertension

A
  • Assign target BP
  • Stepped approach: do not continuously change drugs
  • Use low doses of several drugs: minimises adverse events and maximises patient compliance
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16
Q

Describe the basic outline of the treatment of hypertension

A
  • Assign target BP
  • Stepped approach: do not continuously change drugs, add new drugs until target BP achieved
  • Use low doses of several drugs: minimises adverse events and maximises patient compliance
17
Q

Describe what should be considered when prescribing medication for stage 1 hypertension

A
  • Offer to <80 y.o. with one or more complications
  • Seek advice for <40 y.o.
  • Give same treatment to >80 y.o. accounting for any co-morbidities
18
Q

Discuss the stepped approach to the treatment of hypertension

A

Step 1;

  • > 55 or black patient of any age: CCB
  • Oedema, CCB intolerance, HF: thiazide-LIKE diuretic
  • <55, NOT black or women of child-bearing age: ACEi/ARB

Step 2;
- CCB or ACEi/ARB: add thiazide-TYPE diuretic

Step 3;
- Add CCB, ACEi, diuretic together

Step 4 (resistant hypertension);

  • Consider further diuretic therapy (low dose spironolactone) if blood K+ level <4.5mmol
  • Consider high dose thiazide-LIKE diuretic if >4.5mmol
19
Q

Define systolic hypertension

A

Systolic BP above 140mmHg.

20
Q

Define diastolic hypertension

A

Diastolic BP above 90mmHg.

21
Q

Describe drug-drug interaction to ACEi

A
  • NSAIDs: precipitate acute renal failure
  • Potassium supplements
  • Potassium sparing diuretics
22
Q

Define angiotensin converting enzyme inhibitors

A

Competitively inhibit the actions of ACE.

e.g. ramipril

23
Q

Define angiotensin receptor inhibitors

A

Competitively block the actions ANG II at the ANG AT1 receptor.
e.g. losartan, valsartan, candesartan, irbesartan
Advantage over ACEi: no cough

24
Q

Define calcium channel antagonists

A

e.g. vasoldilators - amlodipine, felodipine, rate limiting - verapamil, diltiazen

25
Q

Define beta-adrenoreceptor antagonist

A
  • Selectively block post-synaptic alpha-1 receptors

- Oppose vasoconstriction

26
Q

Why are CCBs the drug of choice to treat hypertension?

A
  • > 55 y.o.
  • Women of child bearing age
  • High compliance
  • Benefit elderly with systolic hypertension
  • Rarely causes postural hypotension
27
Q

Define methyldopa

A
  • Centrally acting agent
  • Less common
  • Used in pregnancy
28
Q

Describe contraindications to CCBs

A
  • Acute MI

- HF, bradycardia (rate limiting CCBs)

29
Q

Describe adverse drug reaction to CCBs

A
  • Flushing
  • Headache
  • Ankle oedema
  • Indigestion and reflux oesophagitis
30
Q

Describe adverse drug reaction to CCBs

A
  • Flushing
  • Headache
  • Ankle oedema
  • Indigestion and reflux oesophagitis
  • Constipation (rate limiting CCBs)
31
Q

Define thiazide diuretic

A
  • Urinary excretion of sodium
  • May take weeks to work
  • Adverse reactions are uncommon but include gout and impotence
32
Q

Define thiazide diuretic

A
  • Urinary excretion of sodium
  • May take weeks to work
  • Adverse reactions are uncommon but include gout and impotence
    e. g. indapamide, chlortalidone
33
Q

Describe adverse drug reaction to CCBs

A
  • Flushing
  • Headache
  • Ankle oedema
  • Indigestion and reflux oesophagitis
  • Constipation (rate limiting CCBs)
34
Q

Describe adverse drug reaction to alpha-adrenoreceptor antagonists

A
  • First dose hypotension
  • Dizziness
  • Dry mouth
  • Headache
35
Q

Describe adverse drug reactions to methyldopa

A
  • Sedation and drowsiness
  • Dry mouth and nasal congestion
  • Orthostatic hypotension

Cardiovascular System (26 decks)

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