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Week 5 - Cardiology > Hypertension > Flashcards

Hypertension Flashcards

1
Q

Define systemic hypertension [2]

A

Persistent elevation in arterial blood pressure >140/90mmHg that increases the vascular risk in patients sufficient to require intervention

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2
Q

Pathophysiology of hypertension: what are the precursors? [2]

A
  1. genetic factors
  2. environmental factors
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3
Q

Pathophysiology of hypertension: what are the 3 main defects that lead to hypertension? [3]

A
  1. defects in renal sodium homeostasis
  2. functional vasoconstriction
  3. defects in vascular smooth muscle growth and structure
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4
Q

Pathophysiology of hypertension: how does defects in renal sodium homeostasis contribute to the development of hypertension? [5]

A

results in adequate sodium excretion → salt and water retention → increased plasma & extracellular fluid volume (which increases natriuretic hormone release) → increased cardiac output → hypertension

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5
Q

Pathophysiology of hypertension: how does functional vasoconstriction contribute to the development of hypertension? [4]

A

results in increased vascular reactivity (influenced by increased natriuetic hormones and increased vascular wall thickness) → increased total peripheral resistance → hypertension

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6
Q

Pathophysiology of hypertension: how does defects in vascular smooth muscle growth and structure contribute to the development of hypertension? [3]

A

results in increased vascular wall thickness (also influenced by increased vascular reactivity) → increases total peripheral resistance → hypertension

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7
Q

What conditions does systemic hypertension put you at a higher risk of? [7]

A
  1. cerebrovascular disease (stroke)
  2. coronary artery disease
    • left ventricular hypertrophy (LVH)
    • chronic heart disease (CHD)
    • heart failure (HF)
  3. retinopathy
  4. peripheral vascular disease (atherosclerosis)
  5. renal failure
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8
Q

What is classified as an “optimal” BP (in mmHg)? [2]

A
  1. systolic <120 (and)
  2. diastolic <80
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9
Q

What is classified as a “normal” BP (in mmHg)? [2]

A
  1. systolic: 120-129 (and/or)
  2. diastolic: 80-84
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10
Q

What is classified as a “high normal” BP (in mmHg)? [2]

A
  1. systolic: 130-139 (and/or)
  2. diastolic: 85/89
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11
Q

What is classified as Grade 1 hypertension (in mmHg)? [2]

A
  1. systolic: 140-159 (and/or)
  2. diastolic: 90-99
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12
Q

What is classified as Grade 2 hypertension (in mmHg)? [2]

A
  1. systolic: 160-179 (and/or)
  2. diastolic: 100-109
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13
Q

What is classified as Grade 3 hypertension (in mmHg)? [2]

A
  1. systolic ≥ 180 (and/or)
  2. diastolic ≥ 110
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14
Q

What is classified as “isolated systolic hypertension” (in mmHg)? [2]

A
  1. systolic ≥ 140 (and)
  2. diastolic < 90
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15
Q

Define primary hypertension [1]

A

hypertension with no identifiable cause, but instead associated with several risk factors

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16
Q

What are the non-modifiable risk factors associated with primary hypertension? [4]

A
  1. age
  2. gender
  3. ethnicity
  4. genetic factors
17
Q

What are the modifiable risk factors associated with hypertension? [5]

A
  1. Diet
  2. Physical activity
  3. Obesity
  4. Alcohol in excess
  5. Stress
18
Q

Define secondary hypertension [1]

A

hypertension with an underlying cause (less common)

19
Q

What are the underlying endocrine causes associated with secondary hypertension? [4]

A
  1. Hyperaldosteronism
  2. Pheochromocytoma
  3. Thyroid disorders
  4. Cushing’s syndrome
20
Q

What is phaechromocytoma? [1]

A

tumour of adrenal gland resulting in too much adrenaline/noradrenaline being released

21
Q

What are the underlying vascular causes associated with secondary hypertension? [1]

A

coarctation of aorta

22
Q

What are the underlying renal causes associated with secondary hypertension? [4]

A
  1. renal artery stenosis
  2. renal parenchymal disease
23
Q

What are the underlying drug causes associated with secondary hypertension? [4]

A
  1. NSAIDs
  2. herbal remedies
  3. cocaine
  4. exogenous steroid use
24
Q

Diagnosis of hypertension should not be made on a single elevated BP reading. How are serial measurements done? [3]

A
  • at least 2 readings, 5 minutes between readings over at least 2 separate visits
  • 24hr ambulatory blood pressure monitoring
  • home blood pressure monitoring
25
Q

How does 24hr ambulatory blood pressure monitoring work? [1]

A

portable measurement device that takes BP every 20-30mins throughout the day and every 2 hours overnight

26
Q

How are patients asked to monitor their blood pressure at home? [1]

A

patients are asked to take 2 readings twice a day, over 4-7 days

27
Q

What should be determined from the history of a potentially hypertensive patient? [6]

A
  1. risk factors
  2. family history
  3. relevant medical conditions
  4. established complications
  5. current and past BP medications
  6. other drugs
28
Q

What medical conditions should a patient be asked about when investigating hypertension? [3]

A
  1. chronic kidney disease (CKD)
  2. obstructive sleep apnoea (OSA)
  3. diabetes
29
Q

What established complications should a patient be asked about when investigating hypertension? [4]

A
  1. stroke
  2. ischaemic heart disease (IHD)
  3. peripheral vascular disease (PVD)
  4. heart failure
30
Q

What drugs (other than BP medications) should a patient be asked about when investigating hypertension? [7]

A
  1. Oral contraceptive drug (OCD)
  2. Steroids
  3. NSAIDs
  4. Cyclosporin → immunosuppressant medication used in rheumatoid arthritis, Crohn’s disease etc.
  5. Herbal remedies
  6. Liquorice
  7. Illicit substances
31
Q

What examinations should be done on a potentially hypertensive patient? [11]

A
  1. BP measured in both arms
  2. Weight/BMI
  3. Xanthelasma (eyes)
  4. Pulses
  5. Oedema (ascites/peripheral)
  6. Rashes
  7. Heart - murmurs
  8. Lungs - failure
  9. Abdomen - renal masses
  10. Vascular bruits - kidneys & carotids
  11. Eyes - retinopathy
32
Q

What are the initial investigations that should be carried on a potentially hypertensive patient? [7]

A
  1. U&Es
  2. Glucose/HbA1c
  3. Lipid profile
  4. TFTs
  5. LFTs
  6. Urine dipstick +/- ACR/PCR
    • ACR = albumin: creatinine ratio
    • PCR = protein: creatinine ratio
  7. 12-lead ECG
33
Q

What are the factors that can affect CV risk? [5]

A
  1. BP category
  2. Presence of end organ damage
  3. Presence of diabetes
  4. CV disease
  5. Renal disease
34
Q

What drugs are used for pharmacological management of hypertension? [11]

A
  1. diuretics
    • loop diuretics
    • thiazide diuretics
    • potassium sparing diuretics
  2. ACE inhibitors
  3. angiotensin II receptor blockers (ARB)
  4. vasodilators
    • calcium-channel blockers
    • beta blockers
    • alpha blockers
  5. methyldopa
  6. hydralazine
  7. monoxidine

Week 5 - Cardiology (12 decks)

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