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
How does 24hr ambulatory blood pressure monitoring work? [1]
portable measurement device that takes BP every 20-30mins throughout the day and every 2 hours overnight
26
How are patients asked to monitor their blood pressure at home? [1]
patients are asked to take 2 readings twice a day, over 4-7 days
27
What should be determined from the history of a potentially hypertensive patient? [6]
1. risk factors 2. family history 3. relevant medical conditions 4. established complications 5. current and past BP medications 6. other drugs
28
What medical conditions should a patient be asked about when investigating hypertension? [3]
1. chronic kidney disease (CKD) 2. obstructive sleep apnoea (OSA) 3. diabetes
29
What established complications should a patient be asked about when investigating hypertension? [4]
1. stroke 2. ischaemic heart disease (IHD) 3. peripheral vascular disease (PVD) 4. heart failure
30
What drugs (other than BP medications) should a patient be asked about when investigating hypertension? [7]
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
What examinations should be done on a potentially hypertensive patient? [11]
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
What are the initial investigations that should be carried on a potentially hypertensive patient? [7]
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
What are the factors that can affect CV risk? [5]
1. BP category 2. Presence of end organ damage 3. Presence of diabetes 4. CV disease 5. Renal disease
34
What drugs are used for pharmacological management of hypertension? [11]
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