Hypertension Flashcards
Define systemic hypertension [2]
Persistent elevation in arterial blood pressure >140/90mmHg that increases the vascular risk in patients sufficient to require intervention
Pathophysiology of hypertension: what are the precursors? [2]
- genetic factors
- environmental factors
Pathophysiology of hypertension: what are the 3 main defects that lead to hypertension? [3]
- defects in renal sodium homeostasis
- functional vasoconstriction
- defects in vascular smooth muscle growth and structure
Pathophysiology of hypertension: how does defects in renal sodium homeostasis contribute to the development of hypertension? [5]
results in adequate sodium excretion → salt and water retention → increased plasma & extracellular fluid volume (which increases natriuretic hormone release) → increased cardiac output → hypertension
Pathophysiology of hypertension: how does functional vasoconstriction contribute to the development of hypertension? [4]
results in increased vascular reactivity (influenced by increased natriuetic hormones and increased vascular wall thickness) → increased total peripheral resistance → hypertension
Pathophysiology of hypertension: how does defects in vascular smooth muscle growth and structure contribute to the development of hypertension? [3]
results in increased vascular wall thickness (also influenced by increased vascular reactivity) → increases total peripheral resistance → hypertension
What conditions does systemic hypertension put you at a higher risk of? [7]
- cerebrovascular disease (stroke)
- coronary artery disease
- left ventricular hypertrophy (LVH)
- chronic heart disease (CHD)
- heart failure (HF)
- retinopathy
- peripheral vascular disease (atherosclerosis)
- renal failure
What is classified as an “optimal” BP (in mmHg)? [2]
- systolic <120 (and)
- diastolic <80
What is classified as a “normal” BP (in mmHg)? [2]
- systolic: 120-129 (and/or)
- diastolic: 80-84
What is classified as a “high normal” BP (in mmHg)? [2]
- systolic: 130-139 (and/or)
- diastolic: 85/89
What is classified as Grade 1 hypertension (in mmHg)? [2]
- systolic: 140-159 (and/or)
- diastolic: 90-99
What is classified as Grade 2 hypertension (in mmHg)? [2]
- systolic: 160-179 (and/or)
- diastolic: 100-109
What is classified as Grade 3 hypertension (in mmHg)? [2]
- systolic ≥ 180 (and/or)
- diastolic ≥ 110
What is classified as “isolated systolic hypertension” (in mmHg)? [2]
- systolic ≥ 140 (and)
- diastolic < 90
Define primary hypertension [1]
hypertension with no identifiable cause, but instead associated with several risk factors
What are the non-modifiable risk factors associated with primary hypertension? [4]
- age
- gender
- ethnicity
- genetic factors
What are the modifiable risk factors associated with hypertension? [5]
- Diet
- Physical activity
- Obesity
- Alcohol in excess
- Stress
Define secondary hypertension [1]
hypertension with an underlying cause (less common)
What are the underlying endocrine causes associated with secondary hypertension? [4]
- Hyperaldosteronism
- Pheochromocytoma
- Thyroid disorders
- Cushing’s syndrome
What is phaechromocytoma? [1]
tumour of adrenal gland resulting in too much adrenaline/noradrenaline being released
What are the underlying vascular causes associated with secondary hypertension? [1]
coarctation of aorta
What are the underlying renal causes associated with secondary hypertension? [4]
- renal artery stenosis
- renal parenchymal disease
What are the underlying drug causes associated with secondary hypertension? [4]
- NSAIDs
- herbal remedies
- cocaine
- exogenous steroid use
Diagnosis of hypertension should not be made on a single elevated BP reading. How are serial measurements done? [3]
- at least 2 readings, 5 minutes between readings over at least 2 separate visits
- 24hr ambulatory blood pressure monitoring
- home blood pressure monitoring
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
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
What should be determined from the history of a potentially hypertensive patient? [6]
- risk factors
- family history
- relevant medical conditions
- established complications
- current and past BP medications
- other drugs
What medical conditions should a patient be asked about when investigating hypertension? [3]
- chronic kidney disease (CKD)
- obstructive sleep apnoea (OSA)
- diabetes
What established complications should a patient be asked about when investigating hypertension? [4]
- stroke
- ischaemic heart disease (IHD)
- peripheral vascular disease (PVD)
- heart failure
What drugs (other than BP medications) should a patient be asked about when investigating hypertension? [7]
- Oral contraceptive drug (OCD)
- Steroids
- NSAIDs
- Cyclosporin → immunosuppressant medication used in rheumatoid arthritis, Crohn’s disease etc.
- Herbal remedies
- Liquorice
- Illicit substances
What examinations should be done on a potentially hypertensive patient? [11]
- BP measured in both arms
- Weight/BMI
- Xanthelasma (eyes)
- Pulses
- Oedema (ascites/peripheral)
- Rashes
- Heart - murmurs
- Lungs - failure
- Abdomen - renal masses
- Vascular bruits - kidneys & carotids
- Eyes - retinopathy
What are the initial investigations that should be carried on a potentially hypertensive patient? [7]
- U&Es
- Glucose/HbA1c
- Lipid profile
- TFTs
- LFTs
- Urine dipstick +/- ACR/PCR
- ACR = albumin: creatinine ratio
- PCR = protein: creatinine ratio
- 12-lead ECG
What are the factors that can affect CV risk? [5]
- BP category
- Presence of end organ damage
- Presence of diabetes
- CV disease
- Renal disease
What drugs are used for pharmacological management of hypertension? [11]
- diuretics
- loop diuretics
- thiazide diuretics
- potassium sparing diuretics
- ACE inhibitors
- angiotensin II receptor blockers (ARB)
- vasodilators
- calcium-channel blockers
- beta blockers
- alpha blockers
- methyldopa
- hydralazine
- monoxidine
