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T year CVS > Hypertension > Flashcards

Hypertension Flashcards

1
Q

definition of hypertension?

A

chronic and when systemic blood pressure is raised above the normal range expected in that age group.

above 140/90 mmHg based on at least 2 readings on seperate occassions.

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2
Q

what type of hyeprtension should be considered in those under the age of 35?

A

secondary hypertension (those with a cause)

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3
Q

what is the most common type of hypertension and what causes it?

A

IHD (isolated systolic hypertension) caused by atheresclerosis. (mostly over 60s)

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4
Q

what is the risk of IHD?

A

doubles the risk of MI and triples the risk of CVA.

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5
Q

what is considered to be grade I or mild hypertension

A

140 / 90

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6
Q

what is consdiered to be grade II or moderate hypertension?

A

160 / 100

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7
Q

what is consdiered to be grade III or severe hypertension

A

> 180 / >110

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8
Q

what is considered to be grade I Isolated Systolic Hypertension?

A

140 / <90

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9
Q

what is considered to be grade II Isolated Systolic Hypertension?

A

> 160 / <90

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10
Q

what is the optimal blood pressure?

A

<120 / <80

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11
Q

what should you reduce salt intake to?

A

<100 mmol/day

<6g NaCl or <2.4g Na+ a day)

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12
Q

what should you limit alcohol consumption to?

A

<3 units per day for men

<2 units per day for women

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13
Q

what type of excercise should you be doing

A

aerobic physical excercise for ≥ 30 minutes per day, atleast on three days of the week.

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14
Q

what can severe hypertensino present as with as mild to moderate hypertension is normally asymptomatic (7)

A

1) palpitations
2) sweating
3) dizziness
4) fatigue
5) anxiety
6) headache
7) visual impairment

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15
Q

what are the features of secondary hypertension? (3)

A

also asymtpomatic when mild or moderate.
hypertension will not respond to blood pressure medication.
symptoms may correspodm with underlying disease such as Cushing’s syndrome, hyperthyroidism etc.

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16
Q

what signs might be present in both forms of hypertension? (6)

A

1) renal bruits
2) left ventricular hypertrophy
3) radio-femoral delay (aortic coarction)
4) proteinuria
5) palpable kidneys
6) retinopathy

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17
Q

what is the grading system used for retinopathy in hypertension?

A

Keith Wagener staging.

Grade I: tortuous retinal arteries with thick, shiny walls. (silver/copper wiring)
grade II: AV nipping (arteries crossing veins) plus grade I
Grade III: grade II plus flame hearmorrhages and cotton wool exudates
Grade IV: papilloedema.

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18
Q

what are some lesser known risk factors for hyeprtension? (10)

A

1) hypokalaemia
2) vitamin D deficiency
3) sodium sensitivity
4) family history
5) alcohol intake
6) race
7) low birthweight
8) genetic mutation
9) renin elevation
10) inuslin resistance / hyperinsulinism

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19
Q

what renal diseases cause secondary hypertensio?

A 
most common is intrinsic renal disease such as: 
- CRF 
- glomerulonephritis 
- polycystic kidneys 
- polyarteritis nodosa (PAN) 
chornic pyelonephritis

25% due to renovascular disease (most frequently atheromatous - elderly, male cigarretee smokers) and fibromuscular dysplasia.

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20
Q

what endocrine diseases cause secondary hypertension? (5)

A 
Cushing's syndrome
Conn's syndrone 
phaechromocytima 
acromegaly 
hyperthyroidism
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21
Q

what other conditions can cuase secondary hypertensin?

A 
coartation 
pre-eclampsia (3rd trimester) 
steroids 
MAOI 
NSAIDs 
contraceptive 
vasopressin
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22
Q

what defines chronic renal failure (stage 5 CKD)

A

eGFR < 60 mL/min for more than 3 months.

increase in serum creatinine or protein in the urine.

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23
Q

what is glomerulonephritis?

A

inflammaiton of the glomeruli and small renal vessels.

asymptomaitc or may present with haematuria, proteinuria or renal failure.

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24
Q

what is polyarteritis nodosa?

A

vasculitis of medium sized arteries.

weakness, loss of appetitie, weight loss. muslce and joint aches common and skin rashes, swelling, ulcers and lumps.

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25
Q

what is fibromuscular dysplasia? (sten…)

A

stenosis of renal, carotid and abdominal arteries.
usually asymptomatic but may present with symptoms of craniocervical involvemnts: \
headaches, tinnitus and light-headedness.

26
Q

what is Cushing’s syndrome?

A

Hypercortolism.

  • central obesity
  • purple striae
  • moonface
  • hirsuitism
  • mood change
  • osteoporosis
  • supracalvicialur fat distribution
  • insulin resistance
  • buffalo hymp
27
Q

what are the classic symptoms of hyperthyroidism?

A
  • heat intolerance
  • weight loss
  • lig lag
  • fatigue
  • oycholysis
  • chemosis
  • muslce weakness
  • palpitations
  • tremors
  • irritability
  • diarrhoea
  • myopahty
28
Q

what is Conn’s syndrome

A

Primary Hyperaldosternism

often asymptomatic or signs of hypokalamia, muslce cramps and weakness and headaches.

29
Q

what is phaechromycytoma

A

neuroendocrine tumour of the medulla of the adrneal gland.s.

triad: episodic headache, sweating and tachycardia.
additionally: skin sensations, flank pain, anxiety pallor, weight loss.

30
Q

what is coactation?

A

radial- femoral delay, weak or absent femoral pulses.

31
Q

what bloods do you do?

A

FBC, U&E (to exclude secondary cuase - hypokalaemia in coNN’S), fasting lipids, creatnine adn glucose (to help quantify overall risk)

32
Q

what do you look for in urine analysis

A

protein and blood can be as a result of hyeprtension

33
Q

what do you look for in ECG and CXR

A

end organ damae (such as lV hypertrophy, past MI)

34
Q

what special tests would you do

A

renal ultrasound / arteriography
urinary free cortisol / aldosterone
echocardiography
24 hour ambulatory BP monitoring

35
Q

what is the treatment goal?

A

<140 / 85

36
Q

what is the treatment goal if diabetic?

A

<130/80

37
Q

what is the treatment goal if proteinuria?

A

<125 / 75

38
Q

who do you treat?

A
  • malignant hypertension
  • BP persistantly >160 / 100
  • increased CVS disease risk (10 year risk ≥ 20%)
    existing vascular diase
    target organ damage.
39
Q

what is the first line treatment for hypertension?

A

dietary changes etc.

40
Q

what is the aim of pharmacological treatment for hypertnesion?

A

to reduce risk of complications of hypertension.

41
Q

what is an example of Ace Inhibitors and what are its side effects?

A

Captopril

  • first dose hypotension
  • Hyperkalaemia
  • Proteinuria
  • nausea and renal impairment
  • cough
  • headache (angiodema)
  • dizziness
  • fatigue
42
Q

what is an example of calcium channel blocker and SE?

A

Amlodipine
- constipation with verapmail.
rare but headahce, ankle swelling, nausea, flushing

43
Q

what is an exmaple of thiazide diuretics? SE?

A 
Indapamide or Chrlotalidone
SE: 
Hypokalaemia 
hypercalcamiea 
weight gain 
Hyperlipidaemia 
Hyperuricaemia (may precipitate gout) 
impairment of glucose tolerance
headacge
44
Q

what is the treatment algorithm

A

aged under 55 = A
aged over 55 or black person = C
2) A + C
3) A+ C + D

if resistant = A + C + D consider further diuretics or alpha blocker or beta blocer or seek referral.

45
Q

what are other antihypertensives? (4)

A

beta blockers (nausea, diarrheoa, dysponea, bradycardia, hypotension, heart fialure, heart block, fatigue , dizziness, cold extremities)
angiotensin II receptor antagonists
Alpha antagonists
direct renin inhibitors

46
Q

why are ACE i not given to african americans?

A

becuase caucasians tend to have higher renin levels than african americans and so ACEi tend to work better on caucasians.

47
Q

what are thiazide diuretics preferred over loop diuretics such as furesomide even though they are equally effective?

A

becuase thiazide diuretics are longer acting and can reduce risk of strokes.

48
Q

why is not advised to combine beta blockers with diuretics

A

because they both aggravate DM

49
Q

when should diuretics not be given

A

in gout

50
Q

what may varapamil and diliazem exacerbate whereas amliodpin is safe?

A

heart failure

51
Q

what are also given to reduce overall CVS risk?

A

statins and aspirin

52
Q

what should be optimised in diabetic patients?

A

glycaemic control.

53
Q

what is defined as malignant hypertension

A 
severe hypertension (>200 / 130) with bilateral retinal haemorrhages and exudates: with or without papilloedema. 
requires urgent treatment and if left untreated around 90% will die within the first year.
54
Q

what is defined as accelerated hypertension

A

recant significant increase over baselien BP associated wtih target organ damage such as to brain etc.
fundocopic examination - flame shaped haemorrghaes or soft exudates but without papilloedmea.
also medical emergency.

55
Q

what are the symptoms of accelearted hypertension?

A

chest pain, dysopnea, numbness, vomiting, fatigue, congusion and other changes in mental state.

56
Q

what is the characterisitc vascular lesion in malignant hypertension?

A

Fibrinoid Necorsis of Arterioles

causing clinical manifestations of end organ damage

57
Q

what does Fibrinoid Necrosis of Arterioles cause?

A

Microangiopathic haemolytic anaemia

RBCs are damaged as they flow through vessels obstructed by tissue deposition

58
Q

what is the cuase of hyeprtensive encephalopathy>?

A

dialtion of cerebral arteries as blood pressure is beyond upper limit of autoregulation. results in hyperperfusion and cerebral oedema.

59
Q

what is the managemnt of life-threatening hypertension?

A

1) sodium nitroprusside IV (can cause cyanide toxicity)
2) GTN IV
3) Treat cause
(labetaolol of aortic dissection
hydralize for pregnancy induced hypertension
phentolamine for phaechromocytoma)

60
Q

what is the management for non life threatening hypertension?

A
  1. Nifedipine oral tablets
  2. Beta Blockers
  3. ACE i

T year CVS (5 decks)

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