Hypertension Flashcards
definition of hypertension?
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.
what type of hyeprtension should be considered in those under the age of 35?
secondary hypertension (those with a cause)
what is the most common type of hypertension and what causes it?
IHD (isolated systolic hypertension) caused by atheresclerosis. (mostly over 60s)
what is the risk of IHD?
doubles the risk of MI and triples the risk of CVA.
what is considered to be grade I or mild hypertension
140 / 90
what is consdiered to be grade II or moderate hypertension?
160 / 100
what is consdiered to be grade III or severe hypertension
> 180 / >110
what is considered to be grade I Isolated Systolic Hypertension?
140 / <90
what is considered to be grade II Isolated Systolic Hypertension?
> 160 / <90
what is the optimal blood pressure?
<120 / <80
what should you reduce salt intake to?
<100 mmol/day
<6g NaCl or <2.4g Na+ a day)
what should you limit alcohol consumption to?
<3 units per day for men
<2 units per day for women
what type of excercise should you be doing
aerobic physical excercise for ≥ 30 minutes per day, atleast on three days of the week.
what can severe hypertensino present as with as mild to moderate hypertension is normally asymptomatic (7)
1) palpitations
2) sweating
3) dizziness
4) fatigue
5) anxiety
6) headache
7) visual impairment
what are the features of secondary hypertension? (3)
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.
what signs might be present in both forms of hypertension? (6)
1) renal bruits
2) left ventricular hypertrophy
3) radio-femoral delay (aortic coarction)
4) proteinuria
5) palpable kidneys
6) retinopathy
what is the grading system used for retinopathy in hypertension?
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.
what are some lesser known risk factors for hyeprtension? (10)
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
what renal diseases cause secondary hypertensio?
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.
what endocrine diseases cause secondary hypertension? (5)
Cushing's syndrome Conn's syndrone phaechromocytima acromegaly hyperthyroidism
what other conditions can cuase secondary hypertensin?
coartation pre-eclampsia (3rd trimester) steroids MAOI NSAIDs contraceptive vasopressin
what defines chronic renal failure (stage 5 CKD)
eGFR < 60 mL/min for more than 3 months.
increase in serum creatinine or protein in the urine.
what is glomerulonephritis?
inflammaiton of the glomeruli and small renal vessels.
asymptomaitc or may present with haematuria, proteinuria or renal failure.
what is polyarteritis nodosa?
vasculitis of medium sized arteries.
weakness, loss of appetitie, weight loss. muslce and joint aches common and skin rashes, swelling, ulcers and lumps.
what is fibromuscular dysplasia? (sten…)
stenosis of renal, carotid and abdominal arteries.
usually asymptomatic but may present with symptoms of craniocervical involvemnts: \
headaches, tinnitus and light-headedness.
what is Cushing’s syndrome?
Hypercortolism.
- central obesity
- purple striae
- moonface
- hirsuitism
- mood change
- osteoporosis
- supracalvicialur fat distribution
- insulin resistance
- buffalo hymp
what are the classic symptoms of hyperthyroidism?
- heat intolerance
- weight loss
- lig lag
- fatigue
- oycholysis
- chemosis
- muslce weakness
- palpitations
- tremors
- irritability
- diarrhoea
- myopahty
what is Conn’s syndrome
Primary Hyperaldosternism
often asymptomatic or signs of hypokalamia, muslce cramps and weakness and headaches.
what is phaechromycytoma
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.
what is coactation?
radial- femoral delay, weak or absent femoral pulses.
what bloods do you do?
FBC, U&E (to exclude secondary cuase - hypokalaemia in coNN’S), fasting lipids, creatnine adn glucose (to help quantify overall risk)
what do you look for in urine analysis
protein and blood can be as a result of hyeprtension
what do you look for in ECG and CXR
end organ damae (such as lV hypertrophy, past MI)
what special tests would you do
renal ultrasound / arteriography
urinary free cortisol / aldosterone
echocardiography
24 hour ambulatory BP monitoring
what is the treatment goal?
<140 / 85
what is the treatment goal if diabetic?
<130/80
what is the treatment goal if proteinuria?
<125 / 75
who do you treat?
- malignant hypertension
- BP persistantly >160 / 100
- increased CVS disease risk (10 year risk ≥ 20%)
existing vascular diase
target organ damage.
what is the first line treatment for hypertension?
dietary changes etc.
what is the aim of pharmacological treatment for hypertnesion?
to reduce risk of complications of hypertension.
what is an example of Ace Inhibitors and what are its side effects?
Captopril
- first dose hypotension
- Hyperkalaemia
- Proteinuria
- nausea and renal impairment
- cough
- headache (angiodema)
- dizziness
- fatigue
what is an example of calcium channel blocker and SE?
Amlodipine
- constipation with verapmail.
rare but headahce, ankle swelling, nausea, flushing
what is an exmaple of thiazide diuretics? SE?
Indapamide or Chrlotalidone SE: Hypokalaemia hypercalcamiea weight gain Hyperlipidaemia Hyperuricaemia (may precipitate gout) impairment of glucose tolerance headacge
what is the treatment algorithm
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.
what are other antihypertensives? (4)
beta blockers (nausea, diarrheoa, dysponea, bradycardia, hypotension, heart fialure, heart block, fatigue , dizziness, cold extremities)
angiotensin II receptor antagonists
Alpha antagonists
direct renin inhibitors
why are ACE i not given to african americans?
becuase caucasians tend to have higher renin levels than african americans and so ACEi tend to work better on caucasians.
what are thiazide diuretics preferred over loop diuretics such as furesomide even though they are equally effective?
becuase thiazide diuretics are longer acting and can reduce risk of strokes.
why is not advised to combine beta blockers with diuretics
because they both aggravate DM
when should diuretics not be given
in gout
what may varapamil and diliazem exacerbate whereas amliodpin is safe?
heart failure
what are also given to reduce overall CVS risk?
statins and aspirin
what should be optimised in diabetic patients?
glycaemic control.
what is defined as malignant hypertension
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.
what is defined as accelerated hypertension
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.
what are the symptoms of accelearted hypertension?
chest pain, dysopnea, numbness, vomiting, fatigue, congusion and other changes in mental state.
what is the characterisitc vascular lesion in malignant hypertension?
Fibrinoid Necorsis of Arterioles
causing clinical manifestations of end organ damage
what does Fibrinoid Necrosis of Arterioles cause?
Microangiopathic haemolytic anaemia
RBCs are damaged as they flow through vessels obstructed by tissue deposition
what is the cuase of hyeprtensive encephalopathy>?
dialtion of cerebral arteries as blood pressure is beyond upper limit of autoregulation. results in hyperperfusion and cerebral oedema.
what is the managemnt of life-threatening hypertension?
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)
what is the management for non life threatening hypertension?
- Nifedipine oral tablets
- Beta Blockers
- ACE i
