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Hypertension RCM week 6 > Hypertension > Flashcards

Hypertension Flashcards

1
Q

What are the possible causes of secondary hypertension

A 
Renal disease
renovascular disease
Conn's syndrome
Cushing's syndrome
Hyperthyroidism
Phaeochromocytoma
Pregnancy
Drusgs
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2
Q

How does renovascular disease have an effect on blood pressure

A

Narrowing of renal artery has an effect on renin-angiotensin

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3
Q

How does Conn’s disease have an effect on blood pressure

A

Aldosterone formed because of conn’s disease means there is an increase in sodium and water retention

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4
Q

How does pheochromocytoma have an effect on blood pressure

A

Tumour releasing noradrenaline which increases blood pressure

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5
Q

What are the environmental causes of changes in blood pressure

A

Nitrates in some water can decrease blood pressure

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6
Q

What is the biggest diagnostic for high blood pressure and therefore what does treatment aim to reduce to reduce high blood pressure

A

Systole

Treatment aims to reduce systolic bp

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7
Q

How does obesity lead to high blood pressure

A

Production of angiotensin from adipocytes

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8
Q

What is the main goal of treatment when treating hbp

A

Reduction in blood pressure with as few side effects as possible

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9
Q

What are specific goals of hbp treatment

A
  • reduction in cardiovascular damage
  • preservation of renal function
  • LImitation or reversal of left ventricular hypertrophy
  • Prevention of Ischaemic Heart Disease
  • Reduciton in mortality due to stroke and myocardial infarction
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10
Q

Formula for blood pressure

A

BP= CO x TPR

TPR=total peripheral resistance

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11
Q

How do ACE inhibitors reduce bp

A

Inhibit ACE and so there is reductions in arterial and venous vasoconstriction. Also reduced aldosterone production so there is a reduction in salt and water retention

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12
Q

What are the side effects of ACE inhibitors

A

patient may develop a cough

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13
Q

When should ACE inhibitor not be used

A

In renovascular disease because ACEi lead to renal underperfusion and severe hypotension

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14
Q

What drug is beneficial for patients with diabetes as well as those with hbp

A

ACE inhibitors

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15
Q

Why are ACE inhibitors beneficial for patients with diabetes

A

ACE inhibitors are effective at the prevention of nephropathy in diabetes

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16
Q

What can the renin-angiotensin system be stimulated by

A

Sympathetic nervous system

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17
Q

What is a risk of ACE inhibitors and why

A

Hypocalaemia because there is an increase in sodium retention and increase in potassium loss

18
Q

Why are rate limiting drugs (some calcium channel inhibitors) not used for heart failure

A

As they reduce the force of contraction of the heart which will make the heart failure worse

19
Q

What drug would you use for those with heart disease and HBP

A

DHP

20
Q

What is the action of AT1 receptor antagonists

A

Block the action of A2 at the AT1 receptor therefore the production of aldosterone is inhibited and there is no vasoconstriction

21
Q

What drug is used instead when the ACE inhibitors give rise to a cough

A

AT1 receptor antagonist

22
Q

What are some vasodilators

A

Calcium channel inhibitors i.e. diltiazem, verapamil, and dihydropyridines

23
Q

What do calcium channel inhibitors do

A

Inhibit voltage operated Ca2+ channels on vascular smooth muscle

24
Q

What do rate-limiting calcium channel inhibitors (eg verapamil) do

A

Have a greater effect on cardiac tissue

25
Q

What do DHP calcium channel inhibitors (eg amlodipine) do

A

Have a greater effect on vascular smooth muscle

26
Q

What do diuretics do

A

Inhibit Na+/Cl- in distal convoluted tubule so there is a reduction in circulating volume

27
Q

Side effects of diuretics

A

Hypokalaemia
Postural hypotension
Impaired glucose control

28
Q

What are the last choice antihypertensives and what is their course of action and why are they last choice

A

Alpha blockers
-Competitive receptor antagonists of alpha 1 adrenoceptors

-Poorly tolerated

29
Q

How do beta-blockers act

A

Reduce sympathetic drive to the heart and so reduce cardiac output

A reduction in sympathetically evoked renin release

30
Q

When should beta blockers not be used and why

A

May block bronchial beta2 receptors and are contraindicated in asthma and caution in COPD

31
Q

What are the side effects of beta blockers and why do these occur

A

Blockade of peripheral beta 2 adrenoceptors apposes vasodilation to skeletal muscle

  • Leads to cold extremities and fatigue
  • bronchospasm
32
Q

Adverse effects of calcium channel blockers

A

Peripheral oedema
Postural hypotension
Constipation (some)

33
Q

Adverse effects of thiazide-like diuretic

A

Diabetogenic
Alter lipid profile
Hypokalaemia
Postural hypotension

34
Q

Adverse effects of alpha blockers

A

Widespread

Postural hypotension

35
Q

What drug should be used in patients with chronic heart failure and hypertension

A

ACE inhibitors

36
Q

What drug should you use with patients with ischaemic heart disease and hypertension

A

Beta blockers

37
Q

What groups of people should be prescribed ACEi/ATRA as a step 1 treatment

A
  • Hypertension and and type2 diabetes

- <55 y.o or non-black

38
Q

What groups of people should be prescribed calcium channel inhibitors as a step 1 treatment

A

> 55 years old or black

39
Q

What should those that have had ACEi/ATRA as a step 1 treatment be given as a step2 treatment

A

ACEi/ATRA and CCI or diuretic

40
Q

What should those that had CCI as a step 1 treatment be given as a step2 treatment

A

CCI and ACEi/ATRA or diuretic

41
Q

What should the third step of action be if the second step doesnt work for the two groups of people

A

ACEi/ATRA + CCI + Diuretic

42
Q

What should the fourth step of action be if the third step of action doesnt work

A

Referral or add spironolactone or alpha blocker or beta blocker

Hypertension RCM week 6 (3 decks)

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