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cardiology > Hypertension > Flashcards

Hypertension Flashcards

1
Q

Define hypertension

A

Systolic >140 mm Hg &/or diastolic >90 mm Hg measured on 3 separate occasions

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2
Q

Define malignant hypertension

A

BP >200/130 mm Hg

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3
Q

Aetiology of primary hypertension

2

A

Essential or idiopathic hypertension

Responsible for >90% cases

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4
Q

Aetiology of secondary hypertension

5 groups

A 
Renal
Endocrine
Cardiovascular
Drugs
Pregnancy
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5
Q

Aetiology of secondary hypertension - renal

5

A 
Renal artery stenosis 
Chronic glomerulonephritis 
Chronic pyelonephritis 
Polycystic kidney disease
Chronic renal failure
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6
Q

Aetiology of secondary hypertension - endocrine

7

A 
Diabetes mellitus 
Hyperthyroidism 
Cushing’s syndrome
Hyperparathyroidism 
Phaeochromocytoma
Congenital adrenal hyperplasia
Acromegaly
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7
Q

Aetiology of secondary hypertension - cardiovascular

2

A

Coarctation of the aorta

Increased intravascular volume

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8
Q

Aetiology of secondary hypertension - drugs

3

A

Sympathomimetics
Corticosteroids
COCP

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9
Q

Aetiology of secondary hypertension - pregnancy

A

Pre-eclampsia

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10
Q

Epidemiology of hypertension

prevalence, location

A

VERY COMMON

10-20% adults of Western world

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11
Q

Presenting symptoms of hypertension

3

A

Often ASYMPTOMATIC
Symptoms of complications
Symptoms of cause

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12
Q

Presenting symptoms of accelerated/malignant hypertension

6

A 
Scotomas (visual field loss)
Blurred vision 
Headaches 
Seizures
N&V
Acute heart failure
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13
Q

Signs of hypertension of physical examination

5

A

BP should be measured on 2-3 different occasions before diagnosing hypertension
Lowest reading should be recorded

Examination may reveal information about cause:
Radio-femoral delay = coarctation of aorta distal to the left subclavian artery
Renal artery bruit = renal artery stenosis
Fundoscopy to detect hypertensive retinopathy

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14
Q

Keith-Wagner classification of hypertensive retinopathy

4

A

i. Silver wiring
ii. As above + arteriovenous nipping
iii. As above + flame haemorrhages + cotton wool exudates
iv. As above + papilloedma

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15
Q

Investigations for hypertension

5 groups

A

Bloods

Urine dipstick

ECG

Ambulatory BP monitoring

Other investigations may be performed if 2º cause of hypertension is suspected (e.g. renal angiogram)

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16
Q

Investigations for hypertension - bloods

3

A

U&Es
Glucose
Lipids

17
Q

Investigations for hypertension - urine dipstick

A

Blood & protein (e.g. if glomerulonephritis)

18
Q

Investigations for hypertension - ECG

A

May show signs of left ventricular hypertrophy or ischaemia

19
Q

Investigations for hypertension - ambulatory BP monitoring

A

Exclude white coat hypertension

20
Q

Management of hypertension

6 groups

A

Conservative

Investigate for 2º causes (mainly in young patients)

Medical

Target BP

Severe hypertension management

Acute malignant hypertension management

21
Q

Management of hypertension - conservative

4

A

Stop smoking
Lose weight
Reduce alcohol intake
Reduce dietary sodium

22
Q

Management of hypertension - medical

2 general, 4, 2, 3, 2

A

Treatment recommended if systolic >160 mm Hg &/or diastolic >100 mm Hg, or if evidence of end organ damage
Multiple drug therapies often needed

ACE inhibitors or angiotensin receptor blockers 1st line if:
<55 yrs 
Diabetic 
Heart failure
Left ventricular dysfunction

CCBs 1st line if:
>55 yrs
Black
(thiazide diuretic can be used if not tolerated)

β-blockers
Not preferred initial therapy
May be considered in younger patients
May increase risk of heart failure
(combing w/ thiazide diuretic may increase risk of developing diabetes)

α-blockers
4th line
May be used in patients w/ prostate disease

23
Q

Management of hypertension - target BP

3

A

Non-diabetic: <140/90 mm Hg
Diabetes without proteinuria: <130/80 mm Hg
Diabetes with proteinuria: <125/75 mm Hg

24
Q

Management of hypertension - severe hypertension management

2

A

Atenolol

Nifedipine

25
Q

Management of hypertension - acute malignant hypertension management
(4)

A

IV β-blocker (e.g. esmolol)
Labetolol
Hydralazine sodium nitroprusside
Avoid rapid lowering of BP as it can cause cerebral infarction

26
Q

Complications of hypertension

10

A 
Heart failure
Coronary artery disease
Cerebrovascular accidents
Peripheral vascular disease 
Emboli
Hypertensive retinopathy
Renal failure
Hypertensive encephalopathy
Posterior reversible encephalopathy syndrome (PRES)
Malignant hypertension
27
Q

Prognosis of hypertension

3

A

Good prognosis if well controlled
Uncontrolled hypertension associated w/ increased mortality
Treatment reduces incidence of renal damage, stroke & heart failure

cardiology (31 decks)

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