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Cardiovascular > Hypertension > Flashcards

Hypertension Flashcards

1
Q

Define Hypertension?

A

Systolic > 140 mm Hg and/or diastolic > 90 mm Hg measured on three separate occasions

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2
Q

Define Malignant Hypertension?

A

BP > 200/130 mm Hg

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3
Q

What is the primary aetiology of Hypertension?

A

Essential or idiopathic hypertension

Responsible for > 90% of cases

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4
Q

What are the secondary causes of Hypertension?

A 
Renal Causes
Endocrine Causes
Cardiovascular Causes 
Drugs
Pregnancy
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5
Q

What are the Renal Causes of Hypertension?

A 
Renal Artery Stenosis 
Chronic Glomerulonephritis 
Chronic Pyelonephritis 
Polycystic Kidney Disease 
Chronic Renal Failure
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6
Q

What are the Endocrine Causes of Hypertension?

A 
Diabetes Mellitus 
Hyperthyroidism 
Cushing's Syndrome 
Conn's Syndrome 
Hyperparathyroidism
Phaeochromocytoma
Congenital Adrenal Hyperplasia
Acromegaly
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7
Q

What are the Cardiovascular causes of Hypertension?

A

Coarctation of the aorta

Increased intravascular volume

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8
Q

What drugs can cause Hypertension?

A

Sympathomimetics
Corticosteroids
COCP

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9
Q

How can Pregnancy cause Hypertension?

A

Pre-eclampsia

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10
Q

What are the presenting symptoms of Hypertension?

A

Often Asymptomatic
Symptoms of Complications
Symptoms of the cause

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11
Q

What are the presenting symptoms of Accelerated or Malignant Hypertension?

A 
Scotomas (visual field loss)
Blurred Vision
Headache 
Seizures 
Nausea and Vomiting 
Acute Heart Failure
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12
Q

What are the signs of Hypertension on examination?

A

BP should be measured on 2-3 different occasions before diagnosing Hypertension
The lowest reading may be recorded

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13
Q

How can Examination reveal information about the causes of Hypertension?

A

Radiofemoral delay = Coarctation of the aorta distal to the left subclavian artery
Renal Artery Bruit = Renal Artery Stenosis
Fundoscopy to detect hypertensive retinopathy

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14
Q

What is Keith-Wagner Classification of Hypertensive Retinopathy?

A

I - Silver wiring
II - As above + arteriovenous nipping
III - As above + flame haemorrhages + cotton wood exudates
IV - As above + papilloedema

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15
Q

What bloods would you do for Hypertension?

A

U&Es
Glucose
Lipids

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16
Q

What would you look for on a Urine Dipstick in Hypertension?

A

Blood and Protein (e.g. if glomerulonephritis)

17
Q

What would you look for on a ECG for Hypertension?

A

May show signs of Left Ventricular Hypertrophy or ischaemia

18
Q

Why might you do an Ambulatory BP monitoring?

A

Excludes white coat hypertension

19
Q

Why might we do other investigations?

A

If a secondary cause of the Hypertension is suspected

20
Q

What is the conservative management plan for Hypertension?

A 
Stop smoking 
Lose weight
Reduce alcohol intake 
Reduce Dietary Sodium 
Investigate for secondary causes (mainly in young patients)
21
Q

When is medical treatment needed for Hypertension?

A

If systolic > 160 mm Hg and/or diastolic > 100 mm Hg or if evidence of end-organ damage
Multiple drug therapies often needed

22
Q

What are the different lines of drug treatment we can do for Hypertension?

A

ACE inhibitors or ARB blockers
CCBs
Beta-Blockers
Alpha-Blockers

23
Q

When are ACE inhibitors/ ARB receptor blockers first line treatment for Hypertension?

A

< 55 years
Diabetic
Heart Failure
Left Ventricular Dysfunction

24
Q

When are CCBs first line treatment for Hypertension?

A

> 55 yrs

Black

25
Q

What can be used if CCBs are not tolerated for Hypertension treatment?

A

Thiazide Diuretics

26
Q

What are the characteristics of Beta-Blocker usage for Hypertension treatment?

A

Not preferred initial therapy
May be considered in younger patients
Combining with thiazide diuretic may increasing risk of developing diabetes
May increase risk of heart failure

27
Q

What are the characteristics of Alpha-Blocker usage for Hypertension treatment?

A

4th line

May be used in patients with prostate disease

28
Q

What is the target BP in a non-Diabetic patient with Hypertension?

A

< 140/90 mm Hg

29
Q

What is the target BP in a diabetic patient without proteinuria and with Hypertension?

A

< 130/80 mm Hg

30
Q

What is the target BP in a diabetic patient with proteinuria and with Hypertension?

A

< 125/75 mm Hg

31
Q

What drugs would we use in the treatment of Severe Hypertension Management (Diastolic > 140 mm Hg)?

A

Atenolol

Nifedipine

32
Q

What is management of Acute Malignant Hypertension?

A

IV beta-blocker (e.g. esmolol)
Labetolol
Hydralazine Sodium Nitroprusside

33
Q

Why should we be careful of rapid lowering of BP in Acute Malignant Hypertension management?

A

Can Cause Cerebral Infarction

34
Q

Why can rapid lowering of BP cause Cerebral Infarction?

A

The autoregulatory mechanisms within the brain for regulating blood flow will cause vasoconstriction of the vessels in the brain when BP is very high
Lowering the BP too rapidly will mean the autoregulatory mechanisms don’t adapt to the drop in BP and so the vessels remain constricted
A rapid drop in BP with constricted vessels will cause an infarction

35
Q

What are the possible complications of Hypertension?

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
36
Q

What is the prognosis for patients with Hypertension?

A

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

Cardiovascular (34 decks)

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