Hypertension Flashcards
What is the blood pressure of a patient who has hypertension
Systolic >140mmHg
Diastolic >90mmHg
How are ambulatory devices useful when measuring blood pressure
Allows you to see how blood pressure changes in a range of different settings
Why is MAP sometimes more helpful than systolic and diastolic blood pressure
Systolic and diastolic constantly changes
What are the known risk factors of hypertension
Age Race Obesity Alcohol Family history Pregnancy Stress Drugs
What are the categories of drugs that are risk factors of hypertension
Non steroidal
Corticosteroids
Oral contraceptives
Sympathomimetics
What are the main causes of hypertension
Environments eg - stress, obesity, age
Genes
Gene/environment interactions eg - age, gender
How can treating hypertension affect coronary heart disease
Reversing high blood pressure will not reverse the atherosclerosis which has built up in the patient for likely a long time
How does hypertension relate to the risk of MI
Risk of MI from high blood pressure is related to the duration of the hypertension and not directly the pressure itself
How will treating hypertension affect CVA (stroke)
Ideal treatment for stroke as it is directly related to pressure
What is the outcome of hypertension
Accelerated atherosclerosis which can lead to MI, stroke, PVD and renal failure
What effect does renal failure have on hypertension
Makes hypertension worse
What are common triggers of hypertension
None usually found
Likely genetic failure of auto regulation control of blood vessel wall constriction
What is essential hypertension
When no signs or symptoms are found but a patient has hypertension
What are rare triggers of hypertension
Renal artery stenosis
Endocrine tumours
What different endocrine tumours can cause hypertension
Pheochromocytoma
Conn’s Syndrome
Cushing’s Syndrome
What are the signs and symptoms of hypertension
Usually none
May get headache - unusual
May get transient ischaemic attacks
What does a headache indicate in hypertension
Malignant hypertension where blood pressure is rapidly accelerating
What is a Transient Ischaemic Attack
TIA’s are mini strokes with a full neurological return in 24 hours
What indications may be present with hypertension to investigate a patient further
Young patient
Resistant hypertension despite adequate treatment
Accelerated hypertension
Unusual history
What further investigation should be carried out if a patient has accelerated hypertension
Scan to look for endocrine tumours and renal disease
What is a pheochromocytoma and where are they found
An adrenergic endocrine tumour which releases adrenaline into circulation causing vasoconstriction and hypertension
From adrenal gland, above the kidney
In region of kidney, but not a kidney disease
What is Cushing’s syndrome
Endocrine tumour which releases cortisol into circulation increasing circulating blood volume
Gives salt and water retention which leads to excess fluid within the circulation
What is Conn’s Syndrome
Endocrine tumour that releases aldosterone into circulation increasing circulating blood volume
What is renal artery stenosis
Narrowing of vessels into the kidney which makes the auto regulation system think that blood flow has dropped because of hypovolemia
Because of this the body releases renin and through the renin-angiotensin system, aldosterone will be released and salt and water will be retained
What is hypovolemia
The loss of extracellular fluid
What investigations are usually carried out in patients with hypertension
Urinalysis
Serum biochemistry - electrolytes, urea and creatinine
Serum lipids
ECG
What investigations are occasionally carried out in patients with hypertension
Renal ultrasound
Renal angiography
Hormone estimations - cortisol and adrenaline
What is the aim blood pressure when treating a patient with hypertension
120/90mmHg
What can be done to treat hypertension
Modify risk factors such as weight and exercise
Single daily drug use
Which drugs can be used to treat hypertension and what are their side effects
Thiazide diuretic - gout
Beta blocker - COPD and asthma
Calcium channel blockers - gingival hyperplasia
ACE inhibitor - PVD
How should patients with hypertension be monitored
After treatment, review at least annually, before then, every 2-3 months
In which hypertensive patients, is it particularly important to monitor
Elderly patients
Why are hypertensive patients monitored
Drugs can have biochemical effects on the blood such as Na+/K+ changes and dehydration
