Hypertension Flashcards
What is athlerosclerosis?
The formation of a lipid rich plaque in the wall of a blood vessel
What is peripheral vascular disease?
Flurrying up of arteries supplying arms and legs
What are aneurysms?
Abnormal ballooning out of blood vessels
What can high blood pressure cause?
Atherosclerosis
Heart failure
Chronic Kidney Disease
What are the main symptoms of high Bp?
Typically no symptoms except in accelerated hypertension (very rare)
What is systolic BP?
Maximum pressure in the vessels after cardiac contraction
What is diastolic BP?
Minimum pressure in vessels during cardiac contraction
Which artery is normally used to measure BP?
Brachial artery
What constitutes as normal BP?
90/60 - 120/80 mmHg (no definite answer)
What is the clinical BP stage 1 hypertension?
Systolic - 140-159
Diastolic - 90-99
What is the clinical BP stage 2 hypertension?
Systolic - 160-179
Diastolic - 100-119
What is the clinical BP of stage 3 hypertension?
Systolic - over 180
Diastolic - over 120
What are the 3 steps in investigating a patient with hypertension?
- Establish if hypertension is present
- Look for evidence of target organ damage
- Look for evidence of secondary cause
What does an ambulatory monitoring do?
A cuff inflates throughout the day taking BP at different times throughout a 24 hour period
What is primary hyperaldosteronism?
An excessive production of aldosterone (secondary cause of high blood pressure)
What is Cushing’s syndrome?
An excess of corticosteroid production
List secondary causes of hypertension
Primary hyperaldosteronism Cushing’s syndrome Phaeochromocytoma Renal artery stenosis Intrinsic renal disease Coarctation of the aorta Obstructive sleep apnoea
What is renal artery stenosis?
Narrowing of the main artery supplying the kidney causing an increase in BP
What does a high Bp in a pregnant woman indicate?
A high bp in the future
What do non steroidal anti-inflammatory drugs do?
They are taken to relieve inflammation and pain and they cause salt and water retention which can increase bp
If a patient complained of sweating and palpitations, what secondary condition would come to mind?
phaeochromocytoma - when the body decides to pump out more adrenaline and it may be because you have a tumour in your adrenal gland and the tumour makes too much adrenaline (RARE)
If a patient complained of flank pain, what secondary condition would come to mind?
Kidney disease
If a patient had daytime somnolence, snoring and erratic sleep, what secondary condition would come to mind?
Obstructive sleep apnea - body fires or adrenaline every now and then
What is oedema?
Swelling
What is postural hypertension?
When a patient’s bp falls when standing up
What does a bad ophthalmology examination tell us? ( in relation to blood pressure )
High blood pressure for a long period of time
List 4 target organs of high bp?
Heart
Kidney
Eye
Artery walls
What happens the heart in high bp?
The heart can thicken - (Left ventricular hypertrophy)
What on an ECG indicates left ventricular hypertrophy ?
Pronounced P and S waves
What can high bp do to the kidney ?
It can cause kidney disease
How can kidney disease be detected?
- Look at the urine - a healthy kidney won’t let protein out into the urine
- Look at the blood - high creatinine levels can indicate kidney dysfunction and problem with the filtration of the kidney
How do you investigate Cushing’s syndrome?
Measure the amount of steroids in the urine (cortisol)
How to test for phaeochromocytoma ?
Measure the amount of adrenaline in the blood or urine
How to detect renal artery stenosis?
- Wishing noise when listening to patients abdomen
2. Scan of kidney
What website do we use to calculate a patients risk factor if having an MI or stroke ?
QRISK-3
Which of the following is least important in terms of cardiovascular risk? Smoking Diabetes Osteoarthritis Migraine Depression
Osteoarthritis - inflammatory conditions that increase the risk not osteoarthritis
Note - not asked in QRISK questioning
List lifestyle interventions to reduce cardiovascular risk?
- Stop smoking
- Achieve a healthy body weight
- Eat a healthy diet (DASH Diet)
- Restrict diet intake
- Moderate alcohol intake
- Take adequate exercise
- Discourage excessive caffeine intake
Who should you give drug treatment to for hypertension ?
^ persistent stage 2 hypertension
^ stage 1 hypertension of patients who are over 80
Who do you give ACE inhibitors or Angiotension Receptor Blockers to as a first stage ?
~ patients with hypertension and type 2 diabetes
~ patients with hypertension, who are under 55 and are not from black African or African-Caribbean family origin
Who do you give calcium channel blockers to as a first stage?
~ patients age 55 or over
~ patients of black African or African-Caribbean family origin (any age)
