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Cardiology > Hypertension > Flashcards

Hypertension Flashcards

1
Q

What is primary/essential hypertension?

A

Hypertension with no clear cause (90%)

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2
Q

What is secondary hypertension?

A

Hypertension with an underlying cause (10%)

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3
Q

What are the causes of primary hypertension?

A
  1. Over time artery pressure raises
  2. Risk factors – old age, obesity, salt heavy diet, sedentary, lifestyle, alcohol (J shaped), stress, insulin tolerance
  3. Genetic Factors
  4. Foetal factors – low birth weight (adaptive changes in uterus to under nutrition)
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4
Q

What are the causes of secondary hypertension?

A

renal disease, endocrine disease, congenital, neurological, pregnancy, drugs, cardiological causes

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5
Q

what are the renal diseases associated with secondary hypertension?

A

All renal disease

Particularly - Chronic glomerulonephritis, chronic pyelonephritis, polycystic renal disease, renal artery stenosis

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6
Q

what are the endocrine diseases associated with secondary hypertension?

A

Cushing’s, conns, adrenal hyperplasia, pheochromocytoma, acromegaly, corticosteroids, tumours

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7
Q

what are the congenital conditions associated with secondary hypertension?

A

coarctation or aorta

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8
Q

what are the neurological causes associated with secondary hypertension?

A

Raised ICP, brainstem lesions

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9
Q

what are the drugs associated with secondary hypertension?

A

oral contraceptives, steroids, NSAIDs, carbenoxolone, sympathomimetic agents, EPO

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10
Q

how can pregnancy cause secondary hypertension?

A

pre-eclampsia

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11
Q

what are the cardiological diseases associated with secondary hypertension?

A

atherosclerosis, aortic dissection

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12
Q

What are the other causes of secondary hypertension?

A

Vasculitis, Fibromuscular dysplasia

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13
Q

what is the definition of mild hypertension?

A

> 140 systolic or >90 diastolic

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14
Q

what is the definition of moderate hypertension?

A

160 systolic or >100 diastolic

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15
Q

what is the definition of severe hypertension?

A

180 systolic or >110 diastolic

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16
Q

what is the definition of benign hypertension?

A

stable elevation over many years

17
Q

what is the definition of malignant hypertension?

A

acute, severe elevation of BP

diagnosed via retinal signs

18
Q

What is the definition of a hypertensive crisis?

A
  1. Systolic >180mmgHg
  2. Diastolic >120mmgHg
  3. Urgency – no damage to end organs
  4. Emergency – damage to end organs
19
Q

what are the clinical features of primary hypertension

A

usually none

20
Q

what are the clinical features of secondary hypertension?

A

associated with underlying cause

21
Q

what are the clinical features of emergency hypertension?

A

confusion, drowsiness, chest pain, breathlessness

22
Q

how can a diagnosis of hypertension be made?

A

24 hour Ambulatory BP monitoring = DIAGNOSITIC
• Clinic BP of 140/90 mmHg PLUS
• ABPM or HBPM of >135/95 mmHg

23
Q

what further investigations should be done in hypertension?

A 
o	Bloods – HbA1c, eGFR, cholesterol
o	Urinalysis
o	ECG
o	Fundoscopy
o	CXR
o	Aldosterone
24
Q

what is the first line management of hypertension?

A

If under 55 – start with an ACE inhibitor (or ARB if ACEi not tolerated)
If over 55 (or of African origin at any age) and don’t have T2DM then start with a calcium channel blocker
(if a calcium channel blocker is not tolerated, use a thiazide diuretic instead)

25
Q

what is the second line management of hypertension?

A

ACE or ARB PLUS CCB OR thiazide-like diuretic

26
Q

what is the third line management of hypertension?

A

ACE or ARB PLUS CCB PLUS thiazide-like diuretic

27
Q

what is the 4th line management of hypertension?

A

considered resistant hypertension

Add a 4th agent, such as beta blocker, alpha blocker or spironolactone

28
Q

what are the the two main parts of hypertension management?

A

Lifestyle changes

Medications if stage 2/moderate

29
Q

What is the pathophysiology of hypertension?

A
  • High blood pressure causes wear and tear on endothelial cells that line the inside of vessels
  • There is an increase in peripheral vascular resistance as a result of vasoconstriction, and hypertrophy of the arterial wall
  • There may also be endothelial dysfunction – whereby there is decreased EDRF release (NO).
  • Causes atherosclerosis
30
Q

what are the structural changes of arteries in hypertension?

A

muscular hypertrophy of the media, reduplication of the external lamina, intimal thickening. The walls of the arteries often become less compliant
1. General widespread atheroma

31
Q

what are the structural changes of arterioles in hypertension?

A

hyaline arteriosclerosis – this is protein deposition in the arterial wall. The lumen of the artery narrows and aneurysms may develop.

32
Q

what is hyperplastic arteriosclerosis?

A
  1. muscular hypertrophy and reduplication of the basement membrane in arteries
  2. ONLY BASEMENT MEMBRANE
  3. Also associated with fibrin deposition = necrotising arteriolitis
  4. Mostly renal arteries
     Affect renal function
     Exacerbating hypertension through the renin-angiotension system

Cardiology (9 decks)

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