Hypertension Flashcards
Define hypertension?
blood pressure more than 140/90mmHg
what are the causes of hypertension?
Primary (essential) – treat the hypertension itself
- Essential or idiopathic hypertension
- Unknown cause
- Responsible for > 90% of cases
Secondary causes
what are the secondary causes of hypertension?
Renal
- renal artery stenosis
- Chronic glomerulonephritis
- pyelonephritis
- polycystic kidney disease
- Renal failure
Pregnancy
- pre-eclampsia
Enocrine
- diabetes
- hyperthyroidism
- cushing’s
- conn’s
- hyperparathyroidism
- phaeochromocytoma
- congenital adrenal hyperplasia
Cardio
- coarction of aorta
- increased intravascular volume
Drugs
- Sympathomimetics
- corticosteroids
- oral contraceptives
what is isolated systolic hypertension?
Most common form in the UK – affects >50% of the over 60s
Due to stiffening of the large arteries (arteriosclerosis)
what is malignant ( accelerated phase) hypetension?
A rapid rise in BP leading to vascular damage (pathological hallmark is fibrinoid necrosis)
Usually there is severe hypertension + bilateral retinal haemorrhages and exudates; papilloedema may or may not be present
what is a q risk score?
% chance of having a CV event in the next 10 years (heart attack or stroke)
Looks at
- Age
- Gender
- Smoker
- DM
- BP
- Treatment for BP
- Cholesterol
- HDL level
- CKD
- FH of CHD
Use to tell patient to convince them to change lifestyle
If 100 people had a similar presentation as you, then ___ of them would have a risk of a heart attack or stroke
outline the diagnosis of hypertension?
outline the classification of hypertension?
outline the lifestyle management for hypertension?
Stop smoking
Lose weight
Reduce alcohol intake
Reduce dietary sodium
outline the management of hypertension?
what are the BP targets for over 80 years old and under 80 years old?
what is the mechanism of action of ACE inhibitors?
inhibit conversion of angiotensin I to angiotensin II
what are the side effects of ACE inhibitors?
cough
angiooedema
hyperkalaemia
renal failure
what are the important notes for ACE inhibitors?
first line treatment in younger patients ( less than 55)
less effective in Afro-carribean patients
must be avoided in pregnant women
check renal function 2-3 weeks after starting ( risk of worsening renal function in patients with renovascular disease)
drug names end in -pril
what is the mechanism of action of angiotensin II receptor blockers?
block effects of angiotensin II at the AT1 receptor
what are the side effects of angiotensin II receptor blocker?
hyperkalaemia
what are the notes for angiotensin II receptor blockers?
generally used when patients have not tolerated an ACE inhibitor-> Usually due to development of cough
drugs names end in -sartan
what is the mechanism of action of calcium channel blocker ?
block voltage gated calcium channels relaxing vascular smooth muscle and force of myocaridal contraction
what are the side effects of calcium channel blockers?
flushing
ankle oedema
headache
gum hyperplasia
what are the notes for calcium channel blockers?
first line treatment in odler patients ( more than 55)
what is the mechanism of action of thiazide like diuretic?
inhibit sodium absorption at the beginning of the distal convoluted tubule
what are the side effects of thiazide type diuretic?
hyponatraemia
hypokalaemia
dehydration
ECG changed/ arrythmia
what are the side effects of spironolactone?
hyperkalaemia
gynaecomastia- decreases testosterone production and increases peripheral conversion of testosterone to oestrogen
in what people is spironolactone contraindicated in?
Addisons disease
anuria
hyperkalaemia
what are the side effects of beta blockers?
bronchospasm
heart failure
lethargy
who are beta blockers contraindicated in?
asthma
uncontrolled heart failure
what is accelerated hypertension ( Malignant hypertension)
Severe increase in BP to 180/120 mmHg or higher (often over 220/120 mmHg) &signs of retinal haemorrhage and/or papilloedema
Associated with new or progressive target organ damageand is also known as malignant hypertension
What are the risk factors for malignant hypertension?
uncontrolled HTN, CKD, RAS, renal transplant, phaeochromocytoms, pregnancy
outline the management for accelerated hypertension?
Specialist referral + First line treatment: IV labetalol
Goal: reduce MABP by no more than 25% in the first hour, then if stable, to 160/100 or less within the next 2 to 6 hours
Excessive fall in pressure -> renal, cerebral, coronary ischaemia
what is taget organ damage?
Damage to organs such as the heart, brain, kidneys and eyes.
E.g. left ventricular hypertrophy, chronic kidney disease, hypertensive retinopathy or increased urine albumin:creatinine ratio
Congestive heart failure
ENCEPHALOPATHY: headache, CNS signs, seizures, coma
what are the symptoms of phaechromocytoma?
HTN, headaches, palpitations, tremors
outline the management for phaeochromocytoma?
Alpha blockade then Beta blockade
what is the grading of hypertensive retinopathy?
Hypertensive retinopathy is not SAFE
1- Tortuosity (twisting) of retinal arteries with increased reflectiveness (Silver wiring)
2- Grade 1 + Arteriovenous napping (thickened retinal arteries pass over retinal veins)
3 Grade 2 + Flamed shape haemorrhage and cotton wool exudates (due to small infarct)
4- Grade 3 + papilloEdema (blurry margin of the optic disc)
A 58-year-old man is reviewed in a hypertension clinic, where it is found that his blood pressure is 165/105 mmHg. He is currently on ramipril, amlodipine and Bendroflumethiazide.
Which of the following would be your next stage in his management?
A.Arrange urinary catecholamine assays
B.Add spironolactone to his medication
C.Measure serum potassium level
D.Add bisoprolol to this medication
E.Add doxazocin to his medication
A.Measure serum potassium level
A 57-year-old man is reviewed in a hypertension clinic, where it is found that his blood pressure is 165/105 mmHg despite standard doses of amlodipine, perindopril, doxazosin and bendroflumethiazide. Electrolytes and physical examination have been, and remain, normal.
Which of the following would be your next stage in his management?
A.Arrange for his medication to be given under direct observation
B.Add spironolactone to his medication
C.Arrange urinary catecholamine assays
D.Request an adrenal CT scan
E.Add verapamil to his medication
A.Arrange for his medication to be given under direct observation
A 43 year old patient is started on some medication to control his high blood pressure. He now presents to you complaining of ankle swell. O/E you find bilateral ankle oedema.
What is the most likely culprit?
A.Β-blocker
B.Calcium Channel Blocker
C.Losartan
D.Spironolactone
E.ACE-I
calcium channel blocker
A 45 year old gentleman with difficult to control hypertension presents to your practice for an annual review of his medication. On examination you notice gynaecomastia.
What is the most likely culprit?
A.Β-blocker
B.Calcium Channel Blocker
C.Losartan
D.Spironolactone
E.ACE-I
Spironolactone
A 65-year-old man present to his GP complaining of headaches and problems with his vision. O/E the GP finds his BP to be 190/130and on fundoscopy see the edges of the optic disc are blurred.
Which of the following would be your next stage in his management?
A.Send the patient to A&E for specialist review
B.Give Labetalol to control his high blood pressure
C.Arrange urinary catecholamine assays
D.Request an adrenal CT scan
E.Give Amlodipine as first line
A.Send the patient to A&E for specialist review
