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Medicine > Hypertension > Flashcards

Hypertension Flashcards

1
Q

What’s HTN?

A

Systemic hypertension can be defined as persistently elevated office systolic pressure of >=140 and diastolic of >/=90mmHg on two or more occasions at least 4 hours apart.

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2
Q

Isolated systolic HTN

A

Persistent elevated SBP of equal to or more than 140mmHg with a normal DBP at less than 90

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3
Q

What are the BP values for optimal, normal and high normal?

A

Optimal <120/80 mmhg
Normal <130/85 mmhg
High normal 130-139 / 85-89mmhg

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4
Q

Criteria for diagnosing HTN

A

Criteria for diagnosing HTN
Conventional office BP:>/=140/90mmHg
Home BP:>/=135/85mmHg

Ambulatory BP monitoring:
Daytime:>/=135/85mmHg
Nightime:>/=120/70mmHg

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5
Q

Grade of HTN

A

Grade 1/mild: 140-159/90-99
Grade 2/moderate: 160-179/100-110
Grade 3/severe: >180/>110

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6
Q

Classification of HTN

A

Essential/ primary: most common, idiopathic

Secondary: thyrotoxicosis, alcohol, glomerulonephritis, pheocytochromatoma, Cushings, sec hyperaldosterone, pregnancy, obesity,acromegaly, hypoparathyroididsm, congenital adrenal hyperplasia, ladders syndrome.

Coarctation of the aorta

Drugs: ocp, estrogen, anabolic steroids, corticosteroids, NSAIDs, carbenoxolone,, sympathomimetics.

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7
Q

HTN target organs

A

1) Retina: hypertensive retinopathy
2) Brain/CNS: stroke, subarachnoid haemorrhage, hypertensive encephalopathy.
3) Kidneys: proteinemia, CKD
4) Heart: CAD, LVH, atrial fib ffg LVH or cad, HF
5) Blood vessels ( thickening of arterial walls, widespread atheroma causing CAD. Aneurysm)

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8
Q

HTN retinopathy

A

1-Arterial thickening and tortuosity- silver wiring, copper wiring.
2- grade 1+ arteriovenous nipping
3- grade 2+ evidence of retina ischemia , cotton wool spots , soft exudates , flame or blot hemorrhage
4- grade 3+ papilledema

Grade 3&4 = malignant HTN

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9
Q

Signs of long standing HTN

A

Locomotor brachialis with unfolding aorta
Loud A2
Arterial wall thickening
Displaced apex beat
With at least hypertensive retinopathy type 2

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10
Q

Investigations to diagnose HTN

A 
Measure BP
FBC
TFT
RBS/fbs
Urinalysis 
ECG
Echocardiography 
Renal USS 
Fundoscopy
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11
Q

What’s DASH?

And it’s aim

A

Dietary Approach to Stop Hypertension.

To reduce Blood pressure through dietary modifications

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12
Q

First line treatment it HTN

A

Diuretics (thiazides)
Calcium channel blockers
ACE inhibitors/ ARBs

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13
Q

what are the side-effects of ACEI?

A

You can Use this mnemonic CAPTOPRIL

COUGH (dry)
ANGIOEDEMA
POTASSIUM ELEVATION
TERATOGENIC IN PREGNANCY 
OTHER( FATIGUE & HEADCHE) 
PROTEINURIA 
RENAL IMPAIRMENT
ITCHING 
LOW BP
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14
Q

What medication do we give a diabetic hypertensive patient?

A

Ace inhibitors

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15
Q

Why are ACE inhibitors given to hypertensive Dm patients and not Beta blockers?

A

1) ACE inhibitors cause renal efferent arteriole dilation, optimizing GFR in diabetic patients. Therefore avoiding Dm nephropathy
2) β-blockers are thought to contribute to the development of hyperglycemia by impairing the release of insulin from the pancreatic β-cell. Interestingly, carvedilol and nebivolol are not associated with the development of hyperglycemia or new-onset diabetes.

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16
Q

When is ARB’s used in HTN?

A

1) in BPH
2) pheocytochromatoma
3) raynaud disease

17
Q

Classification of HTN crisis and define them

A

Hypertensive emergency is severely elevated BP of >= 180/120 mmHg that comes with end organ damage.

Hypertensive urgency is severely elevated BP of >=180/120mmHg without end organ damage

18
Q

Mgt of HTNive emergency

A

Brief hx

Emergency is treated with parenteral anti-hypertensive,there needs to be a rapid drop of bp within 45mins to 2hrs.

Drug options: IV nitroglycerin 5units/min
IV or IM hydralazine 10mg every 30min
IV Labetalol 40mg/10min

Tx stopped is Dbp

19
Q

Mgt of HTN urgency

A

urgency treated with oral anti - hypertensives, bring down bp over 36-72hrs

Drug options: beta blockers, alpha blockers,
Acei, sublingual nifedipine

20
Q

Side effects of Metyldopa, Acei, CCB, Thiazides and hydralazine

A
  • cough,hyperkalemia,angioedema - Acei
  • Positive Coombs test,hemolyticanemia,hepatitis- Metlydopa
  • hypokalemia, hyperuricemia, hyperglycemia-thiazides
  • peripheral edema, flushing, and constipation- CCB
  • increased angina,tachycardia,systemic lupus erythematosus(SLE) - hydralazine

Medicine (15 decks)

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