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Year 3 > Hypertension > Flashcards

Hypertension Flashcards

1
Q

Define HTN

A

Blood pressure >=140/90 mmHg

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2
Q

HTN causes

A

> 90% cases = PRIMARY – essential/idiopathic

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3
Q

How do you correctly measure BP in clinic?

A

Offer to measure in both arms.

If difference between both arms >15mmHg –> repeat + measure from arm with higher BP

If BP >140/90 –> 2nd measurement –> 3rd measurement + record lower of last 2 measurements

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4
Q

Define white coat effect

A

Discrepancy of more than 20/10mmHg between clinic and average daytime ABPM

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5
Q

Secondary renal causes of HTN

A 
Renal artery stenosis
Chronic glomerulonephritis
Pyelonephritis
Polycystic kidney disease
Renal failure
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6
Q

Secondary endocrine causes of HTN

A 
Diabetes
Hyperthyroidism
Cushing’s
Conn’s
Hyperparathyroidism
Phaeochromocytoma
Congenital Adrenal Hyperplasia
Acromegaly
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7
Q

Secondary non-renal/endocrine causes of HTN

A

pre-eclampsia
CARDIO: coarctation of the aorta,increased intravascular volume
DRUGS: sympathomimetics, corticosteroids, oral contraceptives

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8
Q

What is stage 1 HTN?

A

Clinic BP >=140/90 mmHg

ABPM daytime/HBPM BP >=135/85 mmHg

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9
Q

What is stage 2 HTN?

A

Clinic BP >=160/100 mmHg

ABPM daytime average/HBPM average BP >=150/95 mmHg

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10
Q

What is stage 3 HTN?

A

Clinic systolic BP >= 180 mmHg OR

Clinic diastolic BP >= 110 mmHg

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11
Q

What do you do if someone comes into the clinic with BP >140/90?

A

Offer ABPM or HBPM

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12
Q

If a PT has BP >135/85 (stage 1 HTN) on A/H BPM what is the criteria for management?

(CORD10)

A

Treat if <80 years AND any of the following:

  • Established CVD
  • Target Organ damage
  • Renal disease
  • Diabetes
  • 10 year CV risk equivalent to 10% or greater
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13
Q

If a PT has BP >150/95 (stage 2 HTN) on A/H BPM what is the criteria for management?

A

Treat all patients regardless of age

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14
Q

Management of HTN step 1 (give example)

A

If <55yr / T2DM:

  • ACE-i - ends with ‘-pril’ -eg ramipril
  • or ARB if not tolerated- ends with ‘-sartan’

If >55yrs / Afro-caribbean/black African:
- CCB- ends with ‘dipine’- eg amlodipine

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15
Q

Management of HTN step 2

A

If <55yr / T2DM:
- ACEi/ARB + CCB
OR
- ACEi/ARB + thiazide-like diuretic (‎bendroflumethiazide)

If >55yrs / Afro-caribbean/black African:
- CCB + ACEi/ARB
OR
- CCB + thiazide-like diuretic (‎bendroflumethiazide)

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16
Q

Management of HTN step 3

A

ACEi/ARB + CCB + thiazide-like diuretic

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17
Q

Management of HTN step 4

A

If K+ <= 4.5 mmol/L: add low-dose spironolactone
If K+ > 4.5 mmol/L: add an alpha- or beta-blocker

If BP not controlled on 4 drugs then specialist review

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18
Q

What lifestyle advice would you offer for hypertension?

A

Low salt (<6/day, ideally 3g), fruit + veg rich, reduce caffeine intake
Stop smoking
Drink less alcohol
Exercise, lose weight

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19
Q

ACE inhibitor MOA

A

Inhibit the conversion angiotensin I to angiotensin II

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20
Q

ACE inhibitor side effects

A

Cough
Angioedema
Hyperkalaemia
Renal failure (RAS)

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21
Q

ACE inhibitor contraindications/warnings

A

Must be avoided in pregnant women

Check renal function 2-3 weeks after starting (risk of worsening renal function in PTs with renovascular disease)

22
Q

Name a common ACE inhibitor

23
Q

Angiotensin II receptor blocker MOA

A

Block effects of angiotensin II at the AT1 receptor

24
Q

Angiotensin II receptor blocker side effect

A

Hyperkalaemia

25
Angiotensin II receptor blocker indications
Generally used where patients have not tolerated an ACE inhibitor, usually due to the development of a cough
26
Name a common ARB
Losartan
27
MOA of CCBs
Block voltage-gated calcium channels relaxing vascular smooth muscle and force of myocardial contraction
28
CCB side effects
Flushing Ankle oedema Headache Gum hyperplasia
29
Name a common CCB
amlodipine
30
MOA of thiazide like diuretics
Inhibit sodium absorption at the beginning of the distal convoluted tubule
31
Side effects of thiazide like diuretics
``` Hyponatraemia Hypokalaemia Dehydration ECG changes/ arrythmia Metabolic alkalosis Hypercalcemia. Hyperglycemia Hyperuricemia. Hyperlipidemia. ```
32
Side effects of spironolactone
Hyperkalaemia | Gynaecosmastia- decreases testosterone production, increasing peripheral conversion of testosterone to estradiol
33
BB side effects
Bronchospasm Heart failure Lethargy
34
When are BB contraindicated?
Asthma Uncontrolled HF Hypotension/marked bradycardia
35
When in spironolactone contraindicated?
Addison’s disease Anuria Hyperkalaemia
36
BP targets in HTN (once started on treatment)
Age < 80 years - clinic 140/90 mmHg - home 135/85 mmHg Age > 80 years - clinic 150/90 mmHg - home 145/85 mmHg
37
What is malignant hypertension?
Severe increase in BP to >180/120 mmHg & signs of new or progressive target organ damage e.g. retinal haemorrhage and/or papilloedema (NOTE: urgency = high but no target organ damage)
38
RFs for malignant hypertension
``` uncontrolled HTN CKD RAS renal transplant phaeochromocytoms pregnancy ```
39
1st line Tx for malignant hypertension
Specialist referral + IV labetalol | Reduce MAP by max 25% in 1st hour then 160/100 or less within the next 2-6 hours avoid organ ischaemia
40
Signs of target organ damage in HTN
Congestive heart failure | Encephalopathy: headache, CNS signs, seizures, coma
41
management of hypertensive urgency
if no target organ damage is identified, repeat clinic blood pressure measurement within 7 days
42
Grade 1 of hypertensive retinopathy
``` Tortuosity (twisting) of retinal arteries Increased reflectiveness (SILVER WIRING) ```
43
Grade 2 of hypertensive retinopathy
Grade 1 + ARTERIOVENOUS NIPPING (thickened retinal arteries pass over retinal veins)
44
Grade 3 of hypertensive retinopathy
Grade 2 + FLAME HAEMORRHAGE and COTTON WHOOL exudates (due to small infarct)
45
Grade 4 of hypertensive retinopathy
Grade 3 + PAPILLOEDEMA (blurry margin of the optic disc)
46
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. What would be your next stage in his management?
Measure serum potassium level
47
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. What would be your next stage in his management?
Arrange for his medication to be given under direct observation One of the biggest issues is compliance- before specialist review you'd want to do this
48
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?
Calcium Channel Blocker
49
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?
Spironolactone
50
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 190/130 and on fundoscopy see the edges of the optic disc are blurred. Which of the following would be your next stage in his management?
Send the patient to A&E for specialist review this patient has malignant hypertension- before doing anything need to review in A+E (not done in GP setting)

Year 3 (38 decks)

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