Hypertension and hyperlipidaemia Flashcards
Epidemiology of HTN?
What makes BP?
CO X SVR
Why is BP regulated?
To maintain adequate tissue perfusion
What stimulates renin to be released from the kidneys?
Low perfusion pressure
Describe RAAS
What hormonal control of BP is there?
Circulating catecholamines
Adrenaline + Noradrenaline
What receptors do adrenaline and noradrenaline (circulating catecholamines) act on?
Where are the sensors for blood pressure in our bodies?
Baroreceptors at the aortic arch
Carotid body sends signal to brainstem
What is secondary HTN?
What are the risk factors for essential HTN?
What drugs can cause HTN?
What are the clinical signs of renal artery stenosis?
Does renal artery stenosis cause high or low renin secretion?
High - stimulated by renal under perfusion
What pathologies cause renal artery stenosis?
Fibromuscular dysplasia in young
Atherosclerotic disease in arteriopaths
How do you treat fibromuscular dysplasia?
Balloon dilation of renal arteries
When would you stent renal arteries in renal artery stenosis caused by atherosclerotic disease?
If HTN is refractory
Medical management is first line
What is the pathophysiology of CKD?
Do ACE-I cause high or low K+?
High
What are phaeochromocytomas?
What are the symptoms of phaeochromocytomas?
What are the signs of phaeochromocytoma?
What tests do you do for phaeochromocytoma?
How do you treat phaeochromocytomas?
Why do you give both alpha and beta blockade for phaeochromocytomas?
If you just give BB it can cause unopposed alpha vasoconstriction leading to hypertensive crisis.
What is the difference between cushings syndrome and cushings disease?
When would you suspect cushings syndrome?
How do you test for cushings syndrome?
What is Conn’s syndrome?
When would you suspect Conn’s syndrome?
How would you diagnose Conn’s syndrome?
How do you treat Conn’s syndrome?
what is aortic coarctation?
How would you recognise aortic coarctation clinically?
How do you diagnose and treat aortic coarctation?
What do you do for a BP under 140/90?
Re-check every 5 years
What do you do if BP 180/120 or higher?
ECG - check for LVH
Bloods - Check for kidney damage
What is stage 2 HTN?
150/95 or more
What is stage 1 HTN?
135/85 - 149/94
What are the effects of chronic HTN?
What are the acute effects of severe HTN?
What is the lifestyle advice for HTN?
What examination signs do you look for in HTN?
What are the grades of hypertensive retinopathy?
What blood tests do you do in HTN?
What ECG changes can you get in HTN?
What drug class are Ramipril, Lisinopril and Enalapril?
ACE-I
What drug class are Candesartan and Losartan?
Angiotensin-II receptor blockers
What drug class is Doxazosin?
Alpha blocker
What drug class are Amlodipine, Diltiazem and Verapamil?
Calcium channel blocker
What drug class is Sodium Nitroprusside?
Vasodilator (direct acting)
What drug class is Glyceryl trinitrate and Isosorbide mononitrate?
Nitrates
What drug class is Bumetanide and Furosemide
Loop diuretics
What drug class is indapamide?
Thiazide like diuretics
What drug class is Bendoflumethiazide?
Thiazide diuretics
What drug class is Spironolactone?
Aldosterone antagonist
What drug classes are less effective for HTN in Black African or African Caribbean patients?
ACE-I and AR2Bs
First line treatment for HTN with T2DM?
ACEI or AR2B
First line for HTN in someone >55 or who is black African or african-caribbean?
CCB
What is step two of HTN management from NICE?
What is step three of HTN management from NICE?
What is step four of HTN management from NICE?
What is the HTN treatment target for those with high risk diabetes?
130/80
What is the HTN treatment target for those >80?
150/90
Difference between chronic HTN and Gestational HTN in pregnancy?
Chronic <20/40
Gestational >20/40
When would you treat HTN in pregnancy?
If >140/90
What HTN treatment would you avoid in pregnancy and why?
ACE-I, ARB and diuretics = reduce placental blood flow
What are the HTN drugs of choice in pregnancy?
Labetalol
Nifedipine
Methyldopa
What BP would you aim for with HTN treatment in pregnancy?
<135/85
Signs of accelerated HTN?
Visual disturbances and headaches
Signs of hypertensive encephalopathy?
Confusion and seizures
Signs of aortic dissection?
Acute chest pain
AR murmur
Absent pulses
What conditions require rapid HTN control?
What medications would you give in hypertensive emergencies?
In hypertensive emergencies, what % decrease in BP do you want to aim for immediately?
25%
and to normalise over 24 hours
What are these stigmata of hyperlipidaemia?
Corneal arcus
Triglyceride deposits/spots
Xanthelasma (eyes/face)
Xanthmata (hands)
MOA of statins?
What was the landmark trial that established benefits of statins in IHD?
What secondary prevention dose for statins?
What specific tests do you measure for lipids?
When would you get a specialist review for high lipids?
What are the
Causes of secondary dyslipidaemia?
When is statin primary prevention recommended?
What statin is recommended for primary prevention and when would you re-check lipids?
What % reduction do you aim for in lipids when starting statins?
> 40% reduction in non-HDL cholesterol
What do you give if you don’t get a >40% reduction in non-HDL after statin treatment?
Ezetimibe
How does Ezetimibe work?
What drug class is Evolocumab?
PCSK9 inhibitor
How does Evolocumab work?
When would Evolocumab be used?
Side effects of Evolocumab?
What is first line treatment for patients with very nigh TGs?
Bezafibrate
How do fibrates (bezafibrate) work and what are their side effects?
