Hypertension And Public Health Emergencies Of International Concern Flashcards
What is the most common primary non communicable diagnosis in Ghana
Give four examples of diseases that hypertension is a major risk factor for
Hypertension
strokes, MI, vascular disease and CKD
What is hypertension and the normal ranges for bp
defined as a systolic BP of 140 mmHg or >diastolic 90mmHg or > , or taking antihypertensive medications
•Normal - systolic < 120mmHg
•diastolic < 80mmHg
What are the ranges for pre hypertension,stage 1 and stage 2 hypertension according to the international society of hypertension
Normal BP-
Less than 130mmHg
Less than 85mmHg
High normal BP or Prehypertension
•130 -139mmHg
•85 -89 mmHg
- Stage 1 HPT
- 140-159 mmHg
- 90 -99 mmHg
- Stage 2 HPT
- SPB > or equal to 160mmHg
- DBP > or equal to 100mmHg
At what age do get men hypertension more than women,do men and women both get hypertension often,do women get it more than men
Until age 45years
Until age 45 years •men > women • 45 to 64 years, • men = women. • 64 years and above • women >men
What is the pathogenesis of hypertension
MULTIFACTORIAL –pathogenesis of essential hypertension has been proposed in which multiple factors, including –genetic predisposition, –excess dietary salt intake –adrenergic tone
Hypertension is caused by multiple factors not just one factor
Stroke volume depends on what and what and what does peripheral resistance depend on
1.myocardial contractility
Size of the vascular compartment
2.vascular structure
Vascular function
What are the Types of hypertension and explain and which type is more common
How is resistant hypertension diagnosed
PRIMARY /ESSENTIAL:not caused by one thing or you can’t pin pint what exactly is the cause. It is a clinical syndrome characterized by increased systemic arterial pressure
95percent of patients with hypertension are primary hypertension with unknown causes and 5% are secondary hypertension with defintive causes
•
SECONDARY:caused by something. An underlying cause and once it’s taken away the hypertension usually goes
And bp gets normal
Primary hypertension is more common
Isolated systolic hypertension: blood pressure more than or equal to 130mmHg systolic and less than 80mmHg diastolic
Isolated diastolic hypertension: blood pressure less than 130mmHg systolic and more than or equal to 80mmHg diastolic
White coat hypertension
Masked hypertension: blood pressure that is consistently elevated by out of office measurements but doesn’t meet the criteria for hypertension based on office readings
White coat hypertension:
Blood pressure consistently elevated by office readings but doesn’t meet the diagnostic criteria for hypertension based on out of office reading
Resistant hypertension: high pressure in a hypertensive patient that remains above goal despite despite the use of more than or equal to three antihypertensive agents of different classes typically including CCB, ACE/ARB, or diuretic given at maximal or
Maximally tolerated doses
The diagnosis of resistant hypertension requires exclusion of common causes of pseudoresistance which include;
Improper BP measuring technique
Undertreatment, including clinical inertia
Medication non adherence
Ingestion of substances that can elevate blood pressure
Hypertensive emergency :severely elevated BP(systolic bp more than 220mmHg and diastolic more than 120mmHg) with evidence of end organ damage
Hypertensive urgency : severely elevated BP(systolic bp more than 220mmHg and diastolic more than 120mmHg) with no evidence of end organ damage
State some causes of primary and secondary hypertension
Primary-salt,weight,alcohol,exercise,genetic factors
Secondary-renal disease
Renovascular disease
Aldosterone excess
Phaeochromocytoma
Thyroid,kidney,electrolyte imbalance either due to adrenal causes or kidney causes- cause secondary hypertension
Hypertension is usually asymptomatic,but when you finally start showing symptoms it’ll be headache and dizziness
True or false
State five modifications to be made in hypertensive patients and by how much the bp reduces
True
Reduce dietary sodium to 65-100 mmol/d : it reduces BP by 2-8mmHg
Moderate Alcohol intake limit to less than it equal to 2 drinks per day for men and less than if equal to 1 drink per day fir women and those with lighter weight : it reduces by 2-4mmH
Increased physical activity. Regular aerobic exercise 30mins per day most times if the week: it reduces bp by 4-9mmHg
Weight reduction to attain a normal weight that is a BMI less than 25. This reduces bp by 5-20mmHg/10kg weight loss
DASH diet: rich in fruits and veggies,low fat diary , reduced saturated and total fat and reduced sodium : it reduces BP by 8-14mmHg
Hhow does the heart,brain,inflammation or immunity,endocrine/metabolism,vasculature cause hypertension
Heart-decreased atrial natriuretic peptide,decreased brain natriuretic peptide ,increased cardiac output,increased heart rate causes increased renal factors (increase in RAAS and increase in renal sodium and water handling,shift of renal function curve (pressure natriuresis) )this causes hypertension
Brain-increased sympa,decreased para,,increased vasopressin ,increased renal factors and this causes hypertension
Immunity/inflammation-increased neoantigens,increased T cells/macrophages
Increased cytokines increases renal factors and causes hypertension
Endocrine/metabolism-increased aldosterone/corticosteroids,increased leptin,decreased adiponectin,increased insulin,increased thyroid hormones,increased growth hormones,increased oestrogens /androgens causes increased renal factors and hypertension
Vasculature:increased endothelin,increased calcifications,increased stiffness and decreased nitric oxide,decreased prostaglandins causing increased renal factors causing hypertension but
They can directly cause hypertension without causing increase in renal factors
What investigations are done for hypertension
Lipid profile Check for organ damage Screen for diabetes Do ECG(to check if heart is damaged) Chest X ray Check blood level(to see if hb is low due to a kidney problem
How is hypertension managed and explain
Non pharmacological : Weight loss
•Limit alcohol intake
•Reduce sodium intake
•adequate intake of dietary potassium (approximately 90 mmol/day)
•Stop smoking and reduce intake of dietary saturated fat
•Engage in aerobic exercise at least 30 minutes daily for most days
and pharmacological : ACE inhibitors •Angiotensin receptor blockers •beta blockers •calcium channel blockers –dihydropyridine –non dihydropiridine •Thiazide diuretics •aldosterone antagonists
Class of drugs used:
Diuretics
Vasodilators(older oral vasodilators like hydralazine,calcium channel blockers like nifedipine, parenteral vasodilators like Nitroprusside )
Angiotensin antagonists(like angiotensin converting enzyme inhibitors such as Lisinopril, captopril, and angiotensin receptor blockers such as losartan, valsartan)
Sympathoplegic blockers of (alpha or beta receptors,nerve terminals, ganglia,CNS sympathetic outflow )
Alpha or beta receptors such as propanolol for beta and prazosin for alpha. For nerve terminals there is guanethidine, for ganglia we hav hexamethonium
What drugs are given when there’s hypertension and heart failure,hypertension and myocardial infarction,hypertension and diabetes,hypertension and chronic kidney disease
HYPERTENSION IN SPECIAL CLINICAL SCENARIOS
•Heart failure: Diuretic, beta-blocker, ACE inhibitor/ARB, aldosterone antagonist
•Following myocardial infarction: Beta-blocker, ACE inhibitor
•Diabetes: ACE inhibitor/ARB
•Chronic kidney disease: ACE inhibitor/ARB
What are some complications of hypertension
Myocardial infarction
CCF
What is white coat hypertension
How will you evaluate a patient with hypertension
Increased bp due to anxiety of being in the hospital
You want to know what exactly causes the high bp if it’s due to a change in setting. A machine is put on the arm for 24-48hoirs to know . This is fine for someone w very confusing or varying bps
Patient evaluation:
Asses lifestyle and other cardiovascular risk factors or concomitant disorders that may affect prognosis and guide treatment
Look for identifiable causes of hypertension
Assess the presence or absence of end organ damage or CVD
Conduct history and physical examination
Obtain lab tests such as urinalysis, blood glucose, haematocrit , lipids panel, serum potassium,creatinine and calcium. Optional tests include urinary albumin/creatinine ratio
Obtain electrocardiogram
What is malignant hypertrophy
When the body hasn’t accommodated the hypertension
People who are are hypertensive are not put on medications but non pharmacological managements are used for them
True or false
True
Hypertension can make you blind true or false
True
