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CVS Pathologies > Hypertension and Therapy > Flashcards

Hypertension and Therapy Flashcards

1
Q

Define HYPERTENSION (HTN):

A

BP Above which the Benefits of Treatment Outweigh the Risks in Terms of Morbidity and Mortality

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2
Q

Does Blood Pressure (BP) remain CONSTANT throughout the day?

A

No, it is a Continuous Variable which Fluctuates Widely, i.e. due to Physical and/or Mental Stressors

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3
Q

What did the FRAMINGHAM STUDY indicate?

A

> BP Associated with Exponential > in Risk of Stroke and CVS Disease

Age is a Significant Variable

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4
Q

What is considered an OPTIMUM BP?

A

< 120/<80 mmHg

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5
Q

According to NICE 2011, what is CLINICALLY considered to be STAGE 1 HTN?

A

BP: 140/90 mmHg or Higher

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6
Q

According to NICE 2011, what is CLINICALLY considered to be STAGE 2 HTN?

A

BP: 160/100 mmHg or Higher

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7
Q

According to NICE 2011, what is CLINICALLY considered to be SEVERE HTN?

A

BP: 180/110 mmHg or Higher (Systolic and Diastolic considered independently, also)

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8
Q

What is a more PRECISE way of MEASURING BP among HTN patients?

A

Domiciliary and Ambulatory BP Monitoring (Over 24hrs)

  • Stage 1 HTN = 135/85 mmHg
  • Stage 2 HTN = 150/95 mmHg
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9
Q

What is the CAUSE of PRIMARY HTN?

A

Idiopathic (95% of Cases)

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10
Q

What are the CAUSES of SECONDARY HTN?

A

5-10% of Cases

1) Chronic Renal Disease
2) Endocrine Disease,
i. e. Cushing’s Syndrome
3) Pregnancy, i.e. Pre-eclampsia
4) Congenital Vascular Defects, i.e. Coarctation of the Aorta
5) Sleep Apnoea

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11
Q

What are the RISK FACTORS for HTN?

A

1) Smoking
2) Diabetes
3) Renal Disease
4) Male
5) Hyperlipidaemia
6) Previous MI or Stroke
7) LV Hypertrophy
8) Family History

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12
Q

What PHYSIOLOGICAL MECHANISMS must be MANIPULATED to control acute and chronic HTN?

A

1) Cardiac Output
- Heart Rate
- Stroke Volume
2) Peripheral Vascular Resistance
3) Sympathetic Activation
4) Renin-Angiotensin-Aldosterone System (RAAS)

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13
Q

What are the LIKELY CAUSATIVE FACTORS in the AETIOLOGY of HTN?

A

1) > Reactivity of the Resistance Vessels = > Peripheral Resistance
- Hereditary Tendency for Smooth Muscle to Proliferate
2) Na+ Homeostatic Effect
- Kidneys Unable to Secrete Na+ Properly; Causing Retention of Na+ and H2O and > BP

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14
Q

What are the OTHER FACTORS in the AETIOLOGY of HTN?

A

1) Age
2) Genetics
3) Environment
4) Weight
- Obesity and Low Birth Weight
5) Diet and Salt Intake
5) Alcohol Intake
6) Race
- > Risk Amongst Black Populations

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15
Q

What is the MOST IMPORTANT NON-PHARMACOLOGICAL measure to < HTN?

A

Weight Reduction

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16
Q

What DIAGNOSTIC TOOL can be used to ASSESS a patient’s RISK of HTN?

A

ASSIGN Score

17
Q

Which APPROACH is used in the MANAGEMENT of HTN?

A

Stepped Approach

18
Q

What are the PRINCIPLES of the STEPPED APPROACH to treating HTN?

A

1) Use Low Doses of Several Drugs
2) Do Not Continuously Change Antihypertensive Meds
3) Add a New Medication to Current Therapy Until Target BP is Achieved
4) Minimise Adverse Events
5) Maximise Patient Compliance

19
Q

What is the STEP 1 treatment for a patient < 55 YEARS OLD and/or NOT OF AFRO-CARIBBEAN origin and/or NOT of CHILD-BEARING age?

A

ACE Inhibitor (i.e. Ramipril) or ARB (i.e. Losartan)

20
Q

What is the STEP 1 treatment for a patient > 55 YEARS OLD and/or of AFRO-CARIBBEAN origin and/or of CHILD-BEARING age?

A

Ca2+ Channel Blocker (CCB) (i.e. Amlodipine)
Unless Intolerant or with History/Risk of Heart Failure.

Otherwise - Thiazide-Like Diuretic

21
Q

What is STEP 2 Treatment?

A

*Cohort Dependent

CCB + Thiazide-Type Diuretic (i.e. Indapamide)

OR

ACE/ARB + Thiazide

22
Q

What is STEP 3 treatment?

A

Triple Therapy

- ACEI + CCB + Diuretic

23
Q

What is STEP4 treatment?

A

Consider Adding Spironolactone to Triple Therapy, if Blood K+ Levels are Normal

> Dose of Thiazide-Type Diuretic if Hyperkalaemic

24
Q

What are some of the CONTRAINDICATIONS for ACEI/ARB use?

A

Renal Failure/Artery Stenosis

Hyperkalaemia

25
Q

What TYPES of drugs INTERACT with ACEIs?

A

1) NSAIDS
2) K+ Supplements
3) K+ Sparing Diuretics (i.e. Spironolactone)

26
Q

Why is the use of CCBs BENEFICIAL in ELDERLY populations with HTN?

A

1) < Systolic HTN

2) Rarely Causes Postural Hypotension

27
Q

What is the MAIN TREATMENT of choice for HTN during PREGNANCY?

A

Nifedipine or Methyldopa

Has a Sustained and Modified Release

28
Q

What is a COMMON SIDE EFFECT of METHYLDOPA use during pregnancy?

A

Post-Partum Depression (PPD)

CVS Pathologies (11 decks)

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